Concluded Case

CASE of PLEURISY ;GASTRITIS .... ! Treated with NSAIDs & PPI

A. 47 years old woman complains of left arm pain radiating to chest and back no complain of shortness of breath pain increases during inspiration not responded to NSAIDs Heaviness in chest h/o behcets syndrome .. was on methotrexate 2.5mg DAILY TWICE FOR 4 days Vitals :- BP : 117/78 H.R :- 85 Spo2 :- 97% No h/o cardiac issues .. no h/o respiratory infections . T2DM + , HTN - , Diagnosis ? Findings in ECG & X RAY

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X ray is WNL. ECG NSR and shows poor R wave progression.adv trop i.review dose of Mtx,and treat symptomatically.

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POSSIBLY ..REFERRED. PAIN SECOMDARY. TO EITHER PNEUMONIA OR G I T. DISORDER DD CERVICAL.. SPONDYLOSIS NEEDS . FURTHER. EVALUATION

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CXR..STUDY.. LOOKS NORMAL.. ECG STUDY.. NSR .. ? MUSCULOSKELETAL PAIN.. ? NEUROPATHIC PAIN ..

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agree with @Ved Prakash Singh adv to cardiologist opinion Rx shunthi dhanyak fant for gas trouble Abhyadi qwath bd galo ghan tab 1bd panchsakar powder HS for 2 to 3 weeks.

Non specific chest pain Use buprenorphine dermal patch for analgesia

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Normal ECG and normal chest X Ray ? Muscular pain Adv Inj. Tramadol

@Dr. Jayesh Kalbhande case of pleurisy
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Cxr: Rt hillar lymphadenopathy with prominent bronchovascular margins, Ecg not so significant . May be PUS with anxiety with referred pain left arm & back. Adv: upper GIT endoscopy, Tab.Rabiprazole(40mg) od,Anxiolytic, to avoid spicy & fried foods ,heavy meals .

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X ray is WNL. ECG NSR and shows poor R wave progression.adv trop i.review dose of Mtx,and treat symptomatically.

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X ray chest: NAD ECG: WNL Non specific chest pain

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X Ray normal , ECG normal Cervical spondylosis ? Gastritis

Yes a case of cervical spondylosis & pleurisy / GASTRITIS ! Thank you doctor f
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ECG and X ray both normol There are many reasons why you might have pain in your left arm, including complications from arthritis and other chronic diseases. From a simple problem, here are a few possible causes: Bursitis Bursa is the fluid-filled sack between the bone and moving parts of a joint. When the bursa becomes inflamed, it’s called bursitis. Bursitis of the shoulder is often the result of repetitive movement. The risk of bursitis increases with age. The pain usually increases as you move or if you lie down on your arm or shoulder. You may not be able to fully rotate your shoulder. Other symptoms include burning and tingling. Herniated disk Disks are the pads between the bones in the spinal column. They’re the shock absorbers of your spine. A herniated disk in your neck is one that has ruptured and is pressing on the nerves. The pain may start in your neck. It may then move to your shoulder and down your arm. You may also feel numbness, tingling, or a burning sensation in your arm. Pain may increase when you move. Pinched nerve, or cervical radiculopathy A pinched nerve is one that’s compressed or inflamed. It can be a result of a herniated disk due to trauma or a wear-and-tear injury. Symptoms of a pinched nerve are similar to those of a herniated disk. They may include numbness, tingling, or a burning sensation in your arm. You may feel an increase in pain when you move. Sprains and strains A sprain is when you stretch or tear a ligament. An arm sprain can happen when you start to fall and brace yourself with your arms. A strain is when you twist or pull a tendon or muscle. It can happen when you lift something the wrong way or overstress your muscles. Tendinitis Tendons are the flexible bands of tissue that connect bones and muscles. When tendons are inflamed, it’s called tendinitis. Tendinitis of the shoulder or elbow could cause arm pain. The risk of tendinitis increases as you age. Symptoms of tendinitis are similar to symptoms of bursitis Vascular thoracic outlet syndrome This is a condition in which blood vessels under the collarbone are compressed due to trauma or repetitive injury. If left untreated, it can lead to progressive nerve damage. Vascular thoracic outlet syndrome may cause numbness, tingling, and weakness of your arm. In some cases, your arm can swell. Other signs include discoloration of the hand, cold hand or arm, and a weak pulse in the arm. Treatment:-For sprains and strains, elevate and rest your arm. Ice the area several times a day. Bandages or splints may be helpful. Physical therapy/occupational therapy, rest, and medication for pain and inflammation are the main treatments for: bursitis herniated disk pinched nerve rotator cuff tear tendinitis vascular thoracic outlet syndrome In some cases, corticosteroids or surgery may be necessary. Most of the time, arm pain due to injury will heal with proper rest and treatment. Some shoulder problems may take longer to heal, and some can get worse over time. Recovery time may be longer as you age.

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