The forearm

The forearm

1. Anatomy

   • Bones
   • Muscles
     • Anterior
       • Superficial
         • -Pronator teres -Flexor carpi radialis -Palmaris Radialis -Flexor carp ulnaris
       • Intermediate
         • Flexor digitorum superfacialis
       • Deep
         • -Flexor digitorum profundus -Flexor pollicis brevis -Pronator quadratus
     • posterior compartment
       • Deep
         • -Supinator -Abductor pollicis longus -Extensor pollicis brevis -Extensor pollicis longus -Extensor incidicis
       • Superficial
         • -Brachioradialis -Extensor carpi radialis longus -Extensor Carpi radialis brevis -Extensor digitorum -Extensor digiti minimi - Extensor carpi ulnaris -Anconeous

2. Physiology of pain

   • Pain is
     • An unpleasant sensory & emotional experience associated with actual or potential tissue damage
       • primarily a protective mechanism
         • that is subjective
   • influenced by
     • -Behavioral responses -Emotional reactions -Past or present experiences
   • Localization of Pain
     • Cutaneous Pain
       • example
         • sharp, pricking, burning
           • which can have fast or slow onset
     • Deep Somatic Pain
       • example
         • from tendons, fascia, muscles,joints
     • Psychogenic Pain
       • individual feels pain but the cause is emotional rather than physical
   • Types of pain
     • Slow
     • Fast
   • Pain perception
     • is our conscious interpretation of the external world as created by the brain from a pattern of the nerve impulse delivered to it from sensory receptors
       • It’s not fixed
   • presentation of Pain
     • -ANS stimulation -Sleeplessness -Low appetite Low -quality of life -Stop activity -Facial expression
   • Pain management
     • Voltaren
       • which works by blocking the COX enzymes and reduce prostaglandins throughout the body
         • is used to relieve pain, swelling (inflammation), and joint stiffness
       • has side effects
         • example
           • Upset stomach Nausea Heartburn Diarrhea
     • Pethidine
       • is an opioid
         • where it exerts its principal pharmacological actions on the central nervous system
           • it has analgesic and sedative effects
     • Panadeine Forte
       • used to relieve moderate to severe pain and fever
         • contains paracetamol and codeine
     • Antidepressant
       • used to treat clinical depression or prevent it recurring.
         • and they provide significant pain relief
           • example
             • Amitriptyline

3. Dermatomes of the upper limb

   • is an area of skin that is mainly supplied by a single spinal nerve

4. shingles

   • Is a common late complication of
     • Caused by the varicella virus
       • the virus can enter your nervous system and lie dormant for years especially in the dorsal root ganglion
         • The body’s immune system makes sure that the virus does not replicate and multiply in an uncontrolled manner
           • that’s why shingles is very common in old age and people with weak immune system in general
   • It appears as a single striped Wrapped around the left of the right side of your torso however it can appear in other places too
   • Signs and symptoms
     • -pain -burning sensation -sensitivity to touch - heacache - rash
       • severe rare cases shingles can lead to pnemonia , hearing problems, blindness , brain inflammation (encephilitis) or even death
   • Comparison between shingles and chicken pox
   • Management of Shingles
     • we can use antiviral drugs like
       • Acyclovir (Zovirax)
     • Varivax vaccine is used
   • Post Herpetic Neuralgia
     • complication of shingles
       • affects nerve fibers and skin
         • Signs and Symptoms include
           • Pain that lasts 3 months or longer after the shingles rash has healed
           • Sensitivity to light touch
           • Itching and numbness

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