Stop Neck Pain Naturally
Whiplash injury occurs via an acceleration-deceleration energy transfer to the neck.10 It is most often seen in a person involved in rear-end or side-impact MVC. The bone and soft tissue trauma (whiplash injury) in turn may lead to a variety of clinical manifestations (whiplash-associated disorders).
Typical clinical presentation includes signs and symptoms of focal neurological impairment or personality change in the setting of an acute or subacute febrile illness. However, focal neurological abnormalities such as partial seizures or hemiparesis do not occur in a majority of patients, and lateralized signs may be subtle and or transitory. Fever, head or neck pain, and altered mentation are almost invariably present however, these features are non-specific, and very early in its course herpes simplex encephalitis may be indistinguishable from common viral infections with features of aseptic meningitis. Herpes simplex encephalitis presentation also overlaps a variety of conditions that can cause focal neurological impairment and signs of systemic illness, such as bacterial abscess, stroke from septic emboli, central nervous system vasculitis, cerebral venous thrombosis, or a parameningeal source of bacterial or fungal infection. Thus the major challenge facing the clinician...
On the basis of using intra-articular injections or nerve blocks as the reference standard, the prevalence of the z-joint as a nociceptor in chronic axial-type neck pain has been reported from about 35 in a specialist referral setting (27) to about 50 in postwhiplash patients (28). The level most commonly involved in either group was C5-C6. The C3-C4 level was the most common in the nonwhiplash group and C2-C3 was the most common in the whiplash group. Cervical z-joint pain is common among chronic neck pain patients after whiplash and is of significant clinical importance. In evaluating this patient population, placebo controlled comparative blocks should be the algorithm employed. It has been shown that uncontrolled diagnostic blocks are compromised by substantial false positive rates and diminish the specificity of this modality (29). An alternative to an intra-articular injection is a medial branch block. In this procedure, a needle is placed along the expected course of the medial...
Patients with head, facial, or neck trauma should be assumed to have an unstable cervical spine injury, and the neck should be immobilized until all aspects of the cervical spine have been adequately studied and an injury excluded. However, the absence of neck pain, neck tenderness, and distracting injuries in an awake and alert adult who has not taken mind-altering drugs is usually sufficient to exclude a cervical spine injury.
Patients with cervical spine involvement may be initially asymptomatic. As the disease progresses neck pain may appear. Suboccipital headaches aggravated by neck movements are common, and electrical-like sensation in the torso or extremities that is precipitated by neck flexion or extension may appear. This is frequently referred to as Lhermitte'ssign. Some patients develop earache and occasionally facial pain due to compression or irritation of the sensory fibers of the greater auricular nerve or the spinal trigeminal nucleus. Neurological findings are less common than pain but may be present in up to one-third of the patients. Gait dysfunction (unstable gait, wide-based gait), decreased upper extremity dexterity and weakness, and sphincter dysfunction may develop due to cervical myelopathy.
The classic fracture consists of an avulsion fracture of the spinous process of C7. However, a fracture of any of the other cervical spinous processes without any other fracture can have this name ascribed. The usual mechanism is a direct blow to the posterior elements, although an avulsion associated with a severe flexion mechanism is recognized as another possibility. Patients usually complain of neck pain, but these are stable fractures that can be safely treated in a cervical collar.
Schrader, H., Obelieniene, D., Govim, G., Surkiene, D., Miseviciene, D., and Miseviciene, I. (1996). Natural evolution of late whiplash syndrome outside the medicolegal context. Lancet, 347, 1207-11. 20. Borchgrevink, G.E., Kaasa, A., McDonagh, D., Stiles, T.C., Haraldseth, O., and Lereim, I. (1998). Acute treatment of whiplash neck sprain injuries a randomized trial of treatment during the first 14 days after a car accident. Spine, 23, 25-31.
The peripheral trigger-point injection could be expected to treat a non-cervical cause of appen-dicular pain. If the peripheral trigger point is a point of referred pain from the cervical spine, one would not expect the trigger-point injection to be beneficial. Selected injections involving the nerve roots and or facet joints can be both of diagnostic and therapeutic value. The use of such injections is logical in cases where the patient has localized neck pain or referred pain in a nerve root distribution.
This usually presents either as a referral to a liaison psychiatrist, or in a medico-legal context. A frequent example is a patient with postinjury back or neck pain who is involved in litigation or seeking disability payment. Initial physical injury is not in doubt, but the length and severity of symptoms, disability, and distress may seem out of proportion, and raise the possibility of malingering. Schmand et al.(33 found that 61 per cent of litigants after whiplash neck injury had evidence of underperformance on memory testing compared with 29 per cent of outpatient controls. The underperforming litigants scored as low as controls with definite evidence of closed head injury. By contrast, in a consecutive series of road traffic accident victims Bryant et al.(34) found little evidence of malingering the vast majority had genuine psychosocial problems. These findings suggest that there is a higher prevalence of dissimulation in the minority of patients who become involved in...
Bacterial infections of the meninges (bacterial meningitis) are commonly called leptomeningitis because the causative organisms are usually found in the subarachnoid space and involve the pia and arachnoid. The organism seen in about one-half of adult cases is Streptococcus pneumoniae, while in neonates and children up to about 1 year it is Escherichia coli. The patient becomes acutely ill (i.e., confusion, fever, stiff neck, stupor), may have generalized or focal signs symptoms, and, if not treated rapidly, will likely die. Treatment is with appropriate antibiotics. Patients with viral meningitis may become ill over a period of several days, experience headache, confusion, and fever, but, with supportive care, will recover after an acute phase of approximately 1 2 weeks. These patients usually recover with no permanent deficits.
The use of epidural steroids in the cervical spine to treat chronic neck and upper extremity pain has been reported since 1984 (22). The translaminar route without fluoroscopic control has been utilized in most series (22-26). A criticism of this technique is the difficulty in assuming that the needle placement is in the epidural space as well as the risk of intradural puncture. More recently, the use of fluoroscopy and contrast media epidurography have been advocated by Johnson et al. to improve the safety and efficacy of the cervical epidural steroid injection (27). They performed 669 cervical epidural injections, mostly at C7-T1 over a 5.5-year-period in patients suffering neck pain with or without radiculopathy in a cohort study of 5334 patients receiving lumbar, cervical, and thoracic epidural steroid injections and reported only four complications in all the epidural injections. These consisted of transient hypotension a small dorsal epidural hematoma, which resolved without...
First described by Bell in 1817, these are extremely uncommon 14 . The conscious patient may complain of occipito-cervical or neck pain, or may have lower cranial nerve palsies. These injuries are difficult to identify with plain radiographs and require a high index of suspicion. A retropharyngeal hematoma could be the only sign of serious injury. CT with reconstructions provides the definitive diagnosis.
Patients with chronic occipital, neck, shoulder, or interscapular pain are candidates for intra-articular or medial branch block, if their pain follows the typical distribution as has been shown from previous clinical studies on normal volunteers and patients with head, neck, and shoulder pain (4,9,13). In patients with whiplash, the prevalence of chronic neck pain and headache was found to be as 54 , most commonly arising at the C2-C3 and C5-C6 levels (7). Routine imaging should exclude other possible etiologies such as tumor or infection before the patient undergoes a block, because it is primarily a test to provide a diagnosis in patients who do not show any evident cause for their chronic neck pain and whose pain map indicates a segmental innervation of their referred pain. However, it must be noted that the localization of cervical referred pain is confounded by the fact that the pattern of pain distribution of cervical discogenic origin is similar to that of the zygapophyseal...
The prevalence of chronic neck pain at levels below C3 following whiplash was estimated to be at least 49 by Lord et al. (7) and 36 by Speldewinde et al. (8), utilizing medial branch blocks to localize a specific diagnosis of the side and level of the pain generator. The prevalence of third occipital nerve headache following whiplash injury is 27 diagnosed by double blind, controlled diagnostic blocks of the third occipital nerve, but may be as high as 52 in patients presenting with predominant headache (3).
The predominant symptoms occur due to lower motor neuron symptoms in the upper extremities, and upper motor neuron symptoms in the lower extremities. Weakness and atrophy of the small muscles of the hands result in fine motor coordination deficits handling keys, manipulating buttons, and writing become awkward and clumsy. This may be accompanied by numbness in both hands. Upper motor neuron symptoms such as spasticity and increased reflexes develop in the lower extremities. The toes may become upgo-ing. Clinically this translates to gait dysfunction. The patient may stumble and fall. Quite often it is a close family member that identifies early on the changes in the patient's gait. Most patients retain control of their sphincters for a long time. Pain does not play a major role in the clinical picture of CSM. Most patients may have had neck pain in the past but at the time of diagnosis pain is not a major complaint. The clinical picture just described is very...
Prior to intubation, the stability of the cervical spine must be assessed, particularly in patients with trauma. Also, patients who lose consciousness acutely may fall and injure their cervical spine. Because patients with altered mental status may be unable to tell the examiner about neck pain, all comatose patients should be treated as if their neck is injured unless a reliable witness can attest to the absence of a fall or other potential for neck injury.
ESIs are much less commonly performed in the cervical spine. With the consequent relative paucity of studies compared to the extensive lumbar ESI literature, there is no consensus on indications for cervical ESI. Indications supported by various studies include radicular pain, cervical spondylosis, subacute cervical strain, cervicogenic headache, chronic neck pain (52,54,55,62,63), and a variety of indications (52). While some report reduced efficacy in axial neck pain, most do not (62). Hopefully, future work will clarify a set of standard indications for this procedure.
Lateral cervical radiographs in flexed and extended positions. Dynamic cervical radiographs may be useful in cervical-spine clearance after trauma but should not be undertaken in the presence of known fracture, instability, neck pain or neurological deficit. Limited flexion or extension due to poor cooperation or splinting, as seen here, can also limit the value of the examination. Figure 7. Lateral cervical radiographs in flexed and extended positions. Dynamic cervical radiographs may be useful in cervical-spine clearance after trauma but should not be undertaken in the presence of known fracture, instability, neck pain or neurological deficit. Limited flexion or extension due to poor cooperation or splinting, as seen here, can also limit the value of the examination.
Block because this is the most likely source in 54 of such patients (3). This block should produce cutaneous anesthesia in the posterior occiput to be judged effective. In the case of an unsuccessful block at C2-C3, a C3 and C4 medial branch block would be the next most likely to yield a diagnosis, followed by a C1-C2 intra-articular block, if necessary. Lower neck pain is most likely to be referred from the segments C5 and C6 and less frequently from C6, C7 or C4, C5 (7).
Areas not adequately visualized or fractures identified by plain films should be further explored with CT scanning. The advent of spiral CT scanning has made image acquisition more feasible, especially in specialized trauma centers. In our institution, patients who complain of neck pain, in the absence of visible fractures on plain films, have fallen from heights greater than 10 feet, have been involved in highspeed motor vehicle accidents, are unconscious or have an associated head injury, automatically undergo a specialized imaging protocol of the spine, which examines the occiput to T4 with 3-mm cuts and sagittal and coronal reformations through the area 3 . CT scanning is more sensitive for fractures of the posterior elements and bone displacement is also better appreciated with CT scanning 5 . Limitations of this technology include missing fractures that lie parallel to the plane of imaging. The use of reformations has made this less of an issue of concern.
The 12-year-old boy has a grade 2 concussion. According to the history, his parents had more difficulty than usual awakening him that morning, and he was sleepy on the school bus and during first period in school. No involuntary movements or prior spells had been noted. Patient had been hit in the head while playing basketball the night before. He complained of headache and nausea but did not have a medical evaluation following the incident. His prenatal, birth, developmental, family, and past history was otherwise unremarkable. Physical exam was significant for frontal ecchymosis, stiff neck, and occipital scalp hematoma. Neurologic exam was significant for lethargy, in addition to memory, thinking, and concentration problems. Drug toxicology screening and head CT scan were normal.
Typically seen in adolescents and adults refers to thrombophlebitis of the internal jugular vein, which is thought to occur as a result of oropharyngeal infection. Patients typically present with neck pain and swelling, fever, and rigors infection is due to Fusobacterium necrophorum, bacteroides, and streptococcal and lactobacillus species. Kimura disease. Rare, inflammatory disorder, typically seen in Asian males and characterized by painless unilateral cervical adenopathy or subcutaneous head and neck masses, eosinophilia, and elevated immunoglobulin E (IgE) levels.
A close collaboration between the managing physician and the neuroradiologist is important. Precise knowledge of the patient's symptoms (leg or arm vs. back or neck pain and the symptomatic side of radiculopathy) and what was done in surgery are all-important for the radiological evaluation. Even before performing diagnostic imaging, obtaining a detailed history on the temporal sequence of the patient's complaints after surgery may distinguish between having failed to
Neurenteric cysts are epithelial-lined cysts derived from the neurenteric canal, which transiently connects the embryonic yolk sac with the amniotic cavity during the third week of embryonic development (see Embryology section). Due to the endodermal origin of the cyst lining, gastrointestinal or respiratory epithelium may be found and associated abnormalities of the gut, respiratory tract and vertebrae may occur. Such cysts (also called, for this reason, enterogenous cysts) tend to present as intradural extramedullary lesions situated ventrally in the cervical region. They may also be found in the thoracic region, where a dorsal intradural location is more often seen. Clinically, these lesions generally present in adolescence or early adulthood with neck pain and spinal cord compression, causing a cervical myelopathy. MRI scanning reveals the cyst and its location, allowing surgical excision, which can usually be achieved from a posterior approach. Even if a complete excision cannot...
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