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Marco Arco: A 22-Year-Old Male With Severe Right Wrist Pain

Learning Objectives Learn the common causes of wrist pain. Develop an understanding of the unique anatomy of the wrist joint. Develop an understanding of the musculotendinous units that surround the wrist joint. Develop an understanding of the causes of flexor carpi ulnaris tendinitis. Develop an understanding of the differential diagnosis of flexor carpi ulnaris tendinitis. Learn the clinical presentation of flexor carpi ulnaris tendinitis. Learn how…

Karen Carpenter: A 19-Year-Old Female With Persistent Wrist Pain After Being Thrown From a Horse

Learning Objectives Learn the common causes of wrist pain. Develop an understanding of the unique vascular anatomy of the scaphoid bone. Develop an understanding of the causes of avascular necrosis of the scaphoid. Learn the clinical presentation of avascular necrosis of the scaphoid bone. Learn how to use physical examination to identify pathology of the scaphoid bone. Develop an understanding of the treatment options for avascular…

Bobby Marcelo: A 48-Year-Old Male With a Painful Bump on the Back of His Wrist

Learning Objectives ■ Learn the common causes of wrist pain. ■ Develop an understanding of the anatomy of the wrist. ■ Develop an understanding of the causes of carpal boss. ■ Develop an understanding of the differential diagnosis of wrist pain. ■ Learn the clinical presentation of carpal boss. ■ Learn how to use physical examination to identify carpal boss. ■ Develop an understanding of the…

Jessie Bumgartner: A 64-Year-Old Homemaker With Left Wrist Pain and Swelling

Learning Objectives Learn the common causes of wrist pain. Develop an understanding of the unique anatomy of the wrist joint. Develop an understanding of the characteristics of ganglion cysts. Develop an understanding of the causes of ganglion cysts. Develop an understanding of the differential diagnosis of ganglion cysts. Learn the clinical presentation of ganglion cysts. Learn how to examine the wrist. Learn how to use physical…

Mary Claire Bilman: A 68-Year-Old Female With Right Wrist Pain

Learning Objectives Learn the common causes of wrist pain. Develop an understanding of the unique anatomy of the carpometacarpal joints. Develop an understanding of the causes of arthritis of the carpometacarpal joints. Learn the clinical presentation of osteoarthritis of the carpometacarpal joints. Learn how to use physical examination to identify pathology associated with wrist pain. Develop an understanding of the treatment options for osteoarthritis of the…

Victor Flores: A 36-Year-Old Male With Pain and Paresthesias Radiating Into the Base of the Thumb

Learning Objectives Learn the common causes of wrist pain and hand pain. Learn the common causes of hand numbness. Develop an understanding of the unique relationship of the superficial radial nerve to the bones of the wrist. Develop an understanding of the anatomy of the superficial radial nerve. Develop an understanding of the causes of cheiralgia paresthetica. Develop an understanding of the differential diagnosis of cheiralgia…

Stefon Dawson: A 26-Year-Old Male With Severe Dorsal Wrist Pain Associated With Flexion and Extension of the Wrist

Learning Objectives Learn the common causes of wrist pain. Develop an understanding of the unique anatomy of the wrist joint. Develop an understanding of the musculotendinous units that surround the wrist joint. Develop an understanding of the causes of intersection syndrome. Develop an understanding of the differential diagnosis of intersection syndrome. Learn how to distinguish intersection syndrome from de Quervain tenosynovitis. Learn the clinical presentation of…

Warren Billiter: A 46-Year-Old Male With Severe Wrist Pain Associated With Ulnar Deviation of the Wrist

Learning Objectives Learn the common causes of wrist pain. Develop an understanding of the unique anatomy of the wrist joint. Develop an understanding of the musculotendinous units that surround the wrist joint. Develop an understanding of the causes of de Quervain tenosynovitis. Develop an understanding of the differential diagnosis of de Quervain tenosynovitis. Learn the clinical presentation of de Quervain tenosynovitis. Learn how to examine the…

Chase Armstrong: A 32-Year-Old Male With Pain and Electric Shock–Like Sensation Radiating Into the Lateral Forearm and Ring and Little Fingers

Learning Objectives Learn the common causes of wrist and hand pain. Learn the common causes of hand numbness. Develop an understanding of the unique relationship of the ulnar nerve to the ulnar artery and the ligaments and bones of the wrist. Develop an understanding of the anatomy of the ulnar nerve and the Guyon canal. Develop an understanding of the causes of ulnar nerve entrapment at…

John Walker: A 30-Year-Old Male With Pain, Numbness, Weakness, and Paresthesias, Radiating Into the Thumb, Index and Middle Fingers

Learning Objectives Learn the common causes of wrist pain and hand pain. Learn the common causes of hand numbness. Develop an understanding of the unique relationship of the median nerve to the bones of the wrist. Develop an understanding of the anatomy of the median nerve. Develop an understanding of the causes of carpal tunnel syndrome. Develop an understanding of the differential diagnosis of carpal tunnel…

Harry Boyden: A 58-Year-Old Male With Right Wrist Pain

Learning Objectives Learn the common causes of wrist pain. Develop an understanding of the unique anatomy of the wrist joint. Develop an understanding of the causes of arthritis of the wrist joint. Learn the clinical presentation of osteoarthritis of the wrist joint. Learn how to use physical examination to identify pathology associated with wrist pain. Develop an understanding of the treatment options for osteoarthritis of the…

Pain Control in the Care of the Dying

SUMMARY There is a fear in patients that pain is invariably associated with dying. Fear of dying itself will often lead to an increase in the patient’s perception of pain. The palliative care approach to pain management focuses on the concept of “total pain”: the level of pain that a patient perceives is related to the physical aspects of the disease in addition to psychological, social,…

Cancer Pain: Treatment Overview

SUMMARY Patients with cancer pain typically have a complex pain syndrome composed of multiple physical causes. The median number of the individual pains per patient is four with a range of one to seven. In addition, there is likely to be a substantial affective component consisting of anger, anxiety, and depression. Careful evaluation and identification of the separate pains with a clear diagnosis of their underlying…

Analgesic Therapy and Palliative Care in Children

SUMMARY In this chapter we outline approaches to pain and symptom management, supportive care, and palliative care for children with life-threatening illnesses. Much of the literature on palliative care in adults and children concerns cancer; we focus in large measure on cancer in this chapter but also address a range of other life-threatening conditions, including neurodegenerative disorders, acquired immunodeficiency syndrome, and more rapidly progressive cases of…

Cancer Pain Assessment and Syndromes

SUMMARY Surveys indicate that pain is experienced by 30–60% of cancer patients during active therapy and by more than two-thirds of those with advanced disease ( , ). Unrelieved pain is incapacitating and precludes a satisfying quality of life; it interferes with physical functioning and social interaction and is strongly associated with heightened psychological distress. It can provoke or exacerbate existential distress, disturb normal processes of…

Cancer Pain : Causes, Consequences, and Therapeutic Opportunities

SUMMARY Similar to cancer itself, the factors that drive cancer pain evolve and change with progression of the disease. Surgery, radiation therapy, and chemotherapy are used to remove or kill cancer cells, and all can induce pain and/or dysfunction of sensory and sympathetic nerve fibers. In cases in which the cancer continues to grow or relapse occurs, cancer cells and their associated stromal cells generate ongoing…

Surgery for Back and Neck Pain (Including Radiculopathies)

SUMMARY The field of surgery for spinal disease is currently growing faster than any other surgical area. Thus, it is extremely important to understand the indications for surgery and the appropriate application of surgical procedures for these diseases of the spine. Most acute spinal pain states will relent spontaneously, no matter what the cause. The surgeon must always be alert for red flags that indicate intercurrent…

Pharmacological Therapy for Neuropathic Pain

SUMMARY Neuropathic pain disorders are etiologically heterogeneous and consequences of injury to or disease of the nervous system. Neuropathic pain has gained increased attention from clinicians and scientists as a result of better understanding of the underlying mechanisms and the development of proven analgesic therapies. The pharmacological therapies available offer palliative symptom control but are not curative. Pharmacological therapy should be based on comprehensive assessment and…

Central Pain

SUMMARY Central pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system in the central nervous system (CNS) and can be due to multiple causes such as stroke, injury, inflammation, congenital abnormalities, and immunological disorders. Although the underlying causes differ, central pain conditions seem to share the same two basic clinical characteristics: (1) partial or complete loss…

Pain following Spinal Cord Injury

SUMMARY Pain is a frequent consequence of spinal cord injury (SCI). Most studies indicate that about two-thirds of people with SCI will experience persistent pain. Not only is the prevalence high, but also the impact on the individual is significant. Around one-third of people rate their pain as severe with adverse effects on mood and function. Several types of persistent pain with different distinctive characteristics are…