Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a terrifying event. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Many people who go through traumatic events have difficulty adjusting and coping for a while. But with time and taking care of yourself, such traumatic reactions usually get better. In some cases, though, the symptoms can get worse or last for months or even years. Sometimes they may completely shake up your life. In a case such as this, you may have post-traumatic stress disorder.

Getting treatment as soon as possible after post-traumatic stress disorder symptoms develop may prevent long-term post-traumatic stress disorder.

Post Traumatic Stress Disorder -- Mayo Clinic - http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246

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Postpolio Syndrome Accepted criteria for diagnosis of postpolio syndrome (PPS) are a prior history of poliomyelitis, a stable period after recovery, a residual deficit of the initial polio, new muscle weakness, and, sometimes, new muscle atrophy. Fatigue and muscle pain need not be present to meet the criteria for the syndrome.

One possible cause of PPS is decompensation of a chronic denervation and reinnervation process to the extent that the remaining healthy motor neurons can no longer maintain new sprouts; thus, denervation exceeds reinnervation.

A second possible mechanism for PPS is motor neuronal loss due to reactivation of a persistent latent virus. In addition to muscle atrophy and denervation, foci of perivascular and interstitial inflammatory cells have been found on 50% of biopsies of patients with PPS. Activated T cells and immunoglobulin M and immunoglobulin G antibodies specific for gangliosides also have been found.

Another possibility is an infection of the polio survivor's motor neurons by an enterovirus that is different from the one responsible for the patient's polio. Others sources hypothesize that PPS is merely the loss of strength due to the usual stresses of aging and weight gain. In patients with PPS, these processes occur in muscles that already are weak, so the consequences are more noticeable compared with those of patients who have not had polio.

For more information, please see http://www.emedicine.com/PMR/topic110.htm

Postpolio Syndrome – – Post-Polio Health International – http://www.post-polio.org/

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Nondermatomal Paresthesia or aching pain in one or both arms may occur as a result of a whiplash injury to the neck.  The term “whiplash is not a medical diagnosis, but is the result of soft-tissue trauma to the neck.  A whiplash injury occurs as a result of a sudden acceleration or deceleration of the head and neck, the cervical spine.  Whiplash injury could cause symptoms lasting for several years after the initial trauma.

For more information, please see www.springerlink.com/index/F36323H0345N142Q.pdf

Nondermatomal Paresthesia – – Paresthesia.net – http://www.paresthesia.net/

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Osteoarthritis (OA) is a chronic disease process affecting synovial joints, particularly large weight-bearing joints. OA is particularly common in older patients but can occur in younger patients either through a genetic mechanism or, more commonly, because of previous joint trauma.

Joints can be classified as synovial, fibrous, or combination joints, based on the presence or absence of a synovial membrane and the amount of motion that occurs in the joint. Normal synovial joints allow a significant amount of motion along their extremely smooth articular surface. These joints are comprised of a synovial membrane, articular or hyaline cartilage, subchondral bone, synovial fluid, and a joint capsule.

Although traditional teaching prescribes that OA affects primarily the articular cartilage of synovial joints, pathophysiologic changes also occur in the synovial fluid, as well as in the underlying (subchondral) bone and overlying joint capsule. The affected cartilage initially develops small tears, known as fibrillations, at the articular surface, followed by larger tears; the cartilage eventually fragments off into joints. The cartilage-forming cells (ie, chondrocytes) replicate in an attempt to keep up with the cartilage loss; however, they eventually are unable to do so, and the underlying bone becomes exposed because of gross areas of bone denuded of cartilage.

The osteoarthritic joint is characterized by decreased concentration of hyaluronic acid because of reduced production by synoviocytes and increased water content because of inflammation, particularly during later stages of the disease.

Pain is usually of insidious onset, is generally described as aching or throbbing, and may result from changes that have occurred over the last 15-20 years. Most often, the pain is worse with activity involving the affected joint and is initially relieved with rest; eventually pain occurs even at rest. Since cartilage itself is not innervated, the pain is presumed to be from a combination of mechanisms, including (1) osteophytic periosteal elevation, (2) vascular congestion of subchondral bone leading to increased intraosseous pressure, (3) synovitis with activation of synovial membrane nociceptors, (4) fatigue of muscles that cross the joint, and (5) overall joint contracture.

In addition to the underlying pathophysiologic changes described above, overall, the joint may undergo mechanical deformation with resultant malalignment and instability. Alternatively, the joint can ankylose.

For more information, please see http://www.emedicine.com/PMR/topic93.htm

Osteoarthritis – – Mayo Clinic – http://www.mayoclinic.com/health/osteoarthritis/DS00019

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Myofascial Pain Syndrome and fibromyalgia may coexist, presenting a complex clinical picture; however, fibromyalgia and myofascial pain syndrome are not one and the same condition. Fibromyalgia is a generalized amplification of pain or hypersensitivity condition and is associated with tender points in the muscles. Tender points are focal areas of muscle tissue that are exquisitely tender to compression. The tender points of fibromyalgia are painful locally at the site where the pressure is applied, without referred pain to distant areas.

By contrast, myofascial pain syndrome is considered in the narrow definition to be a disorder of trigger points. Similar to tender points, trigger points also are discreet areas in muscle tissue and/or its associated fascia that are exquisitely tender to compression; however, unlike tender points, when pressure is applied to the trigger point, pain occurs not only at the site of the applied pressure, but also at a distant site (zone of pain referral). Trigger points are found in taut bands (firm elongated bands) within the muscle fibers and are associated with the local twitch response. This local twitch response is an involuntary transient contraction of the taut band muscle fibers and can be elicited by snapping or pinching the taut band. Some authors assert that both disorders (fibromyalgia and myofascial pain syndrome) can magnify and perpetuate the symptoms of the other.

For more information, please see http://www.emedicine.com/PMR/topic84.htm

Myofascial Pain Syndrome – – International MYOPAIN Society – http://www.myopain.org/

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