Atlas of Common Pain Syndromes

571 Pages·2018·92.148 MB·English

by  Steven D. Waldman

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2015v1.0
Fourth Edition

Atlas of
COMMON PAIN
SYNDROMES
Steven D. Waldman, MD, JD
Clinical Professor of Anesthesiology
Professor of Medical Humanities and Bioethics
University of Missouri-Kansas City School of Medicine
Kansas City, Missouri
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
ATLAS OF COMMON PAIN SYNDROMES, FOURTH EDITION ISBN: 978-0-323-54731-4
Copyright © 2019 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information
or methods they should be mindful of their own safety and the safety of others, including parties for
whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration,
and contraindications. It is the responsibility of practitioners, relying on their own experience and
knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
any liability for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
Previous editions copyrighted 2012, 2008, and 2002.
Library of Congress Cataloging-in-Publication Data
Names: Waldman, Steven D., author.
Title: Atlas of common pain syndromes / Steven D. Waldman.
Description: Fourth edition. | Philadelphia, PA : Elsevier, [2019] | Includes bibliographical references
and index.
Identifiers: LCCN 2018001816 | ISBN 9780323547314 (hardcover : alk. paper)
Subjects: | MESH: Pain | Syndrome | Atlases
Classification: LCC RB127 | NLM WL 17 | DDC 616/.0472–dc23
LC record available at https://lccn.loc.gov/2018001816
Content Strategist: Michael Houston
Content Development Specialist: Kathryn DeFrancesco
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Rachel E. McMullen
Design Direction: Ryan Cook
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
P R E FAC E
Recently, a medical student told me that, after several weeks Finally, a second-year medical student suggested that perhaps
of being really sick and being treated for myriad respiratory all this coughing was the result of whooping cough, which
ills, she was finally diagnosed with pertussis. Now keep in the student had just read about in her medical microbiology
mind that we are located in Kansas City, not Bangladesh. In class. At first, everyone laughed and rolled their eyes… two
trying to figure out what went wrong in the care of my student, beats… silence, and then… the correct diagnosis was made.
I asked her several questions: “Were you immunized as a You may be wondering why I include this story in the
child?” Yes. “Had you recently traveled abroad?” No. “What preface to a book about pain management. It seems to me
was the pertussis like?” Horrible! that we, as medical practitioners, tend to limit ourselves to
Having never seen a case of pertussis, I then asked the most specific, personalized constructs that we devise to simplify the
obvious question. “How was it diagnosed?” The student initially diagnosis of painful conditions. Within these constructs are
thought that she had picked up a bad case of bronchitis on the frequent admonition against hunting for zebras when ever
her pediatrics rotation. She took a Z-Pak without improve- we hear hoof beats and pressures to move toward the center
ment and then completed a course of moxifloxacin. She went of the bell curve, to cleave to evidence-based medicine, etc.
to the student health service on two separate occasions, and However, if taken to extremes, these parameters severely limit
both times the doctor concurred with the working diagnosis how we process our patients’ histories as well as the scope of
of bronchitis or early pneumonia. A subsequent trip to the our diagnoses. It is my hope that the fourth edition of Atlas
local emergency department yielded the same diagnosis. Her of Common Pain Syndromes will help clinicians recognize,
admitting diagnosis to the intensive care unit late one night diagnose, and treat painful conditions they otherwise would
was for respiratory failure. Antibiotics were given, and breath- not have even thought of, and as a result, provide more effec-
ing treatments administered, yet diagnosis remained elusive. tive care for their patients who are in pain.
iii
AC K N OW L E D G M E N T
I want to give a special thanks to my editors at Elsevier, Michael Houston and Kathryn DeFrancesco,
for their keen insights, great advice, and amazing work ethic.
Steven D. Waldman, MD, JD
iv
C O N T E N T S
SECTION I: Headache Pain Syndromes SECTION V: Elbow Pain Syndromes
1. Acute Herpes Zoster of the First Division of the 37. Arthritis Pain of the Elbow, 146
Trigeminal Nerve, 1 38. Tennis Elbow, 149
2. Migraine Headache, 6 39. Golfer’s Elbow, 153
3. Tension-Type Headache, 10 40. Distal Biceps Tendon Tear, 157
4. Cluster Headache, 14 41. Thrower’s Elbow, 161
5. Swimmer’s Headache, 18 42. Anconeus Syndrome, 167
6. Analgesic Rebound Headache, 22 43. Supinator Syndrome, 171
7. Occipital Neuralgia, 25 44. Brachioradialis Syndrome, 175
8. Pseudotumor Cerebri, 28 45. Ulnar Nerve Entrapment at the Elbow, 178
9. Intracranial Subarachnoid Hemorrhage, 32 46. Lateral Antebrachial Cutaneous Nerve Entrapment at
the Elbow, 181
47. Osteochondritis Dissecans of the Elbow, 184
SECTION II: Facial Pain Syndromes
48. Olecranon Bursitis, 187
10. Trigeminal Neuralgia, 37
11. Temporomandibular Joint Dysfunction, 42 SECTION VI: Wrist Pain Syndromes
12. Atypical Facial Pain, 47
49. Arthritis Pain of the Wrist, 191
13. Hyoid Syndrome, 50
50. Carpal Tunnel Syndrome, 195
14. Reflex Sympathetic Dystrophy of the Face, 54
51. Flexor Carpi Ulnaris Tendinitis, 200
52. de Quervain’s Tenosynovitis, 204
53. Arthritis Pain at the Carpometacarpal Joints, 208
SECTION III: Neck and Brachial Plexus Pain
54. Ganglion Cysts of the Wrist, 212
Syndromes
15. Cervical Facet Syndrome, 57 SECTION VII: Hand Pain Syndromes
16. Cervical Radiculopathy, 60
17. Fibromyalgia of the Cervical Musculature, 64 55. Trigger Thumb, 217
18. Cervical Strain, 67 56. Trigger Finger, 220
19. Longus Colli Tendinitis, 71 57. Sesamoiditis of the Hand, 224
20. Retropharyngeal Abscess, 75 58. Plastic Bag Palsy, 228
21. Cervicothoracic Interspinous Bursitis, 79 59. Carpal Boss Syndrome, 231
22. Brachial Plexopathy, 82 60. Dupuytren’s Contracture, 236
23. Pancoast’s Tumor Syndrome, 86
24. Thoracic Outlet Syndrome, 92 SECTION VIII: Chest Wall Pain Syndromes
61. Costosternal Syndrome, 239
SECTION IV: Shoulder Pain Syndromes
62. Manubriosternal Syndrome, 242
63. Intercostal Neuralgia, 246
25. Arthritis Pain of the Shoulder, 97
64. Diabetic Truncal Neuropathy, 250
26. Acromioclavicular Joint Pain, 101
65. Tietze’s Syndrome, 254
27. Subdeltoid Bursitis, 105
66. Precordial Catch Syndrome, 257
28. Bicipital Tendinitis, 109
67. Fractured Ribs, 260
29. Avascular Necrosis of the Glenohumeral Joint, 113
68. Postthoracotomy Pain Syndrome, 264
30. Adhesive Capsulitis of the Shoulder, 116
31. Biceps Tendon Tear, 121
32. Supraspinatus Syndrome, 126 SECTION IX: Thoracic Spine Pain Syndromes
33. Rotator Cuff Tear, 129
34. Deltoid Syndrome, 134 69. Acute Herpes Zoster of the Thoracic Dermatomes, 268
35. Teres Major Syndrome, 138 70. Costovertebral Joint Syndrome, 272
36. Scapulocostal Syndrome, 142 71. Postherpetic Neuralgia, 275
v
vi CONTENTS
72. Nephrolithiasis, 278 102. Meralgia Paresthetica, 399
73. Thoracic Vertebral Compression Fracture, 282 103. Phantom Limb Pain, 403
104. Trochanteric Bursitis, 407
SECTION X: Abdominal and Groin Pain
SECTION XIV: Knee and Distal Lower
Syndromes
Extremity Pain Syndromes
74. Acute Pancreatitis, 286
75. Chronic Pancreatitis, 290 105. Arthritis Pain of the Knee, 412
76. Irritable Bowel Syndrome, 294 106. Avascular Necrosis of the Knee Joint, 415
77. Anterior Cutaneous Nerve Entrapment, 298 107. Medial Collateral Ligament Syndrome, 420
78. Diverticulitis, 303 108. Medial Meniscal Tear, 425
79. Acute Appendicitis, 306 109. Anterior Cruciate Ligament Syndrome, 430
80. Ilioinguinal Neuralgia, 311 110. Jumper’s Knee, 435
81. Genitofemoral Neuralgia, 314 111. Runner’s Knee, 440
112. Suprapatellar Bursitis, 445
113. Prepatellar Bursitis, 449
SECTION XI: Lumbar Spine and Sacroiliac 114. Superficial Infrapatellar Bursitis, 453
115. Deep Infrapatellar Bursitis, 456
Joint Pain Syndromes
116. Osgood-Schlatter Disease, 459
82. Lumbar Radiculopathy, 317 117. Baker’s Cyst of the Knee, 464
83. Latissimus Dorsi Syndrome, 321 118. Pes Anserine Bursitis, 468
84. Spinal Stenosis, 324 119. Common Peroneal Nerve Entrapment, 472
85. Arachnoiditis, 328 120. Tennis Leg, 476
86. Discitis, 332
87. Sacroiliac Joint Pain, 337
SECTION XV: Ankle Pain Syndromes
121. Arthritis Pain of the Ankle, 480
SECTION XII: Pelvic Pain Syndromes
122. Arthritis of the Midtarsal Joints, 484
123. Deltoid Ligament Strain, 487
88. Osteitis Pubis, 342
124. Anterior Tarsal Tunnel Syndrome, 492
89. Gluteus Maximus Syndrome, 346
125. Posterior Tarsal Tunnel Syndrome, 496
90. Piriformis Syndrome, 350
126. Achilles Tendinitis, 500
91. Ischiogluteal Bursitis, 355
127. Achilles Tendon Rupture, 503
92. Endometriosis, 358
93. Pelvic Inflammatory Disease, 363
94. Interstitial Cystitis, 368 SECTION XVI: Foot Pain Syndromes
95. Testicular Torsion, 371
96. Levator Ani Syndrome, 374 128. Arthritis Pain of the Toes, 507
97. Coccydynia, 378 129. Bunion Pain, 510
130. Morton’s Neuroma, 513
131. Intermetatarsal Bursitis, 516
SECTION XIII: Hip and Lower Extremity Pain 132. Freiberg Disease, 521
Syndromes 133. Plantar Fasciitis, 525
134. Sesamoiditis, 529
98. Arthritis Pain of the Hip, 383 135. Calcaneal Spur Syndrome, 534
99. Snapping Hip Syndrome, 387 136. Mallet Toe, 538
100. Iliopectineal Bursitis, 391 137. Hammer Toe, 541
101. Ischial Bursitis, 395
SECTION I Headache Pain Syndromes
1
Acute Herpes Zoster of the First Division of
the Trigeminal Nerve
ICD-10 CODE B02.22 Ramsay Hunt syndrome and must be distinguished from acute
herpes zoster involving the first division of the trigeminal
nerve.
THE CLINICAL SYNDROME
Herpes zoster is an infectious disease caused by the varicella-
SIGNS AND SYMPTOMS
zoster virus (VZV). Primary infection with VZV in a nonim-
mune host manifests clinically as the childhood disease As viral reactivation occurs, ganglionitis and peripheral neuritis
chickenpox (varicella). Investigators have postulated that cause pain that may be accompanied by flulike symptoms.
during the course of this primary infection, the virus migrates The pain generally progresses from a dull, aching sensation
to the dorsal root or cranial ganglia, where it remains dormant to dysesthetic or neuritic pain in the distribution of the first
and produces no clinically evident disease. In some individu- division of the trigeminal nerve. In most patients, the pain
als, the virus reactivates and travels along the sensory pathways of acute herpes zoster precedes the eruption of rash by 3 to
of the first division of the trigeminal nerve, where it produces 7 days, and this delay often leads to an erroneous diagnosis
the characteristic pain and skin lesions of herpes zoster, or (see “Differential Diagnosis”). However, in most patients,
shingles. the clinical diagnosis of shingles is readily made when the
Why reactivation occurs in some individuals but not in characteristic rash appears. As with chickenpox, the rash of
others is not fully understood, but investigators have theorized herpes zoster appears in crops of macular lesions that rapidly
that a decrease in cell-mediated immunity may play an impor- progress to papules and then to vesicles (Fig. 1.2). Eventu-
tant role in the evolution of this disease by allowing the virus ally, the vesicles coalesce, and crusting occurs (Fig. 1.3). The
to multiply in the ganglia, spread to the corresponding sensory affected area can be extremely painful, and the pain tends
nerves, and produce clinical disease. Patients who are suffering to be exacerbated by any movement or contact (e.g., with
from malignant disease (particularly lymphoma) or chronic clothing or sheets). As the lesions heal, the crust falls away,
disease and those receiving immunosuppressive therapy (che- leaving pink scars that gradually become hypopigmented and
motherapy, steroids, radiation) are generally debilitated and atrophic.
thus are much more likely than the healthy population to In most patients, the hyperesthesia and pain resolve as the
develop acute herpes zoster. These patients all have in common skin lesions heal. In some patients, however, pain persists
a decreased cell-mediated immune response, which may also beyond lesion healing. This common and feared complication
explain why the incidence of shingles increases dramatically of acute herpes zoster is called postherpetic neuralgia, and
in patients older than 60 years and is relatively uncommon older persons are affected at a higher rate than is the general
in those younger than 20 years. population suffering from acute herpes zoster (Fig. 1.4). The
The first division of the trigeminal nerve is the second most symptoms of postherpetic neuralgia can vary from a mild,
common site for the development of acute herpes zoster, after self-limited condition to a debilitating, constantly burning
the thoracic dermatomes. Rarely, the virus attacks the genicu- pain that is exacerbated by light touch, movement, anxiety,
late ganglion and results in hearing loss, vesicles in the ear, or temperature change. This unremitting pain may be so severe
and pain (Fig. 1.1). This constellation of symptoms is called that it completely devastates the patient’s life; ultimately, it
1
2 SECTION I Headache Pain Syndromes
FIG 1.3 Acute herpes zoster involving the ophthalmic division

of the left trigeminal nerve. (From Waldman SD. Pain manage-
ment. Philadelphia: Elsevier; 2007.)
FIG 1.1 Ramsay Hunt syndrome.

FIG 1.4 Age of patients suffering from acute herpes zoster.

TESTING
Although in most instances the diagnosis is easily made on
clinical grounds, confirmatory testing is occasionally required.
Such testing may be desirable in patients with other skin
lesions that confuse the clinical picture, such as in patients
with acquired immunodeficiency syndrome who are suffering
from Kaposi sarcoma. In such patients, polymerase chain
reaction testing and immunofluorescent antibody testing can
rapidly identify herpes zoster virus and distinguish it from
herpes simplex infections (Fig. 1.5). In uncomplicated cases,
the diagnosis of acute herpes zoster may be strengthened by
obtaining a Tzanck smear from the base of a fresh vesicle; this
smear reveals multinucleated giant cells and eosinophilic
FIG 1.2 The pain of acute herpes zoster of the trigeminal inclusions (Fig. 1.6). However, this inexpensive bedside test

nerve often precedes the characteristic vesicular rash. does not have the ability to distinguish between lesions caused
by the varicella-zoster virus and herpes simplex infections.
can lead to suicide. To avoid this disastrous sequela to a usually
DIFFERENTIAL DIAGNOSIS
benign, self-limited disease, the clinician must use all possible
therapeutic efforts in patients with acute herpes zoster of the A careful initial evaluation, including a thorough history and
trigeminal nerve. physical examination, is indicated in all patients suffering