ABSTRACT
Upper extremity pain can result from many overlapping etiologies. These can be categorized into anatomic regions and specific organ systems. Anatomically, pain etiologies are classified into four major groups: neurologic, musculoskeletal, vascular, and other (eg, tumor, infection). Knowledge of the characteristic clinical presentation and physical examination findings of each group can help distinguish the source of the patient's complaints quickly so that an accurate clinical diagnosis can facilitate appropriate diagnostic measures and treatment. A focus on the neurologic causes of upper extremity pain (ie, cervical spine pathology, peripheral nerve compression, neuropathy) and musculoskeletal causes of shoulder and elbow pain (eg, adhesive capsulitis, calcific tendinitis, biceps tendinitis, synovitis) and the distinguishing characteristics (eg, periscapular pain, two-point discrimination, signal intensity on T2-weighted MRI) helps determine the appropriate diagnosis.
Subject(s)
Arthralgia/diagnosis , Musculoskeletal Pain/diagnosis , Physical Examination , Upper Extremity , Arthralgia/etiology , Diagnosis, Differential , Humans , Musculoskeletal Pain/etiologyABSTRACT
Non healing wounds present a significant social and economic burden. Chronic non healing wounds are estimated to affect as many as 1-2% of individuals during their lifetime, and account for billions of dollars of expense annually on both a national and global basis. Our purpose is to describe the use of a novel dehydrated amniotic membrane allograft (EpiFix(®) ; MiMedx Group, Inc., Kennesaw, GA) for the treatment of chronic non healing wounds. We describe the results of EpiFix treatment in four patients who had not achieved wound closure with both conservative and advanced measures, and had been referred for a definitive plastic surgery procedure. Healing was observed in a variety of wounds with one to three applications of the dehydrated amniotic membrane material. The material was well tolerated by patients. Healed wounds did not recur in long-term follow-up. Further investigation of the use of dehydrated amniotic membrane in broader application to various types of dermal wounds should be considered.
