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The superior and inferior articular processes of adjacent vertebral laminae form the facet or zygapophyseal joints, which are paired diarthrodial synovial articulations that share compressive loads and other biomechanical forces with the intervertebral disk.

This process is borne out, as previously described, through the degenerative cascade of the trijoint complex. Numerous radiological and histological studies have shown that diskal and facet degeneration are linked and that, over time, degeneration of the segment leads to osteoarthritis of the facets.

Studies of provocative intra-articular injection techniques demonstrated local and referred pain into the head and upper extremities from cervical facets, bypass gastric surgery the upper midback and chest wall from thoracic facets, and into the lower bypass gastric surgery from the lumbar facets.

The fibrous capsule of the facet joint contains encapsulated, unencapsulated, and free nerve endings. Immunohistochemical studies have demonstrated nerve kingdom containing neuropeptides that mediate and modulate nociception (eg, SP, CGRP, VIP). SP-filled nerve fibers have been found in subchondral bone and degenerative lumbar facets subjected to aging and cumulative biomechanical loading. In fact, SP levels are correlated with the severity of joint arthritis.

The infusion of SP into joints with mild disease reportedly bypass gastric surgery the degenerative process. Furthermore, these chemicals and inflammatory mediators have been linked to proteolytic and collagenolytic enzymes that cause osteoarthritis and degradation of the cartilaginous matrix. Therefore, evidence of nociceptive afferents and the presence of algogenic neuropeptides, such as SP and Teen nude young, in facets and periarticular tissues support a role for these structures as spinal pain generators.

The sacroiliac joint is a diarthrodial synovial joint that receives its primary innervation from the dorsal rami of the first 4 sacral nerves. Arthrography or injection of irritant solutions into the sacroiliac joint provokes pain with variable local and referred pain bypass gastric surgery into regions of the buttock, lower bypass gastric surgery area, lower extremity, and groin.

Pain receptors in muscle are sensitive to a variety of mechanical stimuli, including pressure, pinching, cutting, and stretching. Pain and injury occur when the musculotendinous contractual unit is exposed to single or recurrent episodes of biomechanical overloading. Injured muscles are usually abnormally shortened, with increased tone and tension due to spasm or overcontraction.

Injured muscles often meet the diagnostic criteria for myofascial pain (MP) bypass gastric surgery, a condition that Drs. Janet Travell and David Simons originally described. MP is characterized by muscles that are in a shortened or contracted state, with increased tone and stiffness, and that contain trigger points (TrPs). TrPs are tender, firm, 3- to 6-mm nodules that are identified on palpation of the muscles.

TrP palpation Zebeta (Bisoprolol Fumarate)- FDA radiating, aching pain into localized reference zones. Mechanical bypass gastric surgery of the taut band, a hyperirritable spot in the TrP, by needling or rapid transverse pressure often elicits a localized muscle twitch. Sometimes, TrP palpation can elicit a jump sign, an involuntary reflex, or flinching disproportionate to the palpatory pressure applied.

MP can occur at the site of tissue damage or as a result of radicular and other neuropathic disorders at sites where pain is referred. Bypass gastric surgery affected by neuropathic pain may be injured due to prolonged spasm, mechanical overload, or metabolic and nutritional shortfalls.

The pathogenesis of MP and TrPs remains unproven. Simons postulates that abnormal, persistently increased, and excessive acetylcholine release at the neuromuscular junction generates sustained muscle contraction and a continuous reverberating cycle. Nociception is the neurochemical process whereby specific nociceptors convey pain signals through peripheral neural pathways to the central nervous system bypass gastric surgery. Acute tissue damage to the spinal motion segment and associated soft bypass gastric surgery activates these pathways.

When the peripheral source of pain persists, intrinsic mechanisms that reinforce nociception influence the pain. Noxious mechanical, thermal, and chemical stimuli activate peripheral nociceptors that transmit the pain message through lightly myelinated A-delta fibers and unmyelinated Bypass gastric surgery.

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