Chronic Pain Syndrome & Brachial Plexus PDF

Chronic pain Syndrome Lec.1 Neurological physiotherapy Dr.Sarkawt S.Kakai Definition Chronic pain syndrome is characterized by persistent pain that lasts for an extended period, typically beyond the expected time for healing. Unlike acute pain, which serves as a warning signal for injury or illness,...

Chronic pain Syndrome Lec.1 Neurological physiotherapy Dr.Sarkawt S.Kakai Definition Chronic pain syndrome is characterized by persistent pain that lasts for an extended period, typically beyond the expected time for healing. Unlike acute pain, which serves as a warning signal for injury or illness, chronic pain can persist for months or even years. It affects not only the physical well-being of individuals but also their emotional and psychological states. Causes of Chronic Pain: A. Physical Causes: Injury: Trauma or accidents can lead to chronic pain, especially if nerve damage occurs. Medical Conditions: Conditions such as arthritis, fibromyalgia, and inflammatory disorders can contribute to chronic pain. Surgery: Some individuals may experience chronic pain following surgical procedures. B. Psychological Factors: Stress and Anxiety: Emotional stress can exacerbate pain perception and contribute to the development of chronic pain. Depression: Chronic pain and depression often coexist, creating a challenging cycle that affects both conditions. Symptoms Fatigue Decreased stamina Numbness or Tingling Depression Irritability Poor Sleep/Lack of sleep Drug or alcohol abuse Suicidal thoughts Joint Pain (Sensations of burning, aches, or stinging) Diagnosis Diagnosing chronic pain syndrome is a complex process that involves a thorough medical history, physical examination, and sometimes, specialized tests such as imaging studies or nerve conduction tests. Healthcare professionals may collaborate with patients to understand the unique aspects of their pain experience. Assessment tools 1.Pain Rating Scale 0 1 2 3 4 5 6 7 8 No pain 9 10 Worst pain imaginable *Ratings of 4 or higher should get further assessment Issues: Hard to compare across patients Pain ratings may not change but function can 2.PEG PEG (3-items) Treatment Options A. Medications: Analgesics: Pain relievers, including nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, may be prescribed. Antidepressants and Anticonvulsants: These medications can help manage chronic pain by affecting the perception of pain signals. B. Physical Therapy: Exercise: Tailored exercise programs can improve strength, flexibility, and overall physical function. Manual Therapy: Techniques such as massage and joint mobilization may provide relief. Treatment Options C. Cognitive-Behavioral Therapy (CBT): CBT helps individuals manage pain by changing their thought patterns and behaviors related to pain. Mindfulness and Relaxation Techniques: Meditation and relaxation exercises can contribute to pain management. D. Multidisciplinary Approach: Effective management of chronic pain often involves a multidisciplinary team, including physicians, physical therapists, psychologists, and pain specialists. This collaborative approach aims to address the diverse aspects of chronic pain, both physical and psychological. Prepared by : Nyan A.Namiq Supervised by : Dr.sarkawt S.kakai Outline Brachial plexus anatomy What ia Erb`s palsy Causes Risk factors Signs & symptoms Diagnosis Treatment Anatomy of brachial plexus The brachial plexus : is a network of nerve fibers that supplies the skin and musculature of the upper limb. It begins in the root of the neck, passes through the axilla, and runs through the entire upper extremity. The plexus is formed by the anterior rami (divisions) of cervical spinal nerves C5, C6, C7 and C8, and the first thoracic spinal nerve T1. The roots : The ‘roots’ refer the anterior rami of the spinal nerves that comprise the brachial plexus. These are the anterior rami of spinal nerves C5, C6, C7, C8, and T1. Each spinal nerve then divides into an anterior and a posterior ramus. The roots of the brachial plexus are formed by the anterior rami of spinal nerves C5-T1 (the posterior divisions innervate the skin and musculature of the intrinsic back muscles). After their formation, these nerves pass between the anterior and medial scalene muscles to enter the base of the neck. Trunk : At the base of the neck, the roots of the brachial plexus converge to form three trunks. These structures are named by their relative anatomical location: ▪ Superior trunk – a combination of C5 and C6 roots. ▪Middle trunk – continuation of C7. ▪Inferior trunk – combination of C8 and T1 roots. Divisions : Each trunk divides into two branches within the posterior triangle of the neck. One division moves anteriorly (toward the front of the body) and the other posteriorly (towards the back of the body). Thus, they are known as the anterior and posterior divisions Cords : Once the anterior and posterior divisions have entered the axilla, they combine together to form three cords, named by their position relative to the axillary artery. ▪ The lateral cord is formed by : the anterior division of the (superior & middle trunk) ▪ The posterior cord is formed by : posterior division of (superior , middle & inferior) trunk ▪ The medial cord is formed by: The anterior division of the inferior trunk Major branches : These cords we explained above gives five major branches : Musculocutaneous N. Axillary N. Median N. Radial N. Ulnar N. Erb’s palsy is muscle weakness in the arm or shoulder that can occur as a result of an injury sustained during birth or later in life. It’s most common in infants who injured their shoulders during delivery. 1- During delivery the healthcare provider pulls the baby shoulder and then cause the nerves to be stretched 2- Erb’s palsy in adults may be caused by motor accidents 3-Other causes of these injuries include gunshot or knife wounds, industrial accidents, accidents related to contact sports like football, surgical complications or tumors. 2cesarean section 1-Excessive maternal weight gain 3-Maternal diabetes 5Forceful pulling on the arm 6-Second stage of labor lasting over an hour 4-Large infant size or high birth weight 7-Small or abnormal maternal pelvis shape Numbness in the shoulder, arm & wrist Problems with grasping objects Muscle weakness Complete or partial paralysis on one side The “waiter’s tip” position ❖ History ❖Physical examination ❖Neurological examination Imaging studies : MRI, X-rays, CT-scan ❖ EMG & NCS 1-Physiotherapy 2-Hydrotherapy 3-Surgery 4-Occupational therapy 5-Botulinum toxin injections are sometimes used to relieve contractures. References: https://teachmeanatomy.info/upper-limb/nerves/brachial-plexus/ https://www.lezdotechmed.com/blog/erbs-palsy/ https://my.clevelandclinic.org/health/diseases/21986-erbs-palsy https://www.baptisthealth.com/care-services/conditionstreatments/erbs-palsy https://orthoinfo.aaos.org/en/diseases--conditions/brachialplexus-injuries/ https://www.childbirthinjuries.com/erbs-palsy/ https://www.lecturio.com/concepts/mononeuropathy-andplexopathy/ https://www.istockphoto.com/illustrations/paralysis https://en.acillust.com/search/Numbness%20of%20arms?is_tag=true https://www.cerebralpalsyguide.com/birth-injury/erbs-palsy/ https://www.healthdirect.gov.au/surgery/elective-caesarean-section https://www.123rf.com/photo_146406331_illustration-of-a-pregnantwoman-suffering-from-weight-gain.html https://ecabiotec.africa/?o=baby-weight-animated-icon-download-in-jsonlottie-or-bb-X5lXdpU4 https://www.shutterstock.com/image-vector/gestational-diabetes-conceptvector-illustration-sad-2341463217 https://www.physio-pedia.com/Erb%27s_Palsy https://www.ncbi.nlm.nih.gov/books/NBK513260/ https://www.babycenter.com/baby/activities-play/when-can-my-baby-goin-a-pool_1368530 https://www.babyphysio.com/baby-brachial-plexus-injury-physiotherapytreatment-london-rehabilitation-belgravia-clapham-axa-bupa/ https://www.baker.edu/about/get-to-know-us/blog/where-dooccupational-therapists-work/ https://www.shutterstock.com/search/cartoon-surgery https://www.youtube.com/watch?v=ycbF6CT-zdov https://www.childbirthinjuries.com/erbs-palsy/ Pain and Pain Pathway Lec.2 Dr.Sarkawt S.Kakai Understanding Pain Definition "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.“ Mechanisms of Pain Pain is a complex sensation involving the transmission and processing of signals along the nervous system. Pain Threshold Individuals may have varying levels of tolerance to pain stimuli, influencing their pain experience. Types of Pain Neuropathic Pain Caused by damage to the nervous system, resulting in abnormal pain signaling and perception. Acute Pain Temporary discomfort often resulting. from injury or illness, typically resolving as healing occurs Chronic Pain. Persistent discomfort lasting beyond the normal healing period, often affecting daily life and function Inflammatory Response Tissue injury or inflammation triggers complex biochemical processes that contribute to pain sensation. Physiology of Pain Nociception The detection and transmission of noxious stimuli through specialized sensory neurons, known as nociceptors. Pain Pathways The transmission and modulation of pain signals involve multiple interconnected pathways within the nervous system. Pain Pathway Transduction The conversion of noxious stimuli into electrical signals by nociceptors to initiate the pain pathway. Transmission Propagation of pain signals through neural pathways, eventually reaching the brain for processing. Perception The brain interprets and perceives the sensory input as pain, integrating emotional and cognitive responses. Sensitization and Modulation Neurotransmitters Involved Norepinephrine Plays a role in the body's stress response and can influence pain perception and processing. Endorphins Act as natural painkillers, reducing pain perception and promoting a sense of well-being. Glutamate A key excitatory neurotransmitter involved in transmitting and modulating signals within the nervous system. The Role of Nerves Neuroplasticity The ability of the nervous system to adapt and reorganize, influencing pain processing and perception. Peripheral Nerves These nerves transmit signals between the body and the central nervous system, including pain-related information. Nerve Injury Damaged or dysfunctional nerves can lead to altered pain signaling, contributing to chronic pain conditions. Pain Management Strategies Multimodal Approaches Combining different therapies and interventions to address the multiple dimensions of pain experience. Holistic Care Personalized Treatment Tailoring interventions based on individual needs, preferences, and response to pain therapies. Considering physical, psychological, and social aspects in formulating comprehensive pain management plans. Treatment Options Medication Pharmaceutical interventions targeting pain mechanisms, including analgesics, anti-inflammatories, and antidepressants. Therapeutic Modalities Physical therapy, acupuncture, cognitivebehavioral therapy, and other non-invasive approaches for pain management. Complementary Medicine Alternative and complementary practices, such as herbal remedies, massage, and mind-body techniques, to alleviate pain.