What are the possible causes and recommended management for pain under the left axilla associated with sweating?

Sakit sa Ilalim ng Kaliwang Kilikili na May Pawis

Ang pinakamahalagang hakbang ay suriin kung may cardiac na sanhi, lalo na kung may kasamang dibdib na sakit, hirap sa paghinga, o pawis sa buong katawan, dahil maaaring ito ay senyales ng heart attack na nangangailangan ng agarang emergency care. 1

Mga Pangunahing Sanhi na Dapat Isaalang-alang

Cardiac na Sanhi (Pinaka-Kritikal)

• Kung ang sakit ay kasama ng chest pain, shortness of breath, nausea, o sweating, ito ay maaaring cardiac origin at nangangailangan ng immediate EMS activation 1
• Ang sweating na kasama ng chest discomfort ay red flag para sa myocardial infarction 1
• Tumawag agad ng 911/emergency kung may mga sintomas na ito, huwag subukang dalhin mismo ang pasyente sa ospital 1

Musculoskeletal na Sanhi (Pinakakaraniwan kung walang cardiac symptoms)

• Costochondritis - sakit sa chest wall na may tenderness kapag pinindot ang area, ang pain ay reproducible sa palpation 2
• Ang musculoskeletal pain ay typically sharp, localized, at lumalala sa paggalaw, pag-ikot, o paghinga 2
• Point tenderness sa examination ay strongly suggests musculoskeletal origin 2

Hyperhidrosis (Excessive Sweating) na May Kasamang Sakit

• Ang focal hyperhidrosis ay maaaring makaapekto sa axillae (kilikili) at maaaring may kasamang dermal pain 3, 4
• Ang tingling dermal pain triggered by sweating ay maaaring mangyari immediately upon exposure sa sweating stimuli at tumatagal ng 10-30 minutes 5
• Ang ganitong pain ay mas karaniwan sa young males at maaaring may o walang kasamang eruptions o hypohidrosis 5

Iba Pang Sanhi

• Lymphadenopathy (manas na lymph nodes) mula sa infection
• Skin infections o abscesses sa axillary area
• Nerve-related pain (neuropathic)

Diagnostic Approach

Immediate Assessment

• Suriin kung may cardiac symptoms: chest pain, radiation sa left arm/jaw, dyspnea, diaphoresis, nausea 1, 2
• Kung may cardiac symptoms, 12-lead ECG dapat gawin within 10 minutes 2
• Tingnan ang vital signs: heart rate, blood pressure, respiratory rate 1

Physical Examination

• Palpate ang area para sa tenderness - kung reproducible ang pain sa palpation, likely musculoskeletal 2
• Suriin ang axillary lymph nodes para sa enlargement o tenderness
• Tingnan kung may visible skin changes, redness, o swelling
• Assess ang pattern ng sweating - focal (localized) o generalized 3, 4

Treatment Algorithm

Kung May Cardiac Symptoms

1. Immediate EMS activation 1
2. Habang naghihintay ng EMS, kung mukhang heart attack at walang allergy sa aspirin:
   • Bigyan ng 1 adult aspirin 325mg tablet o 2-4 baby aspirin (81mg each), chewed and swallowed 1
   • Huwag bigyan ng aspirin kung uncertain o may recent bleeding 1

Kung Musculoskeletal (Costochondritis)

1. NSAIDs for 1-2 weeks bilang initial therapy 6
   • Ibuprofen o naproxen
2. Ice packs o heat application sa affected area 6
3. Acetaminophen kung contraindicated ang NSAIDs 6
4. Kung persistent despite NSAIDs, consider low-dose colchicine 6
5. Para sa refractory cases, local anesthetic-steroid injection 6

Kung Hyperhidrosis na May Dermal Pain

1. Topical aluminum chloride solution - initial treatment para sa axillary hyperhidrosis 4
2. Kung may dermal pain with hypohidrosis, steroid pulse therapy ay effective 5
3. Medications acting on nervous systems at regular sweat-inducing activities para promote perspiration 5
4. Avoid triggers ng excessive sweating kung possible 3

Kung May Infection (lymphadenitis, abscess)

• Antibiotics kung bacterial infection
• Incision and drainage kung may abscess formation

Red Flags Requiring Immediate Medical Attention

• Chest pain na may radiation sa left arm, jaw, o neck 2
• Associated diaphoresis, dyspnea, nausea, o palpitations 2
• Severe pain na hindi gumiginhawa 1
• Fever na may severe tenderness - possible infection
• Visible mass o swelling na lumalaki

Common Pitfalls to Avoid

• Huwag i-assume na simple muscle pain lang kung may kasamang sweating at chest discomfort - cardiac causes dapat i-rule out muna 1
• Huwag mag-delay ng emergency care kung may cardiac symptoms - aspirin at EMS activation ay life-saving 1
• Huwag gumamit ng ice o cold water immersion nang matagal para sa pain relief kung may hyperhidrosis - maaaring mag-cause ng tissue damage 1