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Ulcers—Pressure Ulcers/Decubitus Ulcers/Bedsores
Published in Charles Theisler, Adjuvant Medical Care, 2023
A decubitus ulcer, also known as a pressure ulcer, pressure sore, or bedsore, is an open wound on the skin. Decubitus in Latin means “lying down.” These ulcers are usually the result of lying in one position for too long so that the circulation in the skin is compromised or cut off by the weight of the body against the mattress or chair.1 This leads to a breakdown of the skin. A bedsore initially presents as persistently red, broken, blistered, or necrotic skin. As it further develops, the ulceration can extend into underlying structures including bone, ligaments, and muscle. It is particularly common over bony prominences like on the sacrum, ankles, hips, or heels.
Patient Assessment
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Following the initial assessment of the back during the log roll, this should be supplemented, if clinically indicated, by a more comprehensive assessment. The whole of the back, from occiput to heels, can then be checked and the back of the chest auscultated. The viability of the decubitus skin should be assessed.
Introduction
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
If decubitus the patient may be: Supine (dorsal decubitus) – lying on the back (Fig. 1.9a).Prone (ventral decubitus) – lying face down (Fig. 1.9b).Lateral decubitus – lying on the side. Right lateral decubitus – lying on the right side. Left lateral decubitus – lying on the left side.
Diagnosis and treatment of pudendal and inferior cluneal nerve entrapment syndrome: a narrative review
Published in Acta Chirurgica Belgica, 2022
Katleen Jottard, Pierre Bonnet, Viviane Thill, Stephane Ploteau, Stefan de Wachter
PN and/or cluneal nerve entrapment can cause a chronic neuropathic pain syndrome related to a loss of mobility of the nerves over their course which induces compression [1,2]. Pudendal and cluneal neuralgia coexist in 25% of patients [6]. The age of onset is in adult life, often without a clear etiology. The typical presentation of this pain syndrome is neuropathic pain, exacerbated in the sitting position in the sensitive areas previously described. Patients report a significant reduction or disappearance of pain during standing and in the decubitus position. Pain can be unilateral or bilateral. Because of the chronicity of this pain syndrome, patients often develop a peripheral and central sensitization due to an increase in the excitability of peripheral nerve fibers and the central nervous system so that normal inputs evoke exaggerated responses [9,10]. This is manifested in patients as allodynia or hyperalgesia. Furthermore, a pelvic hypersensitivity, partially related to muscular contractions, can enlarge the syndrome to a real pelviperineal pain syndrome causing urinary, sexual or defecation problems, making diagnosis even more challenging. Patients can also describe a feeling of rectal or vaginal foreign body.
Developments in the assessment of non-motor disease progression in amyotrophic lateral sclerosis
Published in Expert Review of Neurotherapeutics, 2021
Adriano Chiò, Antonio Canosa, Andrea Calvo, Cristina Moglia, Alessandro Cicolin, Gabriele Mora
The pathophysiology of pain in ALS is multifactorial [116,119]. Much of the chronic pain in ALS seems to result as a secondary effect of the motor impairment of ALS (i.e. nociceptive pain). Nociceptive causes of ALS pain develop as disease progresses, due to degenerative changes in connective tissue, bones and joints leading to musculoskeletal pain related to muscle atrophy and weakness and prolonged immobility. Joint contractures are common, as shoulder pain [120]. Spasticity and cramps are also common primary causes of pain in ALS. In a study, about one third of ALS patients had prominent spasticity, and 42.5% of them reported pain, evaluated with a numeric rating scale [121]. In about 25% of patients cramps are the major cause of pain, in particular in those with spinal phenotype [122]. Decubitus ulcers are caused by skin pressure, even if they are rather uncommon despite patients reduced mobility. In the more advenced phases of the disease patients may complain diffuse and unexplained pain.
Wound dressings as growth factor delivery platforms for chronic wound healing
Published in Expert Opinion on Drug Delivery, 2021
Ovidio Catanzano, Fabiana Quaglia, Joshua S. Boateng
A chronic wound occurs when there is an inability to proceed through an orderly and timely reparative process to restore the anatomic and functional integrity of the injured site [13]. Chronic wounds can be mainly classified into vascular ulcers (e.g., venous and arterial ulcers), pressure ulcers, and diabetic ulcers. Almost all chronic wounds can generally be assigned to one of these three clinical categories depending on the underlying cause. Vascular ulcers are frequently (>70%) due to venous deficiencies caused by a sustained level of high blood pressure in the lower leg due to inadequate venous return. Other underlying causes of leg ulcers include arterial disease (reduced arterial blood supply to the lower limb), vasculitis and skin malignancies. Pressure ulcers (PUs), also known as decubitus ulcers or bed sores, often occur in hospitalized or bedridden patients and are caused by a combination of persistent direct pressure and/or shear/friction forces over a bony prominence that obstructs blood flow to the tissue. Diabetic foot ulcers (DFUs) are a complication that has been estimated to occur in 15 to 25% people with diabetes and are caused by neural and vascular complications [14].