Anatomy Notes Referred pain. Updated July 2. 00. Game Counter Strike Zombie Gratis'>Game Counter Strike Zombie Gratis. If you woke up with a pain in your shoulder, youd probably think something was wrong with your shoulder, rightMaybe you slept on it the wrong way, maybe youre a weekend warrior who threw the football a few too many times. In most cases, your hunch is probably right. Pain in the shoulder usually indicates an injury or disease that affects a structure in your shoulder, such as, say, your subacromial bursa or a rotator cuff tendon. Makes sense, doesnt itBut you might be way off. Sometimes the brain gets confused, making you think that one part of the body hurts, when in fact another part of the body, far removed from the pain, is the real source of trouble. This curious and clinically important phenomenon is known as referred pain. For example, its unlikely but possible that your shoulder pain is a sign of something insidious happening in your liver, gall bladder, stomach, spleen, lungs, or pericardial sac the connective tissue bag containing the heart. Strange, isnt it Conditions as diverse as liver abscesses, gallstones, gastric ulcers, splenic rupture, pneumonia, and pericarditis can all cause shoulder pain. How is that possibleNeuroscientists still dont know precisely which anatomical connections are responsible for referred pain, but the prevailing explanation seems to work pretty well. In a nutshell, referred pain happens when nerve fibers from regions of high sensory input such as the skin and nerve fibers from regions of normally low sensory input such as the internal organs happen to converge on the same levels of the spinal cord. The best known example is pain experienced during a heart attack. Nerves from damaged heart tissue convey pain signals to spinal cord levels T1 T4 on the left side, which happen to be the same levels that receive sensation from the left side of the chest and part of the left arm. The brain isnt used to receiving such strong signals from the heart, so it interprets them as pain in the chest and left arm. So what about that shoulder pain All of organs listed above bump up against the diaphragm, the thin, dome shaped muscle that moves up and down with every breath. The diaphragm is innervated by two phrenic nerves left and right, which emerge from spinal cord levels C3, C4, and C5 medical students remember these spinal cord levels using the mnemonic, C3, 4, 5 keeps the diaphragm alive. The phrenic nerves carry both motor and sensory impulses, so they make the diaphragm move and they convey sensation from the diaphragm to the central nervous system. Most of the time there isnt any sensation to convey from the diaphragm, at least at the conscious level. But if a nearby organ gets sick, it may irritate the diaphragm, and the sensory fibers of one of the phrenic nerves are flooded with pain signals that travel to the spinal cord at C3 C5. It turns out that C3 and C4 dont just keep the diaphragm alive neurons at these two spinal cord levels also receive sensation from the shoulders via the supraclavicular nerves. So when pain neurons at C3 and C4 sound the alarm, the brain assumes quite reasonably that the shoulder is to blame. Most Known Unknown Blogspot Search' title='Most Known Unknown Blogspot Search' />Most Known Unknown Blogspot LoginUsually thats a good assumption, but sometimes its wrong. Illustration showing sites of referred pain from abdominal organs. From Moore and Dalleys Clinically Oriented Anatomy. Please note that I added the tighty whities with Photoshop hey, this is a family friendly site. Another example that seems bizarre until you know the anatomy is disease in the stomach causing pain between the shoulder blades. A classmate told me that one of her college professors complained to his doctor about pain in his upper back that wouldnt go away. It turns out that the professor had gastric cancer, a relatively aggressive and often incurable disease unless its caught early. Unfortunately it wasnt caught early enough and it ended up taking his life. Maybe the outcome would have been different if the doctor had remembered that some of the nerve fibers to the stomach specifically, visceral afferents that travel in the greater splanchnic nerve convey pain signals to the same spinal cord levels especially T5 and T6 that receive pain signals from the skin between the shoulder blades. Games Midtown Madness 3 Full Version. This variety of referred pain is rare, but it happens often enough to be mentioned in anatomy textbooks. Not all cases of referred pain are easy to find in textbooks. Take the appendix, for instance. That wormy little appendage of the colon is usually located in the right lower quadrant of the belly, nowhere near the diaphragm. Typically people with appendicitis feel diffuse pain or discomfort around the belly button, or sharp pain in the right lower quadrant if the appendix is getting ready to burst. Bull Creek Rod and Gun club. Trap shooting, handgun and rifle ranges, archery range are just some of what out members enjoy. A private club. DOLLAR SHMOLLAR December 21, 2016 Whenever anything is repeated frequently enough, most people will end up believing it even if it is a preposterous concept. The Shakti Peethas holy places of cosmic power are places of worship consecrated to the goddess Shakti, the female principal of Hinduism and the main. Whether it was for purposes of sadism, anger, or some other unknown sociopathic proclivity, these are the 25 most notorious serial killers known to man. Unknown Ive always heard that Morrison still has stage fright after all these years and he s only effusive when well lubricated, which can put a show on one side. Our Father in heaven, hallowed be your name. Your Kingdom come, your will be done, on earth as in heaven. Give us today our daily bread. Forgive us our. Bow Narrows Camp is a fishing lodge on Red Lake, Ontario, Canada. Anglers fish for northern pike, walleye, lake trout, whitefish and ling or burbot. Most Known Unknown Blogspot' title='Most Known Unknown Blogspot' />But occasionally the pain refers to the right shoulder. Why Note that I said the appendix is usually located in right lower quadrant. Sometimes, early in embryological development, the colon doesnt rotate as much as it should, and the appendix ends up in the right upper quadrant or even on the left side of the belly. That malrotation isnt necessarily a problem for the patient until the appendix becomes swollen with infection, irritating both the diaphragm and the doctor who is trying to make a diagnosis So if your shoulder happens to hurt right now, should you be worrying about something bad in your belly Probably not. The most common causes of shoulder pain are, by far, musculoskeletal problems like osteoarthritis, adhesive capsulitis, and rotator cuff tendinitis. Often, with the help of taking it easy and a few rounds of ibuprofen, the pain goes away on its own. But if youre still concerned, make an appointment with your family physician. Red flags include more ominous symptoms like fever, unexplained weight loss, and pain in the left shoulder or scapular area that gets worse with exertion. Your doctor will want to know all about the pain. Was there a specific injury or did the pain come on slowly Does the pain occur without movement of the shoulder Can you make it worse with specific movements Are there any other symptoms or chronic medical problems The answers to these questions, along with a physical exam and appropriate imaging studies, will provide the information your doctor needs to understand the problem and create a treatment plan. The odds are good that the problem is relatively common and treatable. General Knowledge Questions 1. Which metal is heavier, silver or gold 2. How many legs do butterflies have 3. Which is the country with the most people A Little Glossary of Taylorspeke in no particular order plit popints n. Typo for plot points typed on a keyboard with more than half the characters worn off. Most Known Unknown Blogspot' title='Most Known Unknown Blogspot' />But if your doctor seems stumped, it wouldnt hurt to ask, Is there any chance this could be referred pain. 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