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  /Title (6002-arm-pain.pdf)
  /Creator (Cheatography)
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  /Subject (6002 Arm Pain Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{6002 Arm Pain Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/42080/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}bee.f (bee.f) \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 17th April, 2024.\\
   Updated 17th April, 2024.\\
   Page {\thepage} of \pageref{LastPage}.
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\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Cervical radiculopathy*}}  \tn
% Row 0
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\mymulticolumn{2}{x{17.67cm}}{• {\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Compression or impairment of the nerve root, causing px \& Ssx that extend beyond the neck\{\{nl\}\}- Px in one or both UL which corresponds to the dermatome of the corresponding affected nerve\{\{nl\}\}- Muscle weakness \& impaired deep tendon reflexes are common due to nerve impingement\{\{nl\}\}- Neck pain is a common issue, up to 40\% of work absenteeism attributed to it \tn 
% Row Count 18 (+ 17)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Conditions causing compression or irritation of spinal nerve root lead to radicular Ssx\{\{nl\}\}- In younger pts (30-40s), disc trauma \& herniation are most common causes\{\{nl\}\}- In older pts, degenerative changes become more prevalent\{\{nl\}\}- 50-60s - disc degeneration is most common cause\{\{nl\}\}- 70s - foramina narrowing due to arthritic change is a frequent cause\{\{nl\}\}- Cx radiculopathy less frequent than Lx radiculopathy\{\{nl\}\}- Incidence rate: approx. 85 / 100,000\{\{nl\}\}- {\bf{C7}} nerve root most commonly affected, flooded by {\bf{C6}}\{\{nl\}\}- {\bf{Risk factors:}} manual labour w/ heavy lifting, driving, operating vibrating equipment\{\{nl\}\}- Chronic smoking Hx increases risk of radiculopathies \tn 
% Row Count 50 (+ 32)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Cervical radiculopathy* (cont)}}  \tn
% Row 3
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• {\bf{Pathophysiology:}} & - Primarily involves inflammation\{\{nl\}\}- Inflammation often caused by {\emph{acute herniation}} of a Cx disc pressing on the nerve root \{\{nl\}\}- Inflammation can worsen degenerative changes, such as osteophytes or disc dehydration, affecting the nerve root \{\{nl\}\}- Direct compression of the nerve root causes px, numbness, tingling, \& weakness \tn 
% Row Count 16 (+ 16)
% Row 4
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• {\bf{Clinical presentation:}} & - Pts present w/ radicular px or weakness\{\{nl\}\}- Inquire: occupational risk factors, Hx of trauma, \& px patterns\{\{nl\}\}- Typically unilateral, but B cases are rare\{\{nl\}\}- B presentations can complicate physical Dx\{\{nl\}\}- Cases of trauma or B involvement necessitate advanced imaging for accurate Dx \tn 
% Row Count 30 (+ 14)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Cervical radiculopathy* (cont)}}  \tn
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• {\bf{Physical examination:}} & - Reflexes, compare B\{\{nl\}\}- Reflexes usually reduced\{\{nl\}\}- Reduced muscle strength, innervated by the affected nerve (major sign)\{\{nl\}\}- {\bf{Spurling test:}} compresses foramina to Dx radiculopathy (px radiates down ipsilateral side)\{\{nl\}\}- {\bf{Cx distraction:}} in some cases may relieve Ssx \tn 
% Row Count 14 (+ 14)
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• {\bf{Diagnosis:}} & - X-rays are first step\{\{nl\}\}- CT used in traumatic scenarios\{\{nl\}\}- MRI is the preferred modality\{\{nl\}\}- Electromyography is useful in confirming dysfunction of the affected nerve \tn 
% Row Count 23 (+ 9)
% Row 7
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• {\bf{Management:}} & - Around 85\% resolve within 8-12 weeks\{\{nl\}\}- NSAIDs\{\{nl\}\}- Cx pillows\{\{nl\}\}- Acupancture\{\{nl\}\}- Nerve flossing\{\{nl\}\}- SMT / STW \tn 
% Row Count 29 (+ 6)
% Row 8
\SetRowColor{white}
• {\bf{Ddx:}} & - Brachial plexus injury in sports\{\{nl\}\}- Cx disc injuries\{\{nl\}\}- Cx discogenic px s.\{\{nl\}\}- Cx facet s.\{\{nl\}\}- Cx spine sprain\{\{nl\}\}- RC injuries\{\{nl\}\}- Strain injuries \tn 
% Row Count 37 (+ 8)
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\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK441828/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pancoast syndrome}}  \tn
% Row 0
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\mymulticolumn{2}{x{17.67cm}}{• {\bf{YELLOW}}} \tn 
% Row Count 1 (+ 1)
% Row 1
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• {\bf{Intro:}} & - Pancoast s. should be distinguished from Pancoast tumour itself\{\{nl\}\}- Entails: ipsilateral shoulder \& arm px, paresthesia, paresis, atrophy of the thenar muscles, \& Horner's s. (ptosis, miosis, anhidrosis)\{\{nl\}\}- 1° bronchogenic carcinoma is the most frequent cause of Pancoast s.\{\{nl\}\}- Manifests as radiating parascapular px, atrophy of intrinsic hand muscles, \& a lung apex density w/ localised rib \& vertebrae destruction \tn 
% Row Count 21 (+ 20)
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• {\bf{Aetiology (risk factors):}} & - 1° caused by tumours in the superior sulcus of the lung, mostly non-small cell lung cancer (NSCLC)\{\{nl\}\}- NSCLC accounts for 80-85\% of all lung cancer cases, w/ Pancoast s. making up 3-5\% of these\{\{nl\}\}- Squamos cell carcinoma used to be most common type of NSCLC associated w/ Pancoast s.\{\{nl\}\}- Other malignancies can also cause it\{\{nl\}\}- Rarely, being tumours cause it\{\{nl\}\}- Lung cancer is 2nd most common cancer \& is the leading cause of oncological mortality globally \tn 
% Row Count 43 (+ 22)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pancoast syndrome (cont)}}  \tn
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• {\bf{Pathophysiology:}} & - Pancoast or superior sulcus tumours cause Pancoast s.\{\{nl\}\}- Ssx inc. shoulder \& arm px due to compression of the brachial plexus\{\{nl\}\}- Initial Ssx often misDx as MSK\{\{nl\}\}- Tumour extension can lead to C8-T1 radiculopathy (px \& paresthesia of the dermatomes)\{\{nl\}\}- Weakness of intrinsic hand muscles affects fine motor skills \& handgrip\{\{nl\}\}- Involvement of sympathetic trunk \& Cx ganglion can cause facial flushing \& sweat\{\{nl\}\}- \{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK580489/\#:\textasciitilde{}:text=Harlequin\%20syndrome\%20is\%20a\%20rare,from\%20the\%20other\%20pale\%20half."\}\}Harlequin s.\{\{/popup\}\} may occur w. contralateral flushing \& sweating due to hyperactive sympathetic reaction \tn 
% Row Count 31 (+ 31)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pancoast syndrome (cont)}}  \tn
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• {\bf{Clinical presentation:}} & - Encompasses Ssx related to tumours affecting the lung apex\{\{nl\}\}- Ssx arise due to brachial plexus \& associated structures involvement\{\{nl\}\}- {\bf{1° Ss:}} shoulder or arm px \& paresthesia along the medial half of the 4th \& 5th finger, hand, arm, \& forearm (C8-T1 radiculopathy)\{\{nl\}\}- Pulmonary Ssx, e.g. SOB, develop as the tumour progresses to involve more of the lung \tn 
% Row Count 17 (+ 17)
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• {\bf{Physical examination:}} & - Ipsilateral facial flushing \& sweating due to involvement of sympathetic trunk \& Cx ganglion\{\{nl\}\}- Horner s. (ptosis, miosis, anhidrosis) may also develop w/ further disease \tn 
% Row Count 25 (+ 8)
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• {\bf{Diagnosis:}} & - {\bf{Chest x-ray:}} initial screening, shows increased size of apical cap or lung mass\{\{nl\}\}- {\bf{CT:}} provides additional info on tumour extent, satellite nodules, mediastinal adenopathy; crucial for staging\{\{nl\}\}- {\bf{MRI:}} done after Dx \& before surgery to identify vascular, brachial plexus involvement\{\{nl\}\}- {\bf{CT-guided core biopsy:}} Dx test of choice due to outer tumour location \tn 
% Row Count 43 (+ 18)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pancoast syndrome (cont)}}  \tn
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• {\bf{Complications:}} & - {\bf{Surgical:}} atelectasis (partial lung collapse), px, chest wall deformity, frozen shoulder, CSF leak, prolonged air leak, injury to the brachial plexus\{\{nl\}\}- {\bf{Chemotherapy:}} side effects of the drugs\{\{nl\}\}- {\bf{Radiation:}} alopecia, nausea, vomiting, leathery skin, poor wound healing \tn 
% Row Count 14 (+ 14)
% Row 8
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• {\bf{Management:}} & - Good prognosis: early-stage Dx\{\{nl\}\}- Poor prognosis: advanced disease, poor performance status, \& weight loss\{\{nl\}\}- {\bf{Standard care procedure:}} chemo-radiation followed by surgical resection\{\{nl\}\}{\bf{Contraindication to surgical resection:}}\{\{nl\}\}- Presence of mets\{\{nl\}\}- Involvement of ipsi/contralateral mediastinal nodes or supraclavicular nodes\{\{nl\}\}- Involvement of VB \textgreater{}50\%\{\{nl\}\}- Involvement of oesophagus \&/or trachea\{\{nl\}\}- Involvement of brachial plexus above T1 nerve root \tn 
% Row Count 37 (+ 23)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pancoast syndrome (cont)}}  \tn
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• {\bf{Ddx:}} & - Other malignancies either 1°, or even being tumours are known to cause Pancoast s.\{\{nl\}\}- Even apical lung infections or abscesses can cause Pancoast s. if they involve the chest wall \& surrounding structures \tn 
% Row Count 10 (+ 10)
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\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK482155/"\}\}link text\{\{/popup\}\}}  \tn 
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Thoracic outlet syndrome (TOS)*}}  \tn
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\mymulticolumn{2}{x{17.67cm}}{• {\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
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• {\bf{Intro:}} & - Encompasses various conditions involving compression of neurovascular structures in the Tx outlet\{\{nl\}\}- {\bf{5 types:}} venous, arterial, traumatic, true neurogenic, disputed neurogenic\{\{nl\}\}- {\bf{Tx outlet:}} 1st rib, scalenes, \& clavicles\{\{nl\}\}- Imaging helps in Dx \tn 
% Row Count 14 (+ 13)
% Row 2
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• {\bf{Aetiology (risk factors):}} & - Caused by increased pressure in Tx outlet, often due to anatomical abnormalities, e.g. Tx ribs, space-occupying lesions (e.g. tumours, cysts), or fibrous muscular bands from overuse\{\{nl\}\}- Past trauma \& neck positioning are common causes, leading to impingement of vessels or nerves\{\{nl\}\}- 2° causes: trap deficiency or clavicle \#, which can decrease the outlet space \& increase pressure\{\{nl\}\}- Neurogenic TOS: most prevalent variant, constituting over 90\% of cases\{\{nl\}\}- F\textgreater{}M \& individuals w/ poor muscle development or posture\{\{nl\}\}- Incidence rate: 3-80 / 1000 \tn 
% Row Count 40 (+ 26)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Thoracic outlet syndrome (TOS)* (cont)}}  \tn
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• {\bf{Pathophysiology:}} & - Caused by compression of structures in the Tx outlet\{\{nl\}\}- Extra ribs from 7th vertebrae are common culprits\{\{nl\}\}- Neck trauma preceded 80\% of neurological TOS cases, while 20\% were 1° caused by anatomic variants\{\{nl\}\}- B TOS reported w/ B Cx ribs as 1° cause\{\{nl\}\}- Soft tissue components (fibrous muscular bands \& tumours/cysts), also contribute to TOS\{\{nl\}\}- Athletes w/ repetitive motions inv. extreme ABD \& ER (swimmers) are susceptible to TOS\{\{nl\}\}- Classic presentation in swimmers inc. px, tightness, or numbness in the neck or shoulder area when their hand enters the water\{\{nl\}\}- Other susceptible athletes: baseball, water polo, \& tennis players \tn 
% Row Count 31 (+ 31)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Thoracic outlet syndrome (TOS)* (cont)}}  \tn
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• {\bf{Clinical presentation:}} & - Manifests w/ variety of Ssx depending on its cause\{\{nl\}\}- Common complaints inc. nebulous px regardless of etiology\{\{nl\}\}- Venous obstruction Ssx may inc. UL swelling, venous distention, \& px from hand to forearm\{\{nl\}\}- Persistent venous TOS can lead to UL DVTs\{\{nl\}\}- Arterial TOS may show colour changes in the UL \& diminished pulses\{\{nl\}\}- Ssx may appear gradually due to collateral blood flow, exacerbated by certain positions\{\{nl\}\}- Neurogenic TOS (most common) results from brachial plexus compression\{\{nl\}\}- Ssx inc. vague px, hand muscle atrophy, weakness, \& sensory deficits \tn 
% Row Count 27 (+ 27)
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• {\bf{Physical examination:}} & - Quick overview of pt's posture\{\{nl\}\}- Check symmetry \& ROM of both arms initially\{\{nl\}\}{\bf{Special tests:}}\{\{nl\}\}- Neurological exam to evaluate n. compression\{\{nl\}\}- Brachial plexus compression test\{\{nl\}\}- Spurling's test\{\{nl\}\}- Adson maneuver for suspected arterial compression\{\{nl\}\}- Roo's stress test\{\{nl\}\}- Costoclavicular test \tn 
% Row Count 43 (+ 16)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Thoracic outlet syndrome (TOS)* (cont)}}  \tn
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• {\bf{Diagnosis:}} & - Physical exam 1st, further imaging confirms Dx\{\{nl\}\}- {\bf{Chest or Cx x-ray:}} 1st imaging step, providing crucial anatomical info\{\{nl\}\}- {\bf{US}} only for venous TOS\{\{nl\}\}- {\bf{Venous dopplers}} for detecting compression of subclavian / other veins \tn 
% Row Count 12 (+ 12)
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• {\bf{Complications:}} & - Rare complications\{\{nl\}\}- Ischemic change could manifest if vascular compromise occurs\{\{nl\}\}- Most complications arise from surgical intervention (iatrogenic n. injury, pneumothorax, bleeding complications) \tn 
% Row Count 22 (+ 10)
% Row 8
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• {\bf{Management:}} & - Excellent prognosis (90\% of cases resolve Ssx w/ conservative care)\{\{nl\}\}- Lifestyle modifications - avoiding repetitive postural stress \& workstation modification\{\{nl\}\}- SMT - Cx, Tx, \& 1st rib\{\{nl\}\}- STW - scalenes \& pec minor\{\{nl\}\}- Exercises phase 1: Cx retractions, ulnar n. floss, scalene stretch, corner pec stretch\{\{nl\}\}- Exercises phase 2: resisted shoulder retraction\{\{nl\}\}- Surgery in case of severe compression not responding to conservative care \tn 
% Row Count 43 (+ 21)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Thoracic outlet syndrome (TOS)* (cont)}}  \tn
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• {\bf{Ddx:}} & - Pec minor s. (PMS) - commonly confused w/TOS\{\{nl\}\}- Brachial plexus injuries\{\{nl\}\}- Cx spine injuries\{\{nl\}\}- Cx radiculopathy\{\{nl\}\}- SIS\{\{nl\}\}- Elbow or forearm overuse injuries\{\{nl\}\}- AC joint injury\{\{nl\}\}- Nondescript px disorders (due to vague nature of TOS Ssx) \tn 
% Row Count 13 (+ 13)
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\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK557450/"\}\}link text\{\{/popup\}\}}  \tn 
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Complex regional pain syndrome (CRPS)*}}  \tn
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\mymulticolumn{2}{x{17.67cm}}{• {\bf{YELLOW}}} \tn 
% Row Count 1 (+ 1)
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• {\bf{Intro:}} & - Neuropathic px disorder w/ persistent, disproportionate px beyond typical healing times\{\{nl\}\}- Ssx inc. sensory, motor, \& autonomic abnormalities\{\{nl\}\}- Often follows trauma, \#, or surgery, but spontaneous cases also occur\{\{nl\}\}- Diagnostic criteria: \{\{popup="https://fpm.ac.uk/documents/criteria-diagnosis"\}\}Budapest criteria\{\{/popup\}\}\{\{nl\}\}- {\bf{2 types:}} no nerve trauma \& known nerve trauma (clinically indistinguishable, favouring distal extremities) \tn 
% Row Count 22 (+ 21)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - CRPS can occur due to various types or degrees of tissue trauma, inc. even w/o injury or due to prolonged immobilisation\{\{nl\}\}- Common causes: \#, surgery, sprains, contusions, crush injuries, \& seemingly minor interventions like intravenous line placement\{\{nl\}\}- Psychological distress during physical injury may influence the severity \& prognosis\{\{nl\}\}- Incidence varies (higher rates in Netherlands compared to US)\{\{nl\}\}- F\textgreater{}M, peak incidence 61-70 age group\{\{nl\}\}- Upper extremities are more frequently involved than lower extremities\{\{nl\}\}- \# are the most common trigger (44-46\% of cases)\{\{nl\}\}- Vasomotor Ssx, e.g. swelling, temperature, \& colour changes, are common\{\{nl\}\}- {\bf{Dx tests:}} 3-phase bone scans \& autonomic testing\{\{nl\}\}- {\bf{Risk factors:}} asthma, ACE inhibitor use, menopause, osteoporosis, Hx of migraine, \& smoking \tn 
% Row Count 60 (+ 38)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Complex regional pain syndrome (CRPS)* (cont)}}  \tn
% Row 3
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• {\bf{Pathophysiology:}} & - Multifactorial mechanisms\{\{nl\}\}- Inflammatory changes\{\{nl\}\}- Immunological changes\{\{nl\}\}- Peripheral sensitisation\{\{nl\}\}- Central sensitisation \& neuroplasticity\{\{nl\}\}- Autonomic changes \tn 
% Row Count 9 (+ 9)
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• {\bf{Clinical presentation:}} & - {\bf{Allodynia:}} non-painful stimuli causing px\{\{nl\}\}- {\bf{Hyperalgesia:}} exaggerated px from usually painful stimuli\{\{nl\}\}- {\bf{vasomotor dysfunction:}} skin colour \& temperature changes\{\{nl\}\}- {\bf{Sudomotor dysfunction:}} swelling \& sweating changes\{\{nl\}\}- {\bf{Motor Ssx:}} weakness, reduced ROM, tremor, dystonia in affected extremity \tn 
% Row Count 24 (+ 15)
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• {\bf{Physical examination:}} & - {\bf{Neuropsychological deficits:}} executive functioning, memory, word retrieval\{\{nl\}\}- {\bf{Constitutional Ssx:}} lethargy, weakness, disruptions in sleep architecture\{\{nl\}\}- {\bf{Cardiopulmonary inv.:}} neurocardiogenic syncope, atypical chest px, chest wall muscle dystonia leading to SOB\{\{nl\}\}- {\bf{Endocrinopathies:}} low serum cortisol, hypothyroidism\{\{nl\}\}- {\bf{Urologic dysfunction:}} increased urinary frequency \& urgency, urinary incontinence\{\{nl\}\}- {\bf{GI dysmotility:}} nausea, vomiting, diarrhoea, constipation, indigestion\{\{nl\}\}{\bf{Psychosocial factors:}}\{\{nl\}\}- Associated w/ worsening depression \& anxiety\{\{nl\}\}- Poor function \& diminished quality of life\{\{nl\}\}- No specific personality or psychopathology predictors\{\{nl\}\}- Px-related behaviour \& catastrophic thinking in pts w/ significant comorbid psychological burden or poor coping mechanisms \tn 
% Row Count 63 (+ 39)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Complex regional pain syndrome (CRPS)* (cont)}}  \tn
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• {\bf{Diagnosis:}} & {\bf{Budapest criteria}}\{\{nl\}\}{\bf{A. They should report continuing px disproportionate to the inciting event}}\{\{nl\}\}{\bf{B. They should report at least 1 Ssx in 3/4 following categories:}}\{\{nl\}\}- Sensory: reports of hyperalgesia \&/or allodynia,\{\{nl\}\}- Vasomotor: reports of temperature asymmetry \&/or skin colour changes \&/or skin colour asymmetry,\{\{nl\}\}- Sudomotor/edema: reports of edema \&/or sweating changes \&/or sweating asymmetry,\{\{nl\}\}- Motor/trophic: reports of decreased ROM \&/or motor dysfunction (weakness, tremor, dystonia) \&/or changes (hair, skin, nails)\{\{nl\}\}{\bf{C. Additionally, they must display at least 1 sign at the time of evaluation in 2 or more of the following categories:}}\{\{nl\}\}- Sensory: evidence of hyperalgesia (to pinprick) \&/or allodynia (to light touch or deep somatic pressure),\{\{nl\}\}- Vasomotor: evidence of temperature asymmetry \&/or skin colour changes \&/or asymmetry,\{\{nl\}\}- Sudomotor/edema: edema \&/or sweating changes \&/or sweating asymmetry,\{\{nl\}\}- Motor/trophic: evidence of decreased ROM \&/or motor dysfunction (weakness, tremor, dystonia) \&/or trophic changes (hair, skin, nails)\{\{nl\}\}{\bf{D. Finally, there is no other Dx that better explains the Ssx \& Sx}} \tn 
% Row Count 54 (+ 54)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Complex regional pain syndrome (CRPS)* (cont)}}  \tn
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• {\bf{Complications:}} & - Dystonia\{\{nl\}\}- Cognitive executive dysfunction\{\{nl\}\}- Adrenal insufficiency\{\{nl\}\}- Gastroparesis\{\{nl\}\}- IBS \tn 
% Row Count 5 (+ 5)
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• {\bf{Management:}} & - Early treatment may improve prognosis\{\{nl\}\}- Reported cases of spontaneous improvement\{\{nl\}\}- {\bf{Treatment goal:}} px \& discomfort improvement, functional restoration, \& disability prevention\{\{nl\}\}- PT \& exercise improve ROM, function \& reduce disability through endorphin release\{\{nl\}\}- Px education\{\{nl\}\}- NSAIDs / pharmacotherapy\{\{nl\}\}- Behavioural therapy (related to depression)\{\{nl\}\}- Invasive interventions \tn 
% Row Count 24 (+ 19)
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• {\bf{Ddx:}} & - Arterial insufficiency\{\{nl\}\}- Gillian-Barre s.\{\{nl\}\}- Hysteria\{\{nl\}\}- Monometric amyotrophy\{\{nl\}\}- Multiple sclerosis\{\{nl\}\}- Peripheral atherosclerotic disease\{\{nl\}\}- Phlebothrombosis\{\{nl\}\}- Porphyria\{\{nl\}\}- Poliomyelitis\{\{nl\}\}- Tabes dorsalis \tn 
% Row Count 36 (+ 12)
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\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK430719/"\}\}link text\{\{/popup\}\}}  \tn 
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Bummer or Stinger*}}  \tn
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\mymulticolumn{2}{x{17.67cm}}{• {\bf{YELLOW}}} \tn 
% Row Count 1 (+ 1)
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• {\bf{Intro:}} & - Common injury in contact sports\{\{nl\}\}- Reflects upper Cx root or peripheral nerve dysfunction injury\{\{nl\}\}- Occurs due to over-stretching of upper trunk of brachial plexus or compression of C5/C6 nerve root\{\{nl\}\}- Recurrences ar frequent \& can result in permanent neurological deficits\{\{nl\}\}- Typically graded as Grade I or Grade II nerve injury \tn 
% Row Count 17 (+ 16)
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• {\bf{Aetiology (risk factors):}} & - 1° observed in collision or contact sports (e.g. American football, ice hockey, \& rugby)\{\{nl\}\}- Affects 50-65\% of collegiate American football players\{\{nl\}\}- High recurrence rate requires attention to minimise the problem \tn 
% Row Count 28 (+ 11)
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• {\bf{Pathophysiology:}} & {\bf{3 primary mechanisms:}}\{\{nl\}\}- Forceful blow causing depression of shoulder \& lateral FX of the neck to the contralateral side, leading to traction of the upper roots of the brachial plexus\{\{nl\}\}- A direct blow to supraclavicular fossa or Orb's point causing a percussive injury\{\{nl\}\}- Head forced into hyperEXT, ipsilateral side FX towards trauma side → narrowing of intervertebral foramen at Cx spine, nerve root compression (common in high-level athletes) \tn 
% Row Count 49 (+ 21)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Bummer or Stinger* (cont)}}  \tn
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• {\bf{Clinical presentation:}} & - Immediate, acute traumatic onset of px/ \seqsplit{burning/paresthesia/pins} \& needles/weakness\{\{nl\}\}- Typically presents w/ Ssx circumferentially radiating down the arm\{\{nl\}\}- Reports recent Hx of trauma to the area\{\{nl\}\}- Common in young athletes competing in contact sports\{\{nl\}\}- Previous Hx of burners \tn 
% Row Count 14 (+ 14)
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• {\bf{Physical examination:}} & - Shacking of the upper extremity\{\{nl\}\}- Holding upper extremity close to their body\{\{nl\}\}- Atrophy or asymmetry in the neck\{\{nl\}\}- Shoulder depression\{\{nl\}\}- Atrophy of deltoid or supraspinatus\{\{nl\}\}- Altered motor patterns when using the shoulder\{\{nl\}\}- {\bf{Palpation:}} tenderness, muscle spasm, vertebral tenderness\{\{nl\}\}- {\bf{ROM:}} possible decrease in neck \& shoulder mobility\{\{nl\}\}- {\bf{Strength:}} deltoid (ABD), supraspinatus (ABD - full can), infraspinatus (ER), biceps (elbow FX), pronator teres (forearm pronation), triceps (elbow EXT), \& ADD digits minimi (ABD of 5th digit)\{\{nl\}\}- {\bf{Sensation:}} burning, paresthesia, pins \& needles (usually present circumferentially)\{\{nl\}\}- {\bf{Reflexes:}} triceps \& brachioradialis\{\{nl\}\}- {\bf{Special tests:}} Spurling's test \& Tinel test (supraclavicular fossa) \tn 
% Row Count 51 (+ 37)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Bummer or Stinger* (cont)}}  \tn
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• {\bf{Diagnosis:}} & - Usually through clinical examination \& past medical Hx\{\{nl\}\}- {\bf{EMG \& NCS:}} able to determine where the lesion is \& its severity\{\{nl\}\}- {\bf{X-rays:}} indicate or rule out bone injuries \tn 
% Row Count 9 (+ 9)
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• {\bf{Management:}} & - Length determined by severity of injury\{\{nl\}\}- For some recovery may take minutes, for other weeks to months\{\{nl\}\}- Commonly reoccur (up to 87\%) \tn 
% Row Count 16 (+ 7)
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• {\bf{Ddx:}} & - Necessary to rule out Cx \#, dislocation, or spinal cord injury\{\{nl\}\}{\bf{Alternative/associated Cx injuries inc:}}\{\{nl\}\}- Assessment \& management of concussion\{\{nl\}\}- Transient quadriplegia - B Ssx\{\{nl\}\}- Muscular strain/ligament strain - unlikely to have neurological involvement\{\{nl\}\}- Brachial neuritis - insidious onset\{\{nl\}\}- Radiculopathy - differences in acute presentation \tn 
% Row Count 34 (+ 18)
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\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.physio-pedia.com/Burners\_(Stingers)\_Syndrome"\}\}link text\{\{/popup\}\}}  \tn 
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\end{tabularx}
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\end{document}