A case report of a patient with upper extremity symptoms: differentiating radicular and referred pain

<p>Abstract</p> <p>Background</p> <p>Similar upper extremity symptoms can present with varied physiologic etiologies. However, due to the multifaceted nature of musculoskeletal conditions, a definitive diagnosis using physical examination and advanced testing is not always possible. This report discusses the diagnosis and case management of a patient with two episodes of similar upper extremity symptoms of different etiologies.</p> <p>Case Presentation</p> <p>On two separate occasions a forty-four year old female patient presented to a chiropractic office with a chief complaint of insidious right-sided upper extremity symptoms. During each episode she reported similar pain and parasthesias from her neck and shoulder to her lateral forearm and hand.</p> <p>During the first episode the patient was diagnosed with a cervical radiculopathy. Conservative treatment, including manual cervical traction, spinal manipulation and neuromobilization, was initiated and resolved the symptoms.</p> <p>Approximately eighteen months later the patient again experienced a severe acute flare-up of the upper extremity symptoms. Although the subjective complaint was similar, it was determined that the pain generator of this episode was an active trigger point of the infraspinatus muscle. A diagnosis of myofascial referred pain was made and a protocol of manual trigger point therapy and functional postural rehabilitative exercises improved the condition.</p> <p>Conclusion</p> <p>In this case a thorough physical evaluation was able to differentiate between radicular and referred pain. By accurately identifying the pain generating structures, the appropriate rehabilitative protocol was prescribed and led to a successful outcome for each condition. Conservative manual therapy and rehabilitative exercises may be an effective treatment for certain cases of cervical radiculopathy and myofascial referred pain.</p

What the ‘Moonwalk’ Illusion Reveals about the Perception of Relative Depth from Motion

When one visual object moves behind another, the object farther from the viewer is progressively occluded and/or disoccluded by the nearer object. For nearly half a century, this dynamic occlusion cue has beenthought to be sufficient by itself for determining the relative depth of the two objects. This view is consistent with the self-evident geometric fact that the surface undergoing dynamic occlusion is always farther from the viewer than the occluding surface. Here we use a contextual manipulation ofa previously known motion illusion, which we refer to as the‘Moonwalk’ illusion, to demonstrate that the visual system cannot determine relative depth from dynamic occlusion alone. Indeed, in the Moonwalk illusion, human observers perceive a relative depth contrary to the dynamic occlusion cue. However, the perception of the expected relative depth is restored by contextual manipulations unrelated to dynamic occlusion. On the other hand, we show that an Ideal Observer can determine using dynamic occlusion alone in the same Moonwalk stimuli, indicating that the dynamic occlusion cue is, in principle, sufficient for determining relative depth. Our results indicate that in order to correctly perceive relative depth from dynamic occlusion, the human brain, unlike the Ideal Observer, needs additionalsegmentation information that delineate the occluder from the occluded object. Thus, neural mechanisms of object segmentation must, in addition to motion mechanisms that extract information about relative depth, play a crucial role in the perception of relative depth from motion

Interactions between spatial and spatiotemporal information in spatiotemporal boundary formation

The surface and boundaries of an object generally move in unison, so the motion of a surface could provide information about the motion of its boundaries. Here we report the results of three experiments on spatiotemporal boundary formation that indicate that information about the motion of a surface does influence the formation of its boundaries. In Experiment 1, shape identification at low texture densities was poorer for moving forms in which stationary texture was visible inside than for forms in which the stationary texture was visible only outside. In Experiment 2, the disruption found in Experiment 1 was removed by adding a second external boundary. We hypothesized that the disruption was caused by boundary assignment that perceptually grouped the moving boundary with the static texture. Experiment 3 revealed that accurate information about the motion of the surface facilitated boundary formation only when the motion was seen as coming from the surface of the moving form. Potential mechanisms for surface motion effects in dynamic boundary formation are discussed

1,050 years of Hurricane Strikes on Long Island in The Bahamas

Sedimentary records of past hurricane activity indicate centennial-scale periods over the past millennium with elevated hurricane activity. The search for the underlying mechanism behind these active hurricane periods is confounded by regional variations in their timing. Here, we present a new high resolution paleohurricane record from The Bahamas with a synthesis of published North Atlantic records over the past millennium. We reconstruct hurricane strikes over the past 1,050 years in sediment cores from a blue hole on Long Island in The Bahamas. Coarse-grained deposits in these cores date to the close passage of seven hurricanes over the historical interval. We find that the intensity and angle of approach of these historical storms plays an important role in inducing storm surge near the site. Our new record indicates four active hurricane periods on Long Island that conflict with published records on neighboring islands (Andros and Abaco Island). We demonstrate these three islands do not sample the same storms despite their proximity, and we compile these reconstructions together to create the first regional compilation of annually resolved paleohurricane records in The Bahamas. Integrating our Bahamian compilation with compiled records from the U.S. coastline indicates basin-wide increased storminess during the Medieval Warm Period. Afterward, the hurricane patterns in our Bahamian compilation match those reconstructed along the U.S. East Coast but not in the northeastern Gulf of Mexico. This disconnect may result from shifts in local environmental conditions in the North Atlantic or shifts in hurricane populations from straight-moving to recurving storms over the past millennium

Infants' perception of object trajectories.

Filling in the gaps in what humans see is a fundamental perceptual skill, but little is known about the developmental origins of occlusion perception. Three experiments were conducted with infants between 2 and 6 months of age to investigate perception of the continuity of an object trajectory that was briefly occluded. The pattern of results across experiments provided little evidence of veridical responses to trajectory occlusion in the youngest infants, but by 6 months, perceptual completion was more robust. Four–month–olds’ responses indicated that they perceived continuity under a short duration of occlusion, but when the object was out of sight for a longer interval, they appeared to perceive the trajectory as discontinuous. These results suggest that perceptual completion of a simple object trajectory (and, by logical necessity, veridical object perception) is not functional at birth but emerges across the first several months after onset of visual experience

A Primary Care Musculoskeletal Clinic for Residents: Success and Sustainability

Musculoskeletal complaints are common, but are often underemphasized in residency training. We evaluated the experience of residents (12) in 4 sessions of an innovative concentrated ambulatory, community-based musculoskeletal (MS) clinic precepted by general internists with additional training in teaching MS medicine. Compared with the yearlong longitudinal house staff (HS) clinic experience, the mean number of musculoskeletal diagnoses per resident seen in MS clinic was higher (13.9 [standard deviation 4.0] vs 5.4 [standard deviation 4.0]; P < .01). Common diagnoses in MS clinic included shoulder, hip, and knee tendonitis/bursitis, and the majority of diagnoses in HS clinic were nonspecific arthralgia (66%). Fifty-two injections were performed in MS clinic over the year, compared with one in HS clinic