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Non-NMS Thoracic Pain
- 1. Osteoporosis
- 2. Fibromyalgia
- 3. Psychogenic
- 4. Fracture
- 5. Acromegaly
- 6. Cushing’s syndrome
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Cushing’s syndrome
- Increase in cortisol in the system
- Too much corticosteroid (exogenous)
- ----People with chronic pain (MVA with whiplash)
- Indigenous
- ----Pituitary tumor
- Moon face (more fat absorption)
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Viscerogenic Upper Extremity Pain
- 1. Cancer
- 2. CV
- 3. Pulm
- 4. Gi/Hepatic
- 5. Infection
- 6. Renal
- 7. TOS
- 8. Gynocologic
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Cancer (Viscerogenic Upper Extremity Pain)
- Cord tumor cause nerve pain
- Metastases
- ----To the lungs
- ----To the spine
- Cervical cord tumors
- Bone tumors
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Cardiovascular (Viscerogenic Upper Extremity Pain)
- O2 demand not being met
- 1. TOS
- 2. Angina/MI
- 3. Aortic aneurysm
- 4. Pacemaker
- 5. Bacterial endocarditis
- 6. Pericarditis
- ----Inflammation of Membrane that envelops the heart
- ----Pain with supine; Best sitting
- 7. Collagen vascular disease
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Thoracic Outlet Syndrome (Viscerogenic Upper Extremity Pain)
- Adson’s Test
- ----Shoulder ext, ER, abd
- ----Radial pulse identified
- ----Neck ext, ipsilateral rotation
- Want to detect change in pulse depending on artery
- Reliability poor; But you should still use it
- Rule everything else out
-
TOS occurs
- Pec minor
- 1st rib and clavicle
- btwn ant/middle scalene
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Pulmonary (Viscerogenic Upper Extremity Pain)
- Pneumothorax
- Pancoast tumor
- Pneumonia
- PE
- TB
-
Renal (Viscerogenic Upper Extremity Pain)
- Kidney and ureters
- Upper urinary tract obstruction (internal or external), inflammation, or infection
- ----Internal: stone
- ----External: Ca mass on outside of utterer
- Pain when very irritable and press on diaphragm
-
GI/Hepatic (Viscerogenic Upper Extremity Pain)
- 1. Hiatal hernia
- ----Top part of stomach protrudes through the hiatus
- ----Common
- ----Difficulty swallowing If don’t take small enough bite
- 2. Peptic ulcer
- 3. Ruptured spleen
- ----Traumatic event
- ----Fall from a height or injury on athletic field
- ----Pain in L shoulder
- 4. Biliary/pancreatic disease
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Infection (Viscerogenic Upper Extremity Pain)
- 1. Septic arthritis
- 2. Necrotizing fasciitis
- 3. Mononucleosis
- 4. Transverse myelitis
- ----Infection of the spinal cord occurring anywhere on the cord so its presentation is very variable
- ----Lots dermatomes/Myotomes and pain
- 5. Cellulitis
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Gynecologic (Viscerogenic Upper Extremity Pain)
- 1. Endromeriosis
- 2. Etopic pregnancy
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Endometriosis
- Uterine lining is being produced outside the uterus
- Produces a functional tissue do it will have a cyclic occurrence of pain
- Unknown shoulder pain
- ----If growth implants on or near the diaphragm
- Pelvic pain
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Ectopic pregnancy
- Egg has implanted somewhere other than the uterus (usually fallopian tube)
- Pelvic pain
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