pain and the forearm

pain and the forearm

1. anatomy of the forearm

   • anterior compartment
     • superficial
     • deep
   • posterior compartment
     • superficial
     • deep

2. Physiology of pain

   • An unpleasant sensory & emotional experience associated with actual or potential tissue damage.
   • Types of pain
     • Fast Pain
       • Transmitted by myelinated axon
         • conduct impulses rapidly,respond to mechanical (pressure) stimulus, produce the sensation of sharp, localized, fast pain.
     • Slow/chronic pain
       • Transmitted by unmyelinated axons
         • small & conduct impulses slowly,crude touch, aching pain,warmth
   • Pain pathway
     • Dorsal column medial lemniscus system
     • Anterolateral (spinothalamic) pathway
   • Pain Management
     • Physical techniques
       • hot and cold compresses, physical therapy,
     • medication
       • NSAIDs
         • Mechanism of Action : inhibit the cyclooxygenase (COX) component of G/H synthase reversibly
         • eg : Aspirin Paracetamol
       • Opioid painkillers
         • Mechanism of action : Stimulate opioid receptors which results in relief of pain
         • eg: Morphine - Hydromorphone - tramadol
     • Pain management for Tennis Elbow
       • Icing the elbow, elbow strap, Taking nonsteroidal anti-inflammatory, ROM exercises, physical therapy
     • Transcutaneous Electrical Nerve Stimulation(TENS)
       • Pain relieving method involving the use of a mild electrical current
       • Used to reduce muscle spasms and pain
       • Effects ----> Can reduce pain signals going to the spinal cord and brain, which may relieve pain. Stimulates production of endorphins (body's natural painkillers)

3. Chronic Pain and Mental Health

   • chronic pain can lead to :
     • depression, loss of appetite, insomnia, anxiety, trouble concentrating, fatigue and mood changes

4. VZV (Varicella zoster virus)

   • HHV3 subfamily
   • Linear double stranded DNA
   • Enveloped (susceptible to detergents, acidic solvents, and can dry out)
   • mechanism of action : lytic cycle/infections
     • goes from Lungs to lymphatics then replicates in skin cells
       • some go to the neurons and remain dormant in sensory ganglia (LATS)

5. Chickenpox

   • Exanthematous disease: rash with fever
   • respiratory/droplet transmission
   • Rash heals without scars
   • stages are :
     • 1. Viremia 2. Itching rash starts appearing From the head and trunk to the extremities 3.Macules > papules > vesicles > pustules > crusts (all stages of point 3 are seen together)

6. Shingles

   • it is a Reactivation of the chickenpox caused by VZV
   • Single dermatome distribution, affects only one side of the body
     • dermatome
       • An area of the skin supplied by a single spinal nerve
       • Responsible for the sensation
       • Spinal nerves exit the spine in pairs. There are 31 pairs in total, and 30 of these have corresponding dermatomes
   • causes ulcers and can leave scars behind it
   • Diagnosis : PCR, ELISA, Tzanck smear
   • Treatment:
     • cream/topical treatment
     • antiviral medication : cyclovir, valacyclovir, famciclovir
     • vaccination (VZIg)
   • factors that increase the risk of shingles
     • age, weak immunity, stress, undergoing cancer treatments, certain diseases (HIV/AIDS)

7. Complication of Shingles

   • Postherpetic Neuralgia(most common)
     • factors that increase the chances of having it : old age, severity of shingles, location, antiviral treatment duration
     • treatment :
       • Medication (OTC painkillers, opioids, antiviral drugs, anticonvulsants)
       • capsaicin patches and creams
       • Physical therapy (active and passive)
   • eye problems, Ramsay hunt syndrome, skin problems, swelling

8. erythema and skin changes

   • it is the abnormal reddening of the skin
   • caused by injury or inflammation of superficial blood capillaries, causing them to vasodilate
   • can be due to infections (like vzv), drugs, bacterial infections, etc...

9. causes of abdominal pain

   • constipation
     • Management
       • Self care
         • Drink extra water a day, Avoid caffeine-containing drinks and alcohol, Exercising daily, add high-fibre foods to diet
       • Medications
         • Methylnaltrexone, lactulose, linaclotide
       • Surgery: in case of blockage in the colon, narrowing of the intestines
   • pancreatitis, perforation, hepatitis, gastroenteritis, etc..)

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