מתוך medicontexr.co.il
WESTPORT, CT (Reuters Health) – Trigeminal distribution lesions apparently caused shoulder pain in a 73-year-old man, according to a case report in the November 13th issue of Neurology. Denervation of the infected tooth through root canal relieved the pain.
Dr. Emile Hiesiger and Dr. Darren Orbach, from New York University Medical Center in New York City, report that the man presented with a progressively severe right shoulder pain that had developed over 6 months. He reported no associated neck pain or headache and no other complaints except a 3-year history of vague tooth discomfort on the right side.
MRI of the shoulder showed a partial-thickness tear of the supraspinatus tendon. Physical therapy resulted in minimal improvement for 2 weeks, but the pain recurred at the same severity.
Dental x-rays performed 5 months after the onset of shoulder pain showed a lucency in the right upper premolar. The tooth was denervated through root canal and the patient experienced immediate and complete abolition of pain. Six months after the procedure, the patient was still pain-free.
"One possible explanation is referral of pain from neurons in the caudal aspect of the spinal trigeminal nucleus…to sensory afferents in Lissauer's tract of the cervical cord," Drs. Hiesiger and Orbach suggest.
Another possibility, they note, is that the tooth pain may have been referred to afferents from the trapezius or the sternocleidomastoid through the spinal accessory nerve.
"Alternatively, pain in the trigeminal distribution may have triggered a reflex cervical muscle spasm…culminating in shoulder pain," they add. "Thus, what might have been subclinical pain from the supraspinatus tear itself was possibly amplified by either referred trigeminal pain or trigeminally induced neck spasm."
e-Med Tools
קצר קולע וממוקד
e-Med סמינרים
אי-מד תחקירים
Medscape Tools
Journal Club
מרכזי מידע ושירות
Facebook
מידע למפרסם
מאגר תרופות
מאגר אנשי המקצוע
אינדקס שימושי
חדשות משה"ב
eMed HealthClub
מחקרים קליניים
השאירו תגובה
רוצה להצטרף לדיון?תרגישו חופשי לתרום!