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1. Anatomy of the elbow

   • Type : synovial
   • variety: hinge
   • range of movement: uniaxial
   • it involves 3 bones: radius, ulna and humerus
   • 3 articulations
     • humeroradial
     • superior radioulnar
     • humeroulnar
   • elbow joint capsule
     • it is attached just outside of the margins of the articular surfaces
       • Its weak anteriorly & posteriorly but strengthened on each side by two ligaments
         • the 2 ligaments are: the radial andulnar collateral ligaments

2. Pain: What is it and its different types

   • Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
   • pain sensations are important because pain is primarily a protective mechanism, it brings a conscious awareness to tissue damage.
   • pain receptors are known as nociceptors
     • there are 4 types
       • thermal
       • polymodal
       • mechanical
       • silent
   • types of pain
     • cutaneous pain
       • superficial pain since the nociceptors in the skin get activated (e.g needle prick)
     • viseceral pain
       • pain related to the internal organs, e.g kidney stones
     • deep somatic pain
       • it occurs when stimuli activate the nociceptors deeper in the body including bones, joints and muscles.
     • psychogenic pain
       • This type of pain is emotional and not physical, therefore it does not involve any receptors. It refers to when there is no physiological explanation to the pain but the patient is still experiencing it.

3. Pain pathway

   • 1. Transduction
     • It is the conversion of a stimulus into a nerve impulse. which occurs due to the nociceptors
   • 2. Transmission
     • Fast pain travels in myelinated axons while slow pain travels along unmyelinated axons
       • Fast pain goes through the neo-spinothalamic tract while the slow pain goes through the pleo-spinothalamic tract.
   • 3. central processing
     • Perception happens in the brain stem or the thalamus while the interpretation happens in the cerebral cortex.
       • the hypothalamus connects the perecptin of pain with an autonimic response
   • 4. Modulation
     • 1st order neurons try to excite the 2nd order neurons (using glutamate or substance P) while inhibitory neurons from the brain stem or the thalamus try to inhibit it by using enkephalins

4. Modifying factors of pain

   • physical e.g being healthy and staying in shape
   • psychological, eg having anxiety
   • cultural
   • spiritiual
   • social

5. Infections that affect the PNS

   • varicella zoster virus
     • Causes chicken pox
       • Start with reddish rash (face & trunk).
       • Contagious airborne disease.
       • Lesions heal without scar.
     • VZV remains latent in non-permissive cells such as ganglion cells after being infected with chicken pox
     • May get reactivated after years, then it'll be known as shingles
       • Once reactivated, it infects and destroys axons
         • one of the major complications of shingles is post-herpetic neuralgia
           • This condition affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear

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