Chronic fatigue syndrome (CFS) is a serious disorder characterised by persistent post-exertional fatigue and substantial symptoms related to cognitive, immune and autonomous dysfunction. Disease mechanisms are complex with no single causal factor identified. Yet there are indications that infections and immunological dysfunction contribute to development and maintenance of symptoms, probably interacting with genetic and psychosocial factors.
‘Intractable hiccups’ are present if the attack lasts more than 1 month. The incidence and prevalence of persistent and intractable hiccups in the community have not been studied. Hiccups are more common in diseases affecting the gastrointestinal or central nervous systems. Up to 20% of patients with Parkinson's disease and 10% of patients with reflux symptoms complain of recurrent hiccups compared to approximately 3% of controls.
Dorsal scapular nerve (DSN) entrapment syndrome is an under-recognized cause of neck and shoulder pain. DSN injuries can be the origin of a well-defined chronic pain syndrome, often referred to as DSN syndrome. DSN syndrome is often characterized by a dull ache along the medial border of the scapula. The dorsal scapular nerve may be injured in the neck (at the scalenes) or in the thoracic back at the level of the rhomboids.
Supraorbital neuralgia is characterized by persistent pain in the supraorbital region and forehead with occasional sudden, shocklike paresthesias in the distribution of the supraorbital nerve. Supraorbital neuralgia is the result of compression or trauma of the supraorbital nerves as the nerves exit the supraorbital foramen.
Ilioinguinal neuralgia is one of the most common causes of lower abdominal and pelvic pain encountered in clinical practice. Ilioinguinal neuralgia is caused by compression of the ilioinguinal nerve as it passes through the transverse abdominis muscle at the level of the anterior superior iliac spine. The most common causes of compression of the ilioinguinal nerve at this anatomic location involve injury to the nerve induced by trauma, including direct blunt trauma to the nerve, as well as damage during inguinal herniorrhaphy and pelvic surgery. Rarely, ilioinguinal neuralgia can occur spontaneously.
Morton's neuroma is a benign fibrotic thickening of a plantar interdigital nerve that is a response to irritation. Also known as Morton's metatarsalgia, Morton's entrapment, interdigital neuroma, intermetatarsal neuroma, and interdigital nerve compression syndrome, it is not a true neuroma, as the condition is a degenerative process rather than a neoplastic process. The mean age at presentation is 55 years. It is 4-15 times more common in women than in men.
Post-herpetic neuralgia occurs when the pain associated with shingles becomes chronic. Definitions of post-herpetic neuralgia differ in terms of the time of onset and duration of pain, and this has resulted in difficulty estimating the prevalence of the disease. One source estimates that approximately 20% of people older than 50 years will develop post-herpetic neuralgia, despite antiviral treatment beginning within 72 hours of rash onset.
The terms adhesive capsulitis, frozen shoulder and periarthritis have been used for patients with shoulder pain and mobility deficits. Adhesive capsulitis is defined as having at least 1 month of shoulder pain, an inability to lie on the affected side, and restricted active and passive shoulder motion in 3 or more planes.
Iliotibial band syndrome is a common source of knee pain. The most common symptom is lateral knee pain caused by inflammation of the distal portion of the iliotibial band. Occasionally, however, the iliotibial band becomes inflamed at its proximal origin and causes referred hip pain. The iliotibial band is a thick band of fascia that crosses the hip joint and extends distally to insert on the patella, tibia, and biceps femoris tendon.
Shoulder pain is defined as chronic when it has been present for longer than six months. Common conditions that can result in chronic shoulder pain include rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. Rotator cuff disorders include tendinopathy, partial tears, and complete tears.
Occipital neuralgia is defined as a paroxysmal shooting or stabbing pain in the distribution of the greater or lesser occipital nerves accompanied by diminished sensation or dysesthesia in the affected area. The pain originates in the suboccipital region and radiates over the vertex. A suggestive history and clinical examination with short-term pain relief after infiltration with local anesthetic confirm the diagnosis.
Diabetes is a worldwide epidemic, and associated neuropathy is its most costly and disabling complication. Painful diabetic neuropathy is a common condition that will only increase as the diabetes epidemic grows. All physicians need to be aware of this under-recognized condition. Given the rising prevalence of painful diabetic neuropathy, it is increasingly important that we understand the best ways to diagnose and treat this condition. Diagnostic tests in this field are evolving rapidly.
Epicondylitis is one of the most common elbow problems in adults, occurring both laterally and medially. Medial epicondylitis of the elbow, commonly referred to as 'golfer's elbow,' is characterized by pathologic changes to the musculotendonous origin at the medial epicondyle.
Achilles tendinitis exists along the spectrum of peritendinitis to tendinosis or tendinopathy. This is a painful, swollen, and tender area of the Achilles tendon and peritenon usually secondary to repetitive activity or overuse.
Chronic pelvic pain can be defined as intermittent or constant pain in the lower abdomen or pelvis of at least 6 months in duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy. It is a symptom not a diagnosis. Chronic pelvic pain presents in primary care as frequently as migraine or low-back pain and may significantly impact on a woman’s ability to function.
Trochanteric bursitis is a term used to describe chronic, intermittent pain accompanied by tenderness to palpation overlying the lateral aspect of the hip. First described by Stegemann in 1923, trochanteric bursitis has been referred to as the "Great Mimicker" because it is frequently mistaken for other conditions. Yet, the term 'trochanteric bursitis' may in fact be a misnomer given that three of the cardinal symptoms of inflammation, erythema, edema and rubor are uncommon.
Approximately 96% of all groin hernias are inguinal hernias, with the remaining 4% being femoral. Hernias are bilateral in 20% of cases. The most common abdominal wall hernia is an inguinal hernia with a male to female preponderance of 9 to 1. Femoral hernias are more common in women.
Intercostal neuralgia refers to a neuropathic condition involving the intercostal nerves, manifesting as intense dysesthetic pain, e.g., sharp, shooting, or burning in quality. The pain is localized to one or more of the intercostal spaces. Because the pain can span the chest or upper abdomen, afflicted patients may become alarmed about the possibility of having an underlying serious condition from a visceral origin, e.g., myocardial infarction or gallbladder-related pain, and thus may be apt to solicit medical attention.
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