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Cureus Jan 2023Medial tibial stress syndrome (MTSS), usually referred to as "shin splints," is a common overuse injury of the lower extremities affecting a large percentage of... (Review)
Review
Medial tibial stress syndrome (MTSS), usually referred to as "shin splints," is a common overuse injury of the lower extremities affecting a large percentage of athletes. A variety of factors can lead to shin splints, including overtraining, poor footwear, muscular imbalances at the ankle, overtight or weak triceps surae muscles, imbalances at the thoracolumbar complex, and a body mass index (BMI) above 30. Injuries present with diffuse palpable pain that is often described as a dull ache following exercise. The pain is often alleviated by resting. Often, athletes complain of tenderness along the posteromedial edge of the tibia and pain along the middle to distal third of the posteromedial border of the tibia following an exercise session. The pain caused by a shin splint should be categorized according to its location and cause, such as lower medial tibial pain caused by periostitis or upper lateral tibial pain caused by raised compartment pressure. In order to prevent MTSS or shin splints, it is important to avoid excessive stress. The main objectives of shin splint treatment are to relieve pain and to enable the patient to return to normal activities without pain. To prevent shin splints, repetitive stress should be avoided. In this paper, we review what is known about the pathophysiology of shin splint syndrome, present evidence regarding risk factors associated with shin splints, assess the effectiveness of prevention strategies, and make recommendations for prevention. The purpose of this study is to assess the effectiveness of interventions to prevent shin splints.
PubMed: 36819450
DOI: 10.7759/cureus.33905 -
Annals of Palliative Medicine Mar 2023Painful diabetic peripheral neuropathy (DPN) affects approximately 6-34% of all patients with diabetes. DPN-induced pain reduces the quality of life and makes daily... (Review)
Review
BACKGROUND AND OBJECTIVE
Painful diabetic peripheral neuropathy (DPN) affects approximately 6-34% of all patients with diabetes. DPN-induced pain reduces the quality of life and makes daily activities difficult. Distal symmetric polyneuropathy (DSPN) is the most common type of DPN. Here we review the pathophysiology, diagnosis, and treatment of DPN.
METHODS
A MEDLINE database (PubMed) search was conducted for English-language articles dealing with the effect of DPN that were published until April 1, 2022. To identify potentially relevant articles, the following key search phrases were combined: 'diabetes mellitus', 'diabetes', 'neuropathy', 'polyneuropathy', 'diabetic neuropathies', 'peripheral neuropathy', 'diabetic polyneuropathy', 'pathophysiology', 'diagnosis', and 'treatment'.
KEY CONTENT AND FINDINGS
In a biopsy study of the sural nerve, damage to C and Aδ fibers were seen in patients who had recent onset of pain in their feet consisting of tingling, burning, and prickling, followed by initial demyelination/remyelination of large fibers. DPN is characterized by a pattern of distal-to-proximal axonal loss with symptoms. Hyperglycemia and dyslipidemia are the primary causes of DPN in patients with type 1 and 2 diabetes, respectively. The pattern of pain from DPN is described as "glove and stocking". DPN-induced pain is described as burning, electric, sharp, and dull aching with various pain intensities. DPN is a diagnosis of exclusion; diagnosis is made with a thorough medical history, physical examination, and clinical testing to rule out other causes of pain. Anticonvulsants (pregabalin and gabapentin), antidepressants (duloxetine, venlafaxine, and amitriptyline), opioids (tramadol, tapentadol, and oxycodone), and topical capsaicin are commonly administered to treat DPN. The combination of two or three of these pharmacological agents better resolves pain at lower doses and with fewer side effects.
CONCLUSIONS
Clinicians should have sufficient knowledge of DPN to ensure its accurate diagnosis and appropriate treatment. This review provides clinicians with the necessary knowledge of the pathophysiology, diagnosis, and treatment of painful DPN.
Topics: Humans; Diabetic Neuropathies; Diabetes Mellitus, Type 1; Quality of Life; Diabetes Mellitus, Type 2; Pain
PubMed: 36786097
DOI: 10.21037/apm-22-693 -
Current Osteoporosis Reports Aug 2018This paper describes recent advances in understanding the mechanisms that drive fracture pain and how these findings are helping develop new therapies to treat fracture... (Review)
Review
PURPOSE OF REVIEW
This paper describes recent advances in understanding the mechanisms that drive fracture pain and how these findings are helping develop new therapies to treat fracture pain.
RECENT FINDINGS
Immediately following fracture, mechanosensitive nerve fibers that innervate bone are mechanically distorted. This results in these nerve fibers rapidly discharging and signaling the initial sharp fracture pain to the brain. Within minutes to hours, a host of neurotransmitters, cytokines, and nerve growth factor are released by cells at the fracture site. These factors stimulate, sensitize, and induce ectopic nerve sprouting of the sensory and sympathetic nerve fibers which drive the sharp pain upon movement and the dull aching pain at rest. If rapid and effective healing of the fracture occurs, these factors return to baseline and the pain subsides, but if not, these factors can drive chronic bone pain. New mechanism-based therapies have the potential to fundamentally change the way acute and chronic fracture pain is managed.
Topics: Acute Pain; Analgesics, Opioid; Animals; Bone and Bones; Central Nervous System Sensitization; Chronic Pain; Disease Models, Animal; Fracture Healing; Fractures, Bone; Humans; Neuralgia; Nociceptive Pain; Nociceptors; Pain Management; Peripheral Nerve Injuries; Sensory Receptor Cells
PubMed: 29948820
DOI: 10.1007/s11914-018-0446-8 -
Cureus Aug 2021Tension-type headache is one of the most prevalent types of headache. The common presentation is a mild-to-moderate dull aching pain around the temporal region, like a... (Review)
Review
Tension-type headache is one of the most prevalent types of headache. The common presentation is a mild-to-moderate dull aching pain around the temporal region, like a tight band around the forehead, neck, shoulder, and sometimes behind eyes. It can occur at any age but most commonly in the adult female population. The exact underlying mechanism is not clear but muscle tension is one of the main causes, which can be due to stress and anxiety. There are several non-pharmacologic treatment options suggested for tension-type headaches, such as cognitive behavioral therapy, relaxation, biofeedback, acupuncture, exercise, manual therapy, and even some home remedies. This systematic review was performed to evaluate the effectiveness of acupuncture and manual therapy in tension-type headaches. The literature search was primarily done on PubMed. Eight articles involving 3846 participants showed evidence that acupuncture and manual therapy can be valuable non-pharmacological treatment options for tension-type headaches. Acupuncture was compared to routine care or sham intervention. Acupuncture was not found to be superior to physiotherapy, exercise, and massage therapy. Randomized controlled trials done in various countries showed manual therapy also significantly decreased headache intensity. Manual therapy has an efficacy that equals prophylactic medication and tricyclic antidepressants in treating tension-type headaches. The available data suggests that both acupuncture and manual therapy have beneficial effects on treating symptoms of tension-type headache. However, further clinical trials looking at long-term benefits and risks are needed.
PubMed: 34646653
DOI: 10.7759/cureus.17601 -
Cureus Nov 2022Ovarian pregnancy is a rare uncommon presentation of an ectopic pregnancy. Without any known risk factors, ovarian pregnancy seems to appear at random. A 29-year-old...
Ovarian pregnancy is a rare uncommon presentation of an ectopic pregnancy. Without any known risk factors, ovarian pregnancy seems to appear at random. A 29-year-old female patient with previous two cesarean deliveries visited the gynecology emergency department with the complaint of constant dull aching pain in the lower abdomen, aggravated by postural changes. Per vaginal examination, cervical motion tenderness was present. The patient was admitted, and her transvaginal sonography was done along with a urine pregnancy kit test for the suspicion of ectopic gestation. After the initial treatment and arrangement of two units of packed red blood cells after proper grouping and cross-matching for the patient, laparotomy was done. At the time of surgery, left-sided ruptured ovarian pregnancy was confirmed by the Spiegelberg criteria.
PubMed: 36514605
DOI: 10.7759/cureus.31316 -
Respiratory Medicine Case Reports 2018This case presentation relates to a 21 year young male, cachectic in appearance, who presented with progressive shortness of breath, and dull pain on the lower part of...
This case presentation relates to a 21 year young male, cachectic in appearance, who presented with progressive shortness of breath, and dull pain on the lower part of the chest ongoing over three months. The patient received antitubercular drugs by local physician for suspected tuberculosis with no significant improvement. He was referred to our Respiratory Department for further evaluation of his chest pain and breathlessness. His X-ray showed moderate pleural effusion on the left side which confirmed by USG chest screening which showed multiple septation with thick parietal pleura and USG abdomen was normal. Moreover, the pleural effusion aspiration was performed and pleural fluid examination revealed exudative in character and thoracoscopic view of pleura was reddish with exudatives. Pleural biopsy histological examination showed mixed cell infiltrate with predominantly foamy macrophage along with plasma cells, lymphocytes and eosinophils with capillary proliferation. This is the first care report of xanthomatous pleuritis in the literature.
PubMed: 29719802
DOI: 10.1016/j.rmcr.2017.11.005