Definition, types, understanding Pathological types of pain, How to describe deformity . meant for undergraduate MBBS students

1. Pain
Not a disease or curse
Protective mechanism

2. Dr. Shrikant Gore
M.S. Orthopaedics
• Professor and Head
• Department of Orthopaedics
• Government Medical College
• Latur – 413512
• E-mail – laturmedical@gmail,com

3. • Unpleasant sensation felt, by a person, to any injury
to the body
• Mechanical - pinch, prick, cut, stretch, crush etc.
• Chemical - external & internal (Bradykinines,
Serotonins, prostaglandins, Bacterial toxins)
• Thermal, electrical
• Psychological
Definition

4. • It initiates body’s protective response to injury
• Minimizing the damage and helps in repairs by
initiating healing process
• Pain is essential to maintain health and repair
damage
• Pain needs to be treated as an emergency to
protect body from damage by removing the cause
of pain
Protective

5. • Stimulus
• Sensory receptors at nerve endings
• Receptors are type specific and their
concentration is area specific, depending on the
the need of the area, e.g. maximum
concentration of touch receptors at finger tips
minimum touch receptors on visceral organs
Physiology

6. • On stimulation of receptor biochemical reaction
sets in generating electrical impulse with injury
specific modality, Carried through nerves, spinal
cord.
• Spinal reflex is set in and the part of body
subjected to injury is withdrawn away from the
injury source to avoid damage
Pathway

7. • The impulse is carried further to Sensory cortex
representing the area of stimulus
• The sensory cortex analyses this modality to
recognize the specific injury type resulting in
perfect location of the area of injury and the type
of injury
• It sends suppressive signals to spinal cord to
reduce the severity of further similar impulse
Perception

8. • Nerve ending
• Peripheral Nerves
• Nerves
• Nerve root
• Spinal cord
• Basal Ganglion
• Neuropathies
• Stretching
• Compression,
• Girdle pain
• Involuntary movements
Pathological Sites

9. • Cerebellum
• Cerebrum
• Psyche
• Autonomous n.
• Ataxia, Balance
• Altered, lost,
• Pain without stimulus
• Causalgia
Pathological Sites

10. • Carry electrical current generated at sensory
receptor
• If the nerve is affected by inflammation or
pressure the modality(frequency) of electrical
current changes on its way to brain changing the
perception of sensation (Altered sensation)
• Touch is perceived as Tingling, Burning,
Numbness, pricking etc. due to alteration of the
electrical impulse
Peripheral Nerves

11. • Nutritional - B-complex Vitamins
• Metabolic - Diabetes mellitus
• Toxicity - Lead
• Infections - Leprosy, viral
• Drugs - Alcohol,
Peripheral neuropathies

12. • Throbbing
• Radiating
• Referred
• Shifting
• Phantom
• Causalgia
Abnormal Types

13. • Pulsatile pain
• Spike of pain coming at regular intervals
• Aneurisms Aortic - stretching of outer layer of vascular
wall
Berry’s – increased intra cranial pressure with
each pulsation
Migraine dilated intracranial vessels increased blood with each
pulsation increases intracranial pressure
• Abscess Inflamed abscess wall and surrounding tissue
with hyperactive nerve endings getting stretched and
stimulated with every pulsation
Throbbing pain

14. • Nerves, Nerve roots - Compression, Stretching
• In addition to altered sensation
• Affected nerve becomes painful
• The pain radiating along the course of the nerve
Radiating Pain

15. • Pathology at one site, pain felt at other site
• Cerebral cortex unable to locate the site of pain.
• Commonly seen in pathologies affecting deeper
structures Heart, appendicitis, Hip joint
• Deeper structures less likely to get injured by
physical trauma have very low number of pain
receptors.
Referred Pain

16. • One single nerve supplies multiple organs
• The pain is felt at the organ having better number
of sensory receptors , supplied by same nerve
root
• It gets distributed to larger area of brain making
it difficult for pin point location
Referred Pain

17. • Pain initially felt at one site disappears and is felt
at other site
• Referred pain with progression of damage is
better located by the brain and felt at the site of
pathology. The confusion of site getting cleared
with increase in the injury at the site
Shifting pain

18. • Phantom sensation is felt in amputated part The
person feels presence of limb with every type of
sensation in it.
• The cut nerve at the end of amputation stump
heals by fibrosis forming sensitive neuro-fibromatous
mass which on stimulation sends
impulses to brain which are analyzed by brain as
coming from the limb more the fibrosis more the
chance of phantom sensation
Phantom

19. • Condition where partial peripheral nerve injury in
associated with reflex sympathetic dystrophy
• Injured peripheral nerve with sympathetic
dysfunction
• Commonly seen in Brachial plexus injury
Causalgia
Complex regional pain syndrome

20. • Peripheral vasodilatation – Burning, swelling,
edema, increased sweating, hair & nail growth
initially but loss of hair, dry cracked nails with
progression
• Three times more Common in female patients
• Average age being 42 years
Clinical features

21. • Pain initiated with any stimulus hypersensitivity
• gradually worsens
• Red, hot, shiny skin with excessive or less
sweating
• Wasting of muscles
• Stiffness of joints
• Regional Osteo porosis
Clinical features

22. Attitude
Position taken by the part at the time of
examination

23. • Attitude of joint to be described in every
direction in which normal physiological
movements are possible
• Any position not possible physiologically will be
called as deformity
• Any loss of physiological position will be called
as deformity
Attitude / Deformity

24. Deformity
Loss of form
Any deviation from normal anatomy

25. • Change in size or shape &loss of range of
movement
• Size -The length
-The width
-The Depth
-The circumference
with its exact location, extent & site of
maximum deviation
The Size

26. • The extremity Change in
-The angle
-The shift or step
-The rotation
-The curvature –concavity or
convexity – reduced obliterated or reversed
- The outline -any local bump or
depression
The shape

27. • Change at a site
Lump or swelling
• Presence of
Scar, Sinus, ulcer,
abrasion, wound, blebs
abnormal skin patch,
Local changes

28. • The Skin
-Appearance – Normal, stretched, wrinkled
-Color - pale, red, blue, black
-Dilated veins
-Hydration – Normal, dry, wet, oily, glossy
-Texture – normal, smooth, roughened,
puckered
-The hair distribution & appearance
-The skin thickness- thinned, thickened,
edematous
The look

29. • Loss of range of movement will be called as
fixed deformity
• In fixed flection deformity of 10 degrees neutral
position will not be possible as will be extension
• From fixed flection deformity of 10 degrees
further flection up to certain degrees will be
possible
• To confirm fixed deformity in a joint the joint
above and below must be in normal anatomical
position as the deformity can be masked by
change in the position of joint above or below
Loss of range of movements