STUDY - Technical - New Dacian's Medicine
Arm
pain (Classical / Allopathic Medicine)
Arm pain usually
results from a musculoskeletal disorder, but it can also stem
from a neurovascular or cardiovascular disorder. In some
cases, it may be referred pain from another area, such as the
chest, neck, or abdomen. Its location, onset, and character
provide clues to its cause. The pain may affect the entire arm
or only the upper arm or forearm. It may arise suddenly or
gradually and be constant or intermittent. Arm pain can be
described as sharp or dull, burning or numbing, and shooting
or penetrating. Diffuse arm pain, however, may be difficult to
describe, especially if it isn't associated with injury.
HISTORY:
If the patient reports arm pain after an injury, take a brief history of the injury from the patient or his family.
If the patient reports continuous or intermittent arm pain, ask him to describe it, and find out when it began.
Ask the patient if the pain is associated with repetitive or specific movements or positions.
Ask the patient about activities that he performs during the day at work and if the arm pain prevents him from performing his job.
Ask the patient to point out other painful areas because arm pain may be referred.
Ask the patient if the pain worsens in the morning or in the evening.
Ask the patient if the pain restricts movements.
Ask the patient if the pain is relieved by heat, rest, or drugs.
Review the patient's medical history for preexisting illnesses.
Ask the patient about a family history of gout or arthritis and current drug therapy.
If the patient reports arm pain after an injury, take a brief history of the injury from the patient or his family.
If the patient reports continuous or intermittent arm pain, ask him to describe it, and find out when it began.
Ask the patient if the pain is associated with repetitive or specific movements or positions.
Ask the patient about activities that he performs during the day at work and if the arm pain prevents him from performing his job.
Ask the patient to point out other painful areas because arm pain may be referred.
Ask the patient if the pain worsens in the morning or in the evening.
Ask the patient if the pain restricts movements.
Ask the patient if the pain is relieved by heat, rest, or drugs.
Review the patient's medical history for preexisting illnesses.
Ask the patient about a family history of gout or arthritis and current drug therapy.
PHYSICAL
ASSESSMENT:
Observe the way the patient walks, sits, and holds his arm.
Inspect the entire arm, comparing it with the opposite arm for symmetry, movement, and muscle atrophy.
Palpate the entire arm for swelling, nodules, and tender areas. In both arms, compare active range of motion, muscle strength, and reflexes.
Examine the neck for pain on motion, point tenderness, muscle spasms, or arm pain when the neck is extended with the head toward the involved side.
If the patient reports numbness or tingling, check his sensation to vibration, temperature, and pinprick; then compare bilateral hand grasps and shoulder strength to detect weakness.
If the patient has a cast, splint, or restrictive dressing, check his arm for circulation, sensation, and mobility distal to the dressing; then ask him if he has experienced edema and if the pain has worsened in the last 24 hours as well as which activities he has been performing.
Observe the way the patient walks, sits, and holds his arm.
Inspect the entire arm, comparing it with the opposite arm for symmetry, movement, and muscle atrophy.
Palpate the entire arm for swelling, nodules, and tender areas. In both arms, compare active range of motion, muscle strength, and reflexes.
Examine the neck for pain on motion, point tenderness, muscle spasms, or arm pain when the neck is extended with the head toward the involved side.
If the patient reports numbness or tingling, check his sensation to vibration, temperature, and pinprick; then compare bilateral hand grasps and shoulder strength to detect weakness.
If the patient has a cast, splint, or restrictive dressing, check his arm for circulation, sensation, and mobility distal to the dressing; then ask him if he has experienced edema and if the pain has worsened in the last 24 hours as well as which activities he has been performing.
SPECIAL
CONSIDERATIONS:
If you suspect a fracture, apply a sling or a splint to immobilize the arm, and monitor the patient for worsening pain, numbness, or decreased circulation distal to the injury site. Promote the patient's comfort by elevating his arm and applying ice until diagnostic testing and treatment is administered.
If you suspect a fracture, apply a sling or a splint to immobilize the arm, and monitor the patient for worsening pain, numbness, or decreased circulation distal to the injury site. Promote the patient's comfort by elevating his arm and applying ice until diagnostic testing and treatment is administered.
PEDIATRIC
POINTERS:
In children, arm pain commonly results from a fracture, a muscle sprain, muscular dystrophy, or rheumatoid arthritis.
In young children, the exact location of the pain may be difficult to establish. Watch for nonverbal clues, such as wincing or guarding.
If the child has a fracture or sprain, obtain a complete account of the injury. Closely observe interactions between the child and his family, and don't rule out the possibility of child abuse.
In children, arm pain commonly results from a fracture, a muscle sprain, muscular dystrophy, or rheumatoid arthritis.
In young children, the exact location of the pain may be difficult to establish. Watch for nonverbal clues, such as wincing or guarding.
If the child has a fracture or sprain, obtain a complete account of the injury. Closely observe interactions between the child and his family, and don't rule out the possibility of child abuse.
AGING ISSUES:
Elderly patients with osteoporosis may experience fractures from simple trauma or even from heavy lifting or unexpected movements. They're also prone to degenerative joint disease that can involve several joints in the arm or neck.
Elderly patients with osteoporosis may experience fractures from simple trauma or even from heavy lifting or unexpected movements. They're also prone to degenerative joint disease that can involve several joints in the arm or neck.
PATIENT
COUNSELING:
Advise a patient with a cast to notify his physician if he detects any worsening swelling, purple discoloration of fingers, or numbness or tingling. Advise patients with angina that arm pain, usually left-sided, may represent an ischemic event, especially if accompanied by diaphoresis, nausea, vomiting, and anxiety.
Advise a patient with a cast to notify his physician if he detects any worsening swelling, purple discoloration of fingers, or numbness or tingling. Advise patients with angina that arm pain, usually left-sided, may represent an ischemic event, especially if accompanied by diaphoresis, nausea, vomiting, and anxiety.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)