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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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In the common presentation of acute low back pain, pain develops after movements that involve lifting, twisting, or forward-bending. The symptoms may start soon after the movements or upon waking up the following morning. The description of the symptoms may range from tenderness at a particular point to diffuse pain. It may or may not worsen with certain movements, such as raising a leg, or positions, such as sitting or standing. Pain radiating down the legs (known as sciatica) may be present. The first experience of acute low back pain is typically between the ages of 20 and 40. This is often a person's first reason to see a medical professional as an adult. Recurrent episodes occur in more than half of people with the repeated episodes being generally more painful than the first.
Other problems may occur along with low back pain. Chronic low back pain is associated with sleep problems, including a greater amount of time needed to fall asleep, disturbances during sleep, a shorter duration of sleep, and less satisfaction with sleep. In addition, a majority of those with chronic low back pain show symptoms of depression or anxiety.
Back pain may be classified by various methods to aid its diagnosis and management. The duration of back pain is considered in three categories, following the expected pattern of healing of connective tissue. Acute pain lasts up to 12 weeks, subacute pain refers to the second half of the acute period (6 to 12 weeks), and chronic pain is pain which persists beyond 12 weeks.
Back pain is pain in any region of the back. It is divided into neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia (tailbone or sacral pain) based on the segment affected. The lumbar area is the most common area for pain, as it supports most of the weight in the upper body. Episodes of back pain may be acute, sub-acute, or chronic depending on the duration. The pain may be characterized as a dull ache, shooting or piercing pain, or a burning sensation. Discomfort can radiate into the arms and hands as well as the legs or feet, and may include numbness, or weakness in the legs and arms.
Back pain can originate from the muscles, nerves, bones, joints or other structures in the spine. Internal structures such as the gallbladder, pancreas, aorta, and kidneys may also cause referred pain in the back.
Back pain is common, with about nine out of ten adults experiencing it at some point in their life, and five out of ten working adults having it every year. Some estimate up to 95% of Americans will experience back pain at some point in their lifetime. It is the most common cause of chronic pain, and is a major contributor of missed work and disability. However, it is rare for back pain to be permanently disabling. In most cases of herniated disks and stenosis, rest, injections or surgery have similar general pain resolution outcomes on average after one year. In the United States, acute low back pain is the fifth most common reason for physician visits and causes 40% of missed days off work. Additionally, it is the single leading cause of disability worldwide.
There are a number of ways to classify low back pain with no consensus that any one method is best. There are three general types of low back pain by cause: mechanical back pain (including nonspecific musculoskeletal strains, herniated discs, compressed nerve roots, degenerative discs or joint disease, and broken vertebra), non-mechanical back pain (tumors, inflammatory conditions such as spondyloarthritis, and infections), and referred pain from internal organs (gallbladder disease, kidney stones, kidney infections, and aortic aneurysm, among others). Mechanical or musculoskeletal problems underlie most cases (around 90% or more), and of those, most (around 75%) do not have a specific cause identified, but are thought to be due to muscle strain or injury to ligaments. Rarely, complaints of low back pain result from systemic or psychological problems, such as fibromyalgia and somatoform disorders.
Low back pain may be classified based on the signs and symptoms. Diffuse pain that does not change in response to particular movements, and is localized to the lower back without radiating beyond the buttocks, is classified as "nonspecific", the most common classification. Pain that radiates down the leg below the knee, is located on one side (in the case of disc herniation), or is on both sides (in spinal stenosis), and changes in severity in response to certain positions or maneuvers is "radicular", making up 7% of cases. Pain that is accompanied by red flags such as trauma, fever, a history of cancer or significant muscle weakness may indicate a more serious underlying problem and is classified as "needing urgent or specialized attention".
The symptoms can also be classified by duration as acute, sub-chronic (also known as sub-acute), or chronic. The specific duration required to meet each of these is not universally agreed upon, but generally pain lasting less than six weeks is classified as "acute", pain lasting six to twelve weeks is "sub-chronic", and more than twelve weeks is "chronic". Management and prognosis may change based on the duration of symptoms.
Orchialgia is long-term pain of the testes. It is considered chronic if it has persisted for more than 3 months. Orchialgia may be caused by injury, infection, surgery, cancer or testicular torsion and is a possible complication after vasectomy. IgG4-related disease is a more recently identified cause of chronic orchialgia.
One author describes the syndromes of chronic testicular pain thus:"The complaint is of a squeezing deep ache in the testis like the day after you got kicked there, often bilateral or alternating from one side to the other, intermittent, and, most commonly, associated with lower back pain. Sometimes it feels like the testicle is pinched in the crotch of the underwear but trouser readjustment does not help. There may also be pain in the inguinal area but no nausea or other symptoms. Back pain may be concurrent or absent and some patients have a long history of low back pain. Onset of pain is commonly related to activity that would stress the low back such as lifting heavy objects. Other stresses that might cause low back pain are imaginative coital positions, jogging, sitting hunched over a computer, long car driving, or other such positions of unsupported seating posture that flattens the normal lumbar lordosis curve."
Patients with trochleitis typically experience a dull fluctuating aching over the trochlear region developing over a few days. Some may also feel occasional sharp pains punctuating the ache. In patients with migraines, trochleitis may occur simultaneously with headache. Presentation is usually unilateral with palpable swelling over the affected area supranasal to the eye. The trochlear region is extremely tender to touch. Pain is exacerbated by eye movements looking down and inwards, and especially in supraduction (looking up) and looking outwards, which stretches the superior oblique muscle tendon. Notably, there is no restriction of extraocular movements, no diplopia, and often no apparent ocular signs such as proptosis. However, occasionally mild ptosis is found. The absence of generalized signs of orbital involvement is helpful in eliminating other more common causes of periorbital pain.
Odynophagia (; from "-" "pain" and "" "to eat") is pain when swallowing. The pain may be felt in the mouth or throat and can occur with or without difficulty swallowing. The pain may be described as an ache, burning sensation, or occasionally a stabbing pain that radiates to the back. Odynophagia often results in inadvertent weight loss.
Odynophagia may have environmental or behavioral causes, such as:
- Very hot or cold food and drinks
- Taking certain medications
- Using drugs, tobacco, or alcohol
- Trauma or injury to the mouth, throat, or tongue
Trochleitis is inflammation of the superior oblique tendon trochlea apparatus characterized by localized swelling, tenderness, and severe pain. This condition is an uncommon but treatable cause of periorbital pain. The trochlea is a ring-like apparatus of cartilage through which passes the tendon of the superior oblique muscle. It is located in the superior nasal orbit and functions as a pulley for the superior oblique muscle. Inflammation of the trochlear region leads to a painful syndrome with swelling and exquisite point tenderness in the upper medial rim of the orbit. A vicious cycle may ensue such that inflammation causes swelling and fraying of the tendon which then increases the friction of passing through the trochlea which in turn adds to the inflammation. Trochleitis has also been associated with triggering or worsening of migraine attacks in patients with pre-existing migraines (Yanguela, 2002).
People with CTS experience numbness, tingling, or burning sensations in the thumb and fingers, in particular the index and middle fingers and radial half of the ring finger, because these receive their sensory and motor function (muscle control) from the median nerve. Ache and discomfort can possibly be felt more proximally in the forearm or even the upper arm. Less-specific symptoms may include pain in the wrists or hands, loss of grip strength, and loss of manual dexterity.
Some suggest that median nerve symptoms can arise from compression at the level of the thoracic outlet or the area where the median nerve passes between the two heads of the pronator teres in the forearm, although this is debated.
Numbness and paresthesias in the median nerve distribution are the hallmark neuropathic symptoms (NS) of carpal tunnel entrapment syndrome. Weakness and atrophy of the thumb muscles may occur if the condition remains untreated, because the muscles are not receiving sufficient nerve stimulation. Discomfort is usually worse at night and in the morning.
Symptoms range in severity from mild to disabling.
Symptoms are common, but vague and non-specific for the condition. The most common are feeling tired, "brain fog" (short-term memory problems, difficulty concentrating), gastrointestinal problems, headaches, and muscle pain.
A partial list of other symptoms patients have attributed to MCS include: difficulty breathing, pains in the throat, chest, or abdominal region, skin irritation, headaches, neurological symptoms (nerve pain, pins and needles feelings, weakness, trembling, restless leg syndrome), tendonitis, seizures, visual disturbances (blurring, halo effect, inability to focus), anxiety, panic and/or anger, sleep disturbance, suppression of immune system, digestive difficulties, nausea, indigestion/heartburn, vomiting, diarrhea, joint pains, vertigo/dizziness, abnormally acute sense of smell (hyperosmia), sensitivity to natural plant fragrance or natural pine terpenes, dry mouth, dry eyes, and an overactive bladder.
Testing for gonorrhea and chlamydia should be routinely performed.
One of the hallmarks of arterial claudication is that it occurs intermittently. It disappears after a very brief rest and the patient can start walking again until the pain recurs.
The following signs are general signs of atherosclerosis of the lower extremity arteries:
- cyanosis
- atrophic changes like loss of hair, shiny skin
- decreased temperature
- decreased pulse
- redness when limb is returned to a "dependent" position (part of Buerger's test)
All the "P"s
- Pallor increase
- Pulses decreased
- Perishing cold
- Pain
- Paraesthesia
- Paralysis
Carpal tunnel syndrome (CTS) is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. The main symptoms are pain, numbness, and tingling, in the thumb, index finger, middle finger, and the thumb side of the ring fingers. Symptoms typically start gradually and during the night. Pain may extend up the arm. Weak grip strength may occur and after a long period of time the muscles at the base of the thumb may waste away. In more than half of cases both sides are affected.
Risk factors include obesity, repetitive wrist work, pregnancy, and rheumatoid arthritis. There is tentative evidence that hypothyroidism increases the risk. Diabetes mellitus is weakly associated with CTS. The use of birth control pills does not affect the risk. Types of work that are associated include computer work, work with vibrating tools, and work that requires a strong grip. Diagnosis is suspected based on signs, symptoms, and specific physical tests and may be confirmed with electrodiagnostic tests. If muscle wasting at the base of the thumb is present, the diagnosis is likely.
Being physically active can decrease the risk of developing CTS. Symptoms can be improved by wearing a wrist splint or with corticosteroid injections. Taking NSAIDs or gabapentin does not appear to be useful. Surgery to cut the transverse carpal ligament is effective with better results at a year compared to non surgical options. Further splinting after surgery is not needed. Evidence does not support magnet therapy.
About 5% of people in the United States have carpal tunnel syndrome. It usually begins in adulthood and women are more commonly affected than men. Up to 33% of people may improve without specific treatment over approximately a year. Carpal tunnel syndrome was first fully described after World War II.
Women with this condition experience a constant pain that may be dull and aching, but is occasionally more acute. The pain is worse at the end of the day and after long periods of standing, and sufferers get relief when they lie down. The pain is worse during or after sexual intercourse, and can be worse just before the onset of the menstrual period.
Women with pelvic congestion syndrome have a larger uterus and a thicker endometrium. 56% of women manifest cystic changes to the ovaries, and many report other symptoms, such as dysmenorrhea, back pain, vaginal discharge, abdominal bloating, mood swings or depression, and fatigue.
Intermittent claudication (Latin: "claudicatio intermittens") is a symptom that describes muscle pain on mild exertion (ache, cramp, numbness or sense of fatigue), classically in the calf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest. It is classically associated with early-stage peripheral artery disease, and can progress to critical limb ischemia unless treated or risk factors are modified.
Claudication derives from the Latin verb "claudicare", "to limp".
If not treated right away, there are many consequences and pains various cervical spine disorders can cause.
- Neck pains Pains in the neck area tend to be tenacious and persistent and most muscles in the cervical spinal region tighten causing for discomfort.
- Headaches Headaches are further triggered through the stiffness of neck muscles, which pull at their attachment to the skull. These headaches are recurrent in nature and start from the base of the skull and emanate upwards; they can be painful or mild.
- Arm pains Muscular spasms within the arm are further common symptoms in which such spasms are seen right above the collarbones and pressure is placed on the Brachial plexus causing arms to feel heavy and ache.
- Difficulty walking Hardships arise with cervical spinal injuries when issues with walking, balancing, and posture are affected all due to the spinal cord being compressed resulting in Myelopathy.
- Those with extremely severe outcomes may result in:Impairment
People who suffer from MCS may have a neurological dysfunction in the odor-processing areas of the brain or otherwise have an exaggerated response to scents.
It is through upper frontal chest discomfort (also known as cervical angina) and scapular pains which signs of cervical spine disorders are shown. In 1937 a man named Oille was the first to state that these chest pains originated from the cervical nerve root. This new outlook helped shed light on exactly what signs indicated the beginning of these ailments for those suffering from cervical spine disorders. It is now recognized that these patients feel pain, numbness, discomfort, and weakness along with neurological symptoms.
- Numbness Numbness occurs when one develops a “pinched” nerve not allowing for the flow of electrical charges, which may result in the death of the nerve fiber.
- Weakness An individual becomes weak due to the compression of nerves encompassing cervical spine disorders, thus resulting in the inability to move or use arms. Those who suffer from such symptoms should seek medical treatment as soon as possible.
Diseases of the foot generally are not limited, that is they are related to or manifest elsewhere in the body. However, the foot is often the first place some of these diseases or a sign or symptom of others appear. This is because of the foot's distance from the central circulation, the heart and its constant exposure to pressures from the ground and the weight of the body.
The foot may look simple but is a complex structure with 26 bones, 33 joints, numerous muscles, nerves and different ligament types. Any part of the foot can be affected. Some foot disorders may present with just a mild ache, but other foot disorders can be very serious and limit ability to walk or bear weight. Most minor cases of foot pain respond to home care treatments except when severe pain is present as it is a disabling condition and usually needs some type of medical attention. If foot pain is not treated in time, it can lead to long term disability and continuing damage to the foot.
Pelvic congestion syndrome (also known as pelvic vein incompetence) is a chronic medical condition in women caused by varicose veins in the lower abdomen. The condition causes chronic pain, often manifesting as a constant dull ache, which can be aggravated by standing. Early treatment options include pain medication, alternative therapies such as acupuncture, and suppression of ovarian function. Surgery can be done using noninvasive transcatheter techniques to embolize the varicose veins. Up to 80% of women obtain relief using this method.
The condition can occur as a result of pregnancy or for unknown reasons. The presence of estrogen in the body causes vasodilation, which can result in the accumulation of blood in the veins in the pelvic area. Estrogen can weaken the vein walls, leading to the changes that cause varicosities. Up to 15% of all women have varicose veins in the abdominal area, but not all have symptoms.
Besides a physical examination, an x-ray MRI or an ultrasound study may be obtained to assess the soft tissues and blood vessels.
Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, often leading to a degenerative process in which tissues break down and no longer function well.
Shoulder pain may be localized or may be referred to areas around the shoulder or down the arm. Other regions within the body (such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck) also may generate pain that the brain may interpret as arising from the shoulder.
Symptoms can vary from an ache or pain and swelling to the local area of the ankles, or a burning that surrounds the whole joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day as swelling impinges on the movement of the tendon. Many patients report stressful situations in their lives in correlation with the beginnings of pain which may contribute to the symptoms.
Jumper's knee (patellar tendinopathy, patellar tendinosis, patellar tendinitis) commonly occurs in athletes who are involved in jumping sports such as basketball and volleyball. Patients report anterior knee pain, often with an aching quality. The symptom onset is insidious. Rarely is a discrete injury described. Usually, involvement is infrapatellar at or near the infrapatellar pole, but it may also be suprapatellar.
Depending on the duration of symptoms, jumper's knee can be classified into 1 of 4 stages, as follows:
Stage 1 – Pain only after activity, without functional impairment
Stage 2 – Pain during and after activity, although the patient is still able to perform satisfactorily in his or her sport
Stage 3 – Prolonged pain during and after activity, with increasing difficulty in performing at a satisfactory level
Stage 4 – Complete tendon tear requiring surgical repair
It begins as inflammation in the patellar tendon where it attaches to the patella and may progress by tearing or degenerating the tendon. Patients present with an ache over the patella tendon. Most patients are between 10 and 16 years old. Magnetic resonance imaging can reveal edema (increased T2 signal intensity) in the proximal aspect of the patellar tendon.