Cervical pain is a common musculoskeletal problem. It can be caused by injuries or conditions affecting the cervical spine joints, ligaments, muscles or nerves. Clinical evaluation involves assessing the pain characteristics, neurological examination and diagnostic imaging when needed. The majority of acute cervical pain resolves within weeks with conservative treatment, but some may become chronic. Cervical myelopathy presents with signs of damage to the spinal cord like lower motor neuron signs in the upper limbs and upper motor neuron signs below the level of lesion.
This document provides information on neck pain, including causes, symptoms, classifications, clinical examination, investigations, and treatment. It discusses how neck pain can result from disorders of structures in the neck like bones, joints, nerves and muscles. Examination involves inspection, palpation, and assessment of movement and neurological function. Investigations may include x-rays, MRI, and blood tests. Treatment depends on the underlying cause but typically involves rest, medications, physiotherapy including exercises and manual therapy, and surgery if conservative treatments fail. Prevention emphasizes proper posture, exercise and ergonomics to avoid strain on the neck structures.
This document provides information on lateral epicondylitis (tennis elbow), including its anatomy, causes, symptoms, diagnosis, and treatment options. It describes how lateral epicondylitis is an overuse injury caused by repetitive microtrauma to the common extensor tendon at the lateral epicondyle. The diagnosis is typically made based on physical examination findings of tenderness over the lateral epicondyle with resisted wrist and finger extension. Both non-operative treatments like physiotherapy, bracing, and steroid injections and surgical options are discussed for managing lateral epicondylitis.
Neck pain, almost everyone of us would have definitely suffered with neck pain once in our lifetime. So what is your approach for patient with neck pain? Is it just a sprain or something serious? Know the red flags of neck pain, and learn to examine neck systematically.
De Quervain's tenosynovitis is an inflammation of the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis muscles in the wrist. It commonly affects women ages 30-50 and is caused by repetitive motions like knitting or computer use that strain the thumb and wrist. Symptoms include pain on the radial side of the wrist worsened by thumb movement. Conservative treatment involves splinting, anti-inflammatories, corticosteroid injections, and physical therapy exercises. Surgery may be considered if symptoms persist after several weeks of conservative care.
Carpal tunnel syndrome results from compression of the median nerve at the wrist. It causes tingling, numbness, and pain in the lateral 3.5 fingers. Diagnosis involves physical tests like Phalen's and Tinel's sign as well as electrodiagnostic tests. Treatment starts with splinting, injections, and oral anti-inflammatories. Surgery involves cutting the transverse carpal ligament if more conservative measures fail after 6 months. Complications are rare but include injury to nearby nerves or structures.
The document discusses the examination of cervical disorders. It begins with an introduction to the anatomy of the cervical spine and then describes the various functions of the spine. The document outlines the process for examining the cervical spine, including obtaining a history, inspecting for abnormalities, palpating the spine, and performing special tests to assess range of motion and potential nerve impingement. Common cervical conditions like herniated discs and bone spurs are also summarized. The examination techniques are explained in detail with diagrams to illustrate proper procedures like compression, distraction, and rotation tests.
This document provides information on neck pain, including causes, symptoms, classifications, clinical examination, investigations, and treatment. It discusses how neck pain can result from disorders of structures in the neck like bones, joints, nerves and muscles. Examination involves inspection, palpation, and assessment of movement and neurological function. Investigations may include x-rays, MRI, and blood tests. Treatment depends on the underlying cause but typically involves rest, medications, physiotherapy including exercises and manual therapy, and surgery if conservative treatments fail. Prevention emphasizes proper posture, exercise and ergonomics to avoid strain on the neck structures.
This document provides information on lateral epicondylitis (tennis elbow), including its anatomy, causes, symptoms, diagnosis, and treatment options. It describes how lateral epicondylitis is an overuse injury caused by repetitive microtrauma to the common extensor tendon at the lateral epicondyle. The diagnosis is typically made based on physical examination findings of tenderness over the lateral epicondyle with resisted wrist and finger extension. Both non-operative treatments like physiotherapy, bracing, and steroid injections and surgical options are discussed for managing lateral epicondylitis.
Neck pain, almost everyone of us would have definitely suffered with neck pain once in our lifetime. So what is your approach for patient with neck pain? Is it just a sprain or something serious? Know the red flags of neck pain, and learn to examine neck systematically.
De Quervain's tenosynovitis is an inflammation of the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis muscles in the wrist. It commonly affects women ages 30-50 and is caused by repetitive motions like knitting or computer use that strain the thumb and wrist. Symptoms include pain on the radial side of the wrist worsened by thumb movement. Conservative treatment involves splinting, anti-inflammatories, corticosteroid injections, and physical therapy exercises. Surgery may be considered if symptoms persist after several weeks of conservative care.
Carpal tunnel syndrome results from compression of the median nerve at the wrist. It causes tingling, numbness, and pain in the lateral 3.5 fingers. Diagnosis involves physical tests like Phalen's and Tinel's sign as well as electrodiagnostic tests. Treatment starts with splinting, injections, and oral anti-inflammatories. Surgery involves cutting the transverse carpal ligament if more conservative measures fail after 6 months. Complications are rare but include injury to nearby nerves or structures.
The document discusses the examination of cervical disorders. It begins with an introduction to the anatomy of the cervical spine and then describes the various functions of the spine. The document outlines the process for examining the cervical spine, including obtaining a history, inspecting for abnormalities, palpating the spine, and performing special tests to assess range of motion and potential nerve impingement. Common cervical conditions like herniated discs and bone spurs are also summarized. The examination techniques are explained in detail with diagrams to illustrate proper procedures like compression, distraction, and rotation tests.
Supraspinatus tendinitis is an inflammation of the supraspinatus tendon, which is one of the most commonly affected structures in the rotator cuff. It often results from repeated overhead arm motions or other activities that cause impingement beneath the coracoacromial arch. Symptoms include pain in the shoulder region that is worsened by motions like lifting the arm overhead. Treatment involves rest, exercises to strengthen the rotator cuff muscles, modalities like ultrasound to reduce inflammation, and manual therapy such as transverse friction massage to the tendon.
Adhesive capsulitis is a condition characterized by a painful and progressive loss of shoulder range of motion. It typically progresses through painful, freezing, and thawing phases over 1-2 years. Treatment involves medications to manage pain, physical therapy to restore range of motion, and in refractory cases, procedures like corticosteroid injections or surgery. While pain is usually transient, some patients may develop permanent loss of range of motion.
Low back pain is a common condition affecting the lumbar region of the back. It has many potential causes, including muscle strains, injuries to bones or discs, and underlying medical conditions. Diagnosis involves taking a history and conducting a physical exam. Common tests used to evaluate low back pain include x-rays, MRI, and CT scans. Treatment focuses on pain relief through medications, physical therapy, exercise, and in severe cases, surgery. Proper posture and lifting techniques can help prevent low back pain.
The document provides information about the radial nerve including its anatomy, course, branches and clinical presentations of radial nerve palsies. It discusses the radial nerve's origin from the brachial plexus and branches in the arm and forearm. Common causes of radial nerve palsy include fractures and entrapment in the radial tunnel. Clinical features, investigations, treatment including splinting and tendon transfers, and postoperative management are outlined. Surgical techniques for nerve repair and reconstructive procedures are also described.
Cervical radiculopathy is caused by spinal nerve root dysfunction resulting in dermatomal pain, parasthesias, myotomal weakness, and impaired deep tendon reflexes. It is commonly caused by herniated discs or bony spurs compressing nerve roots. Diagnosis involves history, physical exam testing dermatomes and myotomes, and imaging such as MRI. Treatment includes immobilization, traction, medications, injections, and sometimes surgery for severe or progressive cases.
Dr. Orakwele Arinze presented on cervical spondylosis. The presentation included an introduction to cervical spondylosis, relevant anatomy, epidemiology, etiology, pathophysiology, clinical features, diagnosis, differential diagnosis, management, physiotherapy management, and a case study. Cervical spondylosis is an age-related degeneration of the cervical spine that can lead to nerve root or spinal cord compression. Symptoms include neck and arm pain, weakness, and sensory changes. Physiotherapy is an effective treatment and includes modalities like TENS, traction, exercises and lifestyle advice. The case study demonstrated improvement in a patient's neck pain, range of motion and strength following physiotherapy
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by pain and stiffness in the shoulder joint that limits range of motion. It involves thickening and scarring of the shoulder joint capsule. Treatment involves conservative measures like oral anti-inflammatory drugs, corticosteroid injections into the joint, physical therapy including heat therapy and gentle range of motion exercises, and manipulation under anesthesia for refractory cases. Physical therapy aims to reduce pain and inflammation in the early stage and increase mobility in the stiffening stage through heat, passive range of motion, and home exercises.
1) This document provides guidance on evaluating and differentiating the causes of low back pain through patient history, physical examination, and imaging.
2) The differential diagnosis depends on characteristics of the pain such as duration, location, radiation, and aggravating/relieving factors. Common etiologies include inflammatory, mechanical, and radicular causes.
3) The physical examination focuses on the spine, hips, and tests to reproduce pain including range of motion and provocative maneuvers. Red flags are identified.
4) Imaging like MRI can identify abnormalities in the discs, vertebrae, nerves and surrounding tissues that provide diagnostic clues. Both regular sequences and enhanced images after contrast are useful.
The document describes two patients with lumbar spinal stenosis who were treated with non-surgical approaches. Both patients presented with low back pain and leg pain that worsened with walking. They underwent physical therapy evaluations including questionnaires, examinations, and treadmill tests. Physical therapy focused on exercises to improve strength, flexibility, and walking tolerance without worsening pain. Non-surgical treatments were aimed at reducing pain and disability from lumbar spinal stenosis.
The document discusses stroke, including its definition, causes, risk factors, symptoms, assessment, recovery stages, and complications. Key points include:
- Stroke is defined as sudden neurological dysfunction due to abnormal cerebral circulation lasting over 24 hours.
- Common causes include atherosclerosis, cerebral thrombus, embolism from the heart.
- Risk factors include hypertension, diabetes, heart disease, smoking, obesity.
- Symptoms can include weakness, numbness, vision issues, speech problems.
- Recovery is assessed based on severity, duration, and affected brain region. Complications can include contractures, seizures, DVT.
This document discusses cervical spondylosis and its management. It begins with the anatomy of the cervical spine and describes the intervertebral discs and muscles. It then covers the biomechanics, epidemiology, etiology, clinical manifestations, investigations, differential diagnosis, and management including medical, surgical, and physiotherapy approaches. The goals of physiotherapy treatment are to relieve pain, improve neck movement and posture, and decrease reliance on pain medications. Exercises and modalities like heat, cold, traction, and electrical stimulation are used.
Tennis elbow, also known as lateral epicondylitis, is a tendinopathy of the extensor tendons of the forearm caused by repetitive strain from activities like tennis or manual labor. It presents as lateral elbow pain that is exacerbated by wrist extension movements. While the name suggests it is caused by tennis, 95% of cases occur in non-tennis players engaged in repetitive arm motions. Treatment begins conservatively with rest, ice, braces, and physical therapy, while corticosteroid injections provide temporary pain relief. Surgery is considered if conservative measures fail after 6-12 months.
Therapeutic management of knee osteoarthritis; physiotherap case studyenweluntaobed
The document discusses the therapeutic management of knee osteoarthritis. It provides background on the epidemiology and economic burden of the condition. Key points include that knee OA prevalence is rising with population aging and affects nearly 10% of those over 55 years old. Treatment involves a multidisciplinary approach including pharmacological interventions, physiotherapy, and sometimes surgery, with the overall goals of reducing pain and improving joint function and quality of life. Assessment involves evaluating pain levels, range of motion, muscle strength, and radiological imaging to determine the severity and appropriate treatment.
This document provides information on low back pain, including its definition, prevalence, costs, causes, examination, diagnosis, and treatment options. Some key points:
- Low back pain is very common, affecting 60-80% of adults at some point. It costs the US over $90 billion annually in direct medical expenses and lost work.
- Causes can be non-spinal (e.g. hernia, infection) or spinal (e.g. arthritis, herniated disc, stenosis).
- Examination involves assessing gait, range of motion, motor strength, sensation, and reflexes. Common diagnostic tests are x-rays, MRI, CT.
- Treatment depends on cause but
This document discusses the assessment of the cervical spine. It begins with an introduction to the anatomy and biomechanics of the cervical spine. It then describes taking a patient history, including questions about pain and symptoms. The examination involves observation, palpation, range of motion testing, muscle strength testing, sensory testing, and special tests like Spurling's test. Diagnostic imaging options like x-rays, CT scans, and MRI are also discussed.
This document provides an overview of the clinical examination of the spine. It discusses the anatomy of the spine and common spinal conditions. The examination involves obtaining a history, inspecting the spine, palpating for tenderness, and assessing range of motion. Special tests like the straight leg raise test help localize pain and diagnose conditions like herniated discs. A neurological exam evaluates muscle strength, sensation, and reflexes to identify abnormalities affecting the spinal cord or nerves. A thorough spinal exam provides important clues for diagnosing underlying spinal problems.
Cervical radiculopathy is a peripheral nerve syndrome caused by mechanical injury or chemical irritation of the cervical nerve roots. It typically affects the C5-T1 nerve roots, accounting for 5-30% of radiculopathy cases. Common causes include spondylosis, cervical disc disease, disc herniation, and biochemically-induced inflammation. Symptoms include neck pain radiating into the arms and hands with weakness, numbness, or tingling. Diagnosis involves electrodiagnostic tests, imaging like MRI, and the Spurling maneuver. Initial treatment focuses on conservative options like medication and physical therapy, with surgery reserved for cases that fail non-operative management.
Peripheral neuropathy refers to damage to peripheral nerves. There are three main types: mononeuropathy affecting a single nerve, mononeuritis multiplex affecting multiple nerves asymmetrically, and polyneuropathy affecting multiple nerves concurrently and symmetrically. Polyneuropathy can be classified as axonopathy, myelinopathy, or neuronopathy depending on whether the axons, myelin sheaths, or neurons are affected. Symptoms and signs include both negative symptoms like numbness and weakness as well as positive symptoms like tingling and pain. Evaluation involves taking a history and examining for patterns of onset, progression, fluctuations, and other systemic diseases. Diagnosis involves nerve conduction studies and sometimes nerve biopsies. Treatment focuses
This document provides information on spinal injuries, including epidemiology, mechanisms of injury, clinical assessment, radiographic evaluation, and management. Some key points:
- Spinal injuries most commonly occur in the cervical region in individuals ages 16-30. Mortality is 40-50%.
- Clinical assessment includes inspection, palpation, and neurological examination to evaluate for tenderness, deficits, and classify the level of injury.
- The NEXUS and Canadian C-Spine rules can help determine which patients require radiographic imaging based on factors like mechanism of injury, neurological status, and range of motion.
- Management involves immobilization, monitoring ABCs, ruling out other injuries, pain control,
Cervical disc disorders include cervical spondylosis, radiculopathy, and myelopathy. Cervical spondylosis is a general term referring to degenerative changes in the cervical spine. It commonly causes neck pain but can also cause radiculopathy or myelopathy. Cervical radiculopathy involves compression of a cervical nerve root, causing pain and weakness along the nerve distribution. Cervical myelopathy refers to compression of the spinal cord, which can cause gait abnormalities, leg weakness, and hand/arm symptoms. Management involves conservative treatments like physical therapy initially, with surgery considered for worsening or persistent symptoms.
Supraspinatus tendinitis is an inflammation of the supraspinatus tendon, which is one of the most commonly affected structures in the rotator cuff. It often results from repeated overhead arm motions or other activities that cause impingement beneath the coracoacromial arch. Symptoms include pain in the shoulder region that is worsened by motions like lifting the arm overhead. Treatment involves rest, exercises to strengthen the rotator cuff muscles, modalities like ultrasound to reduce inflammation, and manual therapy such as transverse friction massage to the tendon.
Adhesive capsulitis is a condition characterized by a painful and progressive loss of shoulder range of motion. It typically progresses through painful, freezing, and thawing phases over 1-2 years. Treatment involves medications to manage pain, physical therapy to restore range of motion, and in refractory cases, procedures like corticosteroid injections or surgery. While pain is usually transient, some patients may develop permanent loss of range of motion.
Low back pain is a common condition affecting the lumbar region of the back. It has many potential causes, including muscle strains, injuries to bones or discs, and underlying medical conditions. Diagnosis involves taking a history and conducting a physical exam. Common tests used to evaluate low back pain include x-rays, MRI, and CT scans. Treatment focuses on pain relief through medications, physical therapy, exercise, and in severe cases, surgery. Proper posture and lifting techniques can help prevent low back pain.
The document provides information about the radial nerve including its anatomy, course, branches and clinical presentations of radial nerve palsies. It discusses the radial nerve's origin from the brachial plexus and branches in the arm and forearm. Common causes of radial nerve palsy include fractures and entrapment in the radial tunnel. Clinical features, investigations, treatment including splinting and tendon transfers, and postoperative management are outlined. Surgical techniques for nerve repair and reconstructive procedures are also described.
Cervical radiculopathy is caused by spinal nerve root dysfunction resulting in dermatomal pain, parasthesias, myotomal weakness, and impaired deep tendon reflexes. It is commonly caused by herniated discs or bony spurs compressing nerve roots. Diagnosis involves history, physical exam testing dermatomes and myotomes, and imaging such as MRI. Treatment includes immobilization, traction, medications, injections, and sometimes surgery for severe or progressive cases.
Dr. Orakwele Arinze presented on cervical spondylosis. The presentation included an introduction to cervical spondylosis, relevant anatomy, epidemiology, etiology, pathophysiology, clinical features, diagnosis, differential diagnosis, management, physiotherapy management, and a case study. Cervical spondylosis is an age-related degeneration of the cervical spine that can lead to nerve root or spinal cord compression. Symptoms include neck and arm pain, weakness, and sensory changes. Physiotherapy is an effective treatment and includes modalities like TENS, traction, exercises and lifestyle advice. The case study demonstrated improvement in a patient's neck pain, range of motion and strength following physiotherapy
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by pain and stiffness in the shoulder joint that limits range of motion. It involves thickening and scarring of the shoulder joint capsule. Treatment involves conservative measures like oral anti-inflammatory drugs, corticosteroid injections into the joint, physical therapy including heat therapy and gentle range of motion exercises, and manipulation under anesthesia for refractory cases. Physical therapy aims to reduce pain and inflammation in the early stage and increase mobility in the stiffening stage through heat, passive range of motion, and home exercises.
1) This document provides guidance on evaluating and differentiating the causes of low back pain through patient history, physical examination, and imaging.
2) The differential diagnosis depends on characteristics of the pain such as duration, location, radiation, and aggravating/relieving factors. Common etiologies include inflammatory, mechanical, and radicular causes.
3) The physical examination focuses on the spine, hips, and tests to reproduce pain including range of motion and provocative maneuvers. Red flags are identified.
4) Imaging like MRI can identify abnormalities in the discs, vertebrae, nerves and surrounding tissues that provide diagnostic clues. Both regular sequences and enhanced images after contrast are useful.
The document describes two patients with lumbar spinal stenosis who were treated with non-surgical approaches. Both patients presented with low back pain and leg pain that worsened with walking. They underwent physical therapy evaluations including questionnaires, examinations, and treadmill tests. Physical therapy focused on exercises to improve strength, flexibility, and walking tolerance without worsening pain. Non-surgical treatments were aimed at reducing pain and disability from lumbar spinal stenosis.
The document discusses stroke, including its definition, causes, risk factors, symptoms, assessment, recovery stages, and complications. Key points include:
- Stroke is defined as sudden neurological dysfunction due to abnormal cerebral circulation lasting over 24 hours.
- Common causes include atherosclerosis, cerebral thrombus, embolism from the heart.
- Risk factors include hypertension, diabetes, heart disease, smoking, obesity.
- Symptoms can include weakness, numbness, vision issues, speech problems.
- Recovery is assessed based on severity, duration, and affected brain region. Complications can include contractures, seizures, DVT.
This document discusses cervical spondylosis and its management. It begins with the anatomy of the cervical spine and describes the intervertebral discs and muscles. It then covers the biomechanics, epidemiology, etiology, clinical manifestations, investigations, differential diagnosis, and management including medical, surgical, and physiotherapy approaches. The goals of physiotherapy treatment are to relieve pain, improve neck movement and posture, and decrease reliance on pain medications. Exercises and modalities like heat, cold, traction, and electrical stimulation are used.
Tennis elbow, also known as lateral epicondylitis, is a tendinopathy of the extensor tendons of the forearm caused by repetitive strain from activities like tennis or manual labor. It presents as lateral elbow pain that is exacerbated by wrist extension movements. While the name suggests it is caused by tennis, 95% of cases occur in non-tennis players engaged in repetitive arm motions. Treatment begins conservatively with rest, ice, braces, and physical therapy, while corticosteroid injections provide temporary pain relief. Surgery is considered if conservative measures fail after 6-12 months.
Therapeutic management of knee osteoarthritis; physiotherap case studyenweluntaobed
The document discusses the therapeutic management of knee osteoarthritis. It provides background on the epidemiology and economic burden of the condition. Key points include that knee OA prevalence is rising with population aging and affects nearly 10% of those over 55 years old. Treatment involves a multidisciplinary approach including pharmacological interventions, physiotherapy, and sometimes surgery, with the overall goals of reducing pain and improving joint function and quality of life. Assessment involves evaluating pain levels, range of motion, muscle strength, and radiological imaging to determine the severity and appropriate treatment.
This document provides information on low back pain, including its definition, prevalence, costs, causes, examination, diagnosis, and treatment options. Some key points:
- Low back pain is very common, affecting 60-80% of adults at some point. It costs the US over $90 billion annually in direct medical expenses and lost work.
- Causes can be non-spinal (e.g. hernia, infection) or spinal (e.g. arthritis, herniated disc, stenosis).
- Examination involves assessing gait, range of motion, motor strength, sensation, and reflexes. Common diagnostic tests are x-rays, MRI, CT.
- Treatment depends on cause but
This document discusses the assessment of the cervical spine. It begins with an introduction to the anatomy and biomechanics of the cervical spine. It then describes taking a patient history, including questions about pain and symptoms. The examination involves observation, palpation, range of motion testing, muscle strength testing, sensory testing, and special tests like Spurling's test. Diagnostic imaging options like x-rays, CT scans, and MRI are also discussed.
This document provides an overview of the clinical examination of the spine. It discusses the anatomy of the spine and common spinal conditions. The examination involves obtaining a history, inspecting the spine, palpating for tenderness, and assessing range of motion. Special tests like the straight leg raise test help localize pain and diagnose conditions like herniated discs. A neurological exam evaluates muscle strength, sensation, and reflexes to identify abnormalities affecting the spinal cord or nerves. A thorough spinal exam provides important clues for diagnosing underlying spinal problems.
Cervical radiculopathy is a peripheral nerve syndrome caused by mechanical injury or chemical irritation of the cervical nerve roots. It typically affects the C5-T1 nerve roots, accounting for 5-30% of radiculopathy cases. Common causes include spondylosis, cervical disc disease, disc herniation, and biochemically-induced inflammation. Symptoms include neck pain radiating into the arms and hands with weakness, numbness, or tingling. Diagnosis involves electrodiagnostic tests, imaging like MRI, and the Spurling maneuver. Initial treatment focuses on conservative options like medication and physical therapy, with surgery reserved for cases that fail non-operative management.
Peripheral neuropathy refers to damage to peripheral nerves. There are three main types: mononeuropathy affecting a single nerve, mononeuritis multiplex affecting multiple nerves asymmetrically, and polyneuropathy affecting multiple nerves concurrently and symmetrically. Polyneuropathy can be classified as axonopathy, myelinopathy, or neuronopathy depending on whether the axons, myelin sheaths, or neurons are affected. Symptoms and signs include both negative symptoms like numbness and weakness as well as positive symptoms like tingling and pain. Evaluation involves taking a history and examining for patterns of onset, progression, fluctuations, and other systemic diseases. Diagnosis involves nerve conduction studies and sometimes nerve biopsies. Treatment focuses
This document provides information on spinal injuries, including epidemiology, mechanisms of injury, clinical assessment, radiographic evaluation, and management. Some key points:
- Spinal injuries most commonly occur in the cervical region in individuals ages 16-30. Mortality is 40-50%.
- Clinical assessment includes inspection, palpation, and neurological examination to evaluate for tenderness, deficits, and classify the level of injury.
- The NEXUS and Canadian C-Spine rules can help determine which patients require radiographic imaging based on factors like mechanism of injury, neurological status, and range of motion.
- Management involves immobilization, monitoring ABCs, ruling out other injuries, pain control,
Cervical disc disorders include cervical spondylosis, radiculopathy, and myelopathy. Cervical spondylosis is a general term referring to degenerative changes in the cervical spine. It commonly causes neck pain but can also cause radiculopathy or myelopathy. Cervical radiculopathy involves compression of a cervical nerve root, causing pain and weakness along the nerve distribution. Cervical myelopathy refers to compression of the spinal cord, which can cause gait abnormalities, leg weakness, and hand/arm symptoms. Management involves conservative treatments like physical therapy initially, with surgery considered for worsening or persistent symptoms.
The document provides information on the assessment and management of head and spinal trauma. It outlines the ABC approach for head trauma and emphasizes preventing secondary brain injury. It describes evaluating the Glasgow Coma Scale and pupillary responses. For spinal trauma, it stresses immobilization and protecting the spine during transport. Key factors include preventing further neurological injury and addressing airway, breathing, circulation issues.
Ankylosing spondylitis is a form of arthritis that primarily affects the spine and sacroiliac joints, causing fusion of the spine over time. It typically develops in young adults aged 18-30 and is more common in men. Genetics play a role, as 90% of patients have the HLA-B27 gene. Symptoms include chronic lower back pain and stiffness that worsens with inactivity. Diagnosis involves blood tests, x-rays showing spinal changes, and assessment of limited range of motion. Treatment focuses on reducing inflammation and pain through NSAIDs, DMARDs, biologics that target tumor necrosis factor-alpha, and occasionally surgery for deformities.
This document discusses neck pain, its causes, evaluation, and treatment. It notes that neck pain is the fourth leading cause of disability in the US. Causes include trauma, degeneration, inflammation, infection, infiltration, and compression. Neck pain is categorized as uncomplicated, radiculopathy, or myelopathy. Evaluation involves history, physical exam including tests like Spurling's sign, and imaging like x-rays or MRI. Common conditions are mechanical disorders, disc herniation, spondylosis, stenosis, cancer, and myofascial syndrome. Treatment depends on severity but may include conservative options like physiotherapy, medications, collar, or referral to specialist. Uncomplicated neck pain is usually treated with
Cervical spondylosis is a common cause of neck pain and stiffness that occurs due to wear and tear on the cervical vertebrae. It involves degeneration of the discs and joints between the vertebrae. Symptoms include neck pain that may radiate to the arms, numbness, weakness, and stiffness. Diagnosis is made through x-rays or MRI showing abnormalities. Most cases are treated successfully with conservative measures like physical therapy, medications, and lifestyle changes, while a small percentage may require surgery.
Cervical radiculopathy is pain in an arm caused by compression of a cervical nerve root. It is commonly caused by cervical spondylosis which results in decreased disc height and bone spurs around the vertebrae that can compress nerve roots. Physical exam findings may include pain and sensory changes in the arm corresponding to the affected nerve root level as well as weakness or reflex changes. Diagnosis is based on history, physical exam, and imaging such as MRI which is the most sensitive test for evaluating soft tissues like discs and nerves. Most cases improve over time but surgery may be needed if conservative treatment fails.
Final case presentation sci (kimberly walsh)Kimberly Walsh
This document provides an overview of cervical myelopathy and spinal cord injury, including:
- Definitions of spinal cord injury and cervical myelopathy.
- Descriptions of anatomy including the spine, cervical spine, intervertebral discs, and ligaments.
- Causes, pathophysiology, and clinical manifestations of both cervical myelopathy and spinal cord injury.
- Details on epidemiology, diagnosis, complications and management of spinal cord injury.
Spinal cord injuries complete topic about it and how to make good rehabilitation for the patient with spinal cord injuries .
wish it help people
my pleasure :)
Mostafa shakshak
Spinal cord injury results in loss of function below the site of damage. Common causes include vehicle accidents, falls, and sports injuries. Complete injuries result in total loss of sensation and movement below the injury, while incomplete injuries allow some sensation or movement. Management involves immobilization, surgery to decompress the spine, and rehabilitation to regain function. Nursing care focuses on preventing complications like pressure ulcers, respiratory issues, and autonomic dysreflexia.
Spinal cord injury results in loss of function below the site of damage. Common causes include vehicle accidents, falls, and sports injuries. Complete injuries result in total loss of sensation and movement below the injury, while incomplete injuries allow some sensation or movement. Management involves immobilization, surgery to decompress the spine, and rehabilitation to regain function. Nursing care focuses on preventing complications like pressure ulcers, respiratory issues, and autonomic dysreflexia.
This document provides an overview of examining the neck and various neck deformities. It begins with a brief anatomy section covering the bones and structures of the neck. It then outlines the steps to examine the neck - looking at the neck from all angles, feeling the bony contours and muscles, and moving the neck through its range of motion. Various neck deformities are classified and described, including congenital torticollis, Klippel-Feil syndrome, congenital high scapula, and ankylosing spondylitis. Treatment options are mentioned for each condition. Special tests to evaluate neurological involvement are also outlined.
This document provides information to help differentiate between cervical radiculopathy and peripheral neuropathy.
Cervical radiculopathy usually involves one spinal nerve root and follows myotomal and dermatomal patterns, with proximal pathology like a disc or osteophyte. Peripheral neuropathy usually involves one peripheral nerve branch with distal entrapment. Key differences are seen on neurologic examination, with radiculopathy showing reflex changes and neuropathy typically not. Supplementing with tests like electrodiagnostic studies can help determine the level and location of pathology.
Case examples demonstrate how to distinguish between C8 radiculopathy and an ulnar neuropathy based on the patterns of motor weakness, sensory loss, presence of pain, and
This document provides information on ideal diagnostics and summarizing various medical conditions and diagnostic tests. It begins with an overview of considerations for investigations, reading reports, and next steps. It then discusses the importance of confirmatory diagnosis through a team effort between diagnosticians and therapeuticians. Several sections provide details on specific conditions like shoulder pain, neck pain, low back pain, and leg swellings, outlining causes, anatomy, and potential diagnostic imaging tests and their findings.
Spinal trauma management involves immobilization, intravenous fluids, medications, and prompt referral. Anatomy and mechanisms of injury vary by spinal region. Evaluation assesses neurological function using dermatomes, myotomes, and reflexes to localize injury level. Injuries may cause hypovolaemic or neurogenic shock. Corticosteroids within 8 hours may improve outcomes but evidence is limited. Prompt management aims to prevent secondary spinal cord injury.
This document provides information on examining and assessing the cervical spine. It discusses common cervical disorders like whiplash injuries, cervical instability, and acute disk bulges. For whiplash injuries, it describes the acute, subacute, and chronic phases and associated signs and symptoms. It also outlines tests to evaluate range of motion, nerve roots, dermatomes, and special tests like Spurling's test and distraction test to assess the cervical spine.
Evaluation of Spinal Injury & Emergency ManagementAtif Shahzad
This document provides information on spinal injuries, including:
- Traumatic spinal cord injuries result in 12,000 new cases per year in the US. Most injuries occur in men aged 16-30 from vehicle crashes, falls, or sports.
- Injuries are categorized by location (cervical, thoracic, lumbar), stability (stable or unstable), and neurological status (complete or incomplete paralysis).
- Initial treatment follows ATLS protocols to stabilize the spine and assess airway, breathing, circulation, disability, and exposure. Advanced imaging can further evaluate bone and neurological injuries.
Similar to Cervical Spine Pain - Dr S L Yadav (20)
Patients with spinal cord injury face a number of challenges, with continence being a top priority. For those affected by neurogenic bladder and bowel, there are various management options available. To help understand these options, study notes in this area can be useful. These notes, which are similar to index cards, can highlight key information related to the management of neurogenic bladder and bowel in spinal cord injury patients.
This document contains summaries of 4 research studies:
1. A randomized controlled trial that found suprascapular nerve blocks were no more effective than saline injections for treating subacute adhesive capsulitis.
2. A study that found intra-articular injections of hyaluronic acid plus dextrose for knee osteoarthritis resulted in greater improvements in physical function and pain reduction compared to hyaluronic acid plus saline.
3. A randomized controlled trial that demonstrated alendronate effectively prevented bone loss in the hip in men during the first year after a traumatic spinal cord injury.
4. A study that found patients with acquired brain injuries who had contractures required more intensive rehabilitation therapy, longer
This document summarizes 4 research articles on topics related to physical medicine and rehabilitation (PMR). The first article finds that certain hematological parameters can predict abnormal CT scan findings and injury severity in pediatric patients with traumatic brain injury. The second article identifies sociodemographic and clinical factors associated with readmission within 30 days of hospitalization for traumatic brain injury. The third article estimates the minimal clinically important difference in Berg Balance Scale scores for patients with early subacute stroke who require walking assistance versus those who do not. The fourth article finds that early, intensive lower extremity rehabilitation shows preliminary efficacy in improving gross motor function in young children with perinatal stroke.
presentation about relation between posture and pain. there is lot of talk and research regarding bad posture and chronic pain. but posture, disease along with physical activity intervention should be done to manage.
community inclusion of people with disabilities mrinal joshi
Community inclusion aims to provide equal access and opportunities for people with disabilities through participation in employment, housing, education, recreation, and civic roles. Factors influencing participation include medical care, self-efficacy, physical abilities, accessible equipment and environments, social support, and disability policies. Promoting inclusion requires addressing barriers like low education, poverty, prejudice, and inaccessible settings through rehabilitation, community support, empowerment, and addressing social justice. Life care planning can support community reintegration by outlining medical, housing, equipment, preventative, and cost needs over a person's lifetime.
This document summarizes a systematic review that compared the effectiveness of task-specific training using assistive devices to task-specific usual care for improving upper limb performance after stroke. Seventeen studies were included in the review. A meta-analysis found that in the subacute phase post-stroke, task-specific training using assistive devices was more effective at reducing upper limb impairment than task-specific usual care alone, based on Fugl-Meyer Assessment scores. However, in the chronic phase post-stroke, both interventions led to similar improvements in upper limb performance, with no significant differences found between the groups. The review concluded that both interventions can improve upper limb function after stroke but task-specific training using assistive devices may
This study compared the incidence of neurobehavioral side effects of levetiracetam versus phenytoin in patients with traumatic brain injury (TBI). In a prospective observational study of 100 TBI patients treated with either levetiracetam or phenytoin, researchers found:
1. Levetiracetam was associated with significantly fewer neurobehavioral side effects than phenytoin, including less irritability, aggression, and confusion.
2. Phenytoin treatment resulted in nearly double the incidence of neurobehavioral side effects compared to levetiracetam.
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This document summarizes and discusses several articles on physical medicine and rehabilitation (PMR) topics that were published in recent issues of various journals. The articles cover a range of topics including the treatment of 12th rib syndrome, the use of the tourniquet ischemia test to diagnose complex regional pain syndrome, physiotherapy interventions for treating spasticity, a telehealth intervention to increase fitness for those with spinal cord injuries, spinal cord involvement in COVID-19, the use of local anesthetic injections in athletes, and a comparison of video-based and text-based physical activity interventions. The document also provides an introduction and welcome from the editor as well as information about new contributors.
Shoulder impingement occurs when soft tissues in the shoulder joint become entrapped and causes pain when raising the arm or lying on the affected shoulder. It is usually caused by overuse or repetitive strain without preceding trauma and affects those over 40 years old. Evaluation involves clinical exams, imaging like x-rays and MRI, and injections to diagnose impingement. Conservative treatments include immobilization, anti-inflammatories, physical therapy, cortisone injections, and exercises to strengthen muscles and improve range of motion.
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Cancer Rehabilitation. integrating rehabilitation with oncology. a model of care. cancer survivorship. rehabilitation care in low resource area. Mrinal Joshi. Rehabilitation Research Center. Jaipur.
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The document discusses different types of prosthetics including transfemoral sockets, ischial containment sockets, suction sockets, prosthetic knees, stance control knees, hydraulic knees, and pneumatic knees. It provides details on the design, advantages, and disadvantages of each type. The Dr. P.K. Sethi Rehabilitation Centre in Jaipur, India was the first private hospital in the country to have a prosthetics and orthotics center, established in 1985.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
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Are you looking for a long-lasting solution to your missing tooth?
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
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Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
1. Management of Cervical Pain
Dr S L Yadav, MD
Department of Physical Medicine & Rehabilitation
All India Institute of Medical Sciences, New Delhi
2. Neck pain is generally defined as pain and /or stiffness
felt dorsally in the cervical region
95% of patients with neck pain – Benign clinical diagnosis
(Neck sprain, mechanical neck pain, muscular neck pain, postural neck
pain, Myofascial pain syndrome)
Patients often search for a more definitive diagnosis
Cervical Pain
Gore D.R. Medscape General Medicine 1999;
Ferrari R Best practice & Research Clinical Rheumatology 2003; 17(1): 57 - 70
3. • Neck pain – Acute ( < 6 weeks) or Chronic (> 6 weeks)
• 80% of all acute neck pain resolves within days to weeks
• Common problem – Second only to Low back pain
• Population studies – prevalence of 13.8% (Norway)
• Slightly more common in Females (M:F :: 9.5% :13.5%)
• 10% of population – Neck pain on at least 7 days/month
• Neck pain occurs in 80% population at some time in their life
Cervical Pain – Epidemiology
Gore D.R. Medscape General Medicine 1999;
Ferrari R Best practice & Research Clinical Rheumatology 2003; 17(1): 57 - 70
4. Epidemiology
•Prevalence : 9-18% of general population.
•Workplace : 20-30% < 30 yrs age
50% over 45 yrs.
•Cervical pain- 2 types.
–Axial pain – pain occuring from inferior occiput to
superior interscapular region, localising to
midline or just paramidline.
–Radicular pain – pain involving shoulder girdle & distally,
manifests as pain in UE.
Equating cervical axial & cervical radicular pain can result in
misdiagnosis, inappropriate investigation & suboptimal treatment.
5. Biomechanics of Cervical Spine
• Support & stabilizes head: allowing movt. in all
planes.
• Protect spinal cord, nerve roots, vertebral artery.
• Atlanto-occipital (C0-1): 10
o
flexion & 25
o
extn.
• C1-2: 40-50% of all cervical rotation.
• Below C2-3 level, lat flexion coupled with rotation
in same direction. This motion is due to 45
o
sagital
inclination of zygapophyseal jt.
• Greatest flexion at C4-5 & C5-6
• Greatest lateral bending at C3-4 & C4-5.
6. Neck pain
Three categories
• Uncomplicated -joints,
ligaments and muscles
• Associated with
Radiculopathy [Single
nerve root ]
• Associated with
Myelopathy [Spinal
cord lesion, stenosis or
compression ]
7. Acute neck pain
• What Causes Acute Neck Pain?
– In most cases it is not
possible to pinpoint the cause
of the neck pain, or it may be
the result of an injury.
– In either case, it is necessary
to have a specific diagnosis of
the cause in order to manage
the pain effectively.
– There is a less than 1%
chance that the pain is due to
a serious medical condition.
http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp94c.pdf
10. How to differentiate the source of
Cervical pain
Pain from nerve roots or the spinal cord
c/o root pain
Sharp, intense often burning pain
Radiates to trapezi, interscapular
areas or down the arm Numbness &
motor weakness in a myotomal
distribution
Headache may occur with upper root
involvement
Symptoms aggravated by neck
hyperextension.
Pain from joints
ligaments/muscles
c/o pain & stiffness
Deep, dull aching & often episodic
pain
h/o excessive/unaccustomed activity
or of sustaining an awkward posture
No h/o injury
Localized asymmetric pain
Upper cervical pain is referred to the
head, lower cervical to the arm
Aggravated by movement, relieved
by rest
11. Clinical Evaluation
• History
• Pain
– Character/ location/
mechanism and timing
of onset/ duration/
clinical course
• Associated symptoms
– Radiation/ neurological
symptoms/ functional
limitations/
psychosocial stresses
etc.
• Examination
– Appearance/ posture/
stance/ gait
– Range of movement
– Neurological examination
– Specific tests
• Spurling test
• Axial cervical
distraction test
• Arm abduction test
12. Red Flags
• Bowel/ bladder of sexual
dysfunction:
– consider cervical
myelopathy
• Unexplained fever/ symptoms
of infection
– Consider infection related
to recent previous neck
surgery,
immunosuppressed
patient, intravenous drug
use, or prolonged steroid
use
• Unexplained weight loss
– Consider malignancy/
metastatic lesion
• Yellow flags:
– Non-physiological pain
distribution, non-organic
physical signs, repetitive
neck injuries, multiple
failed treatment, litigation
and or disability claims,
apparent secondary pain,
substance abuse,
depression or other
psychiatric diagnosis.
Carette S et. al. N Engl J Med 2005;353:392-9.
13. Physical Examination
• Cervical +shoulder ROM, Find
out whether movement
causes pain , and pain is felt
locally or radiating to UL.
• Neurologic examination -
sensory and motor + reflexes
is vital.
• Shoulder girdle, arm, forearm
& hand examination for
atrophy / fasciculation.
• Extrinsic causes of neck pain –
ear, throat conditions.
• Flexion :80°
• Extension :50°
• Lateral flexion :45°
• Rotation :80° to
either side
14. Neurological exam
• C1-C4 involvement will show no motor weakness or
reflex changes clinically
C5 C6 C7 C8
Sensory Lateral arm Thumb Middle finger Little finger
Motor Deltoid Wrst extensors Tricep Finger flexion
Disc C4-C5 C5-C6 C6-C7 C7-T1
Reflex Bicep Brachioradialis Tricep
15. Common Cervical Rediculopathy Patterns
Root Symptoms Motor Reflex
C2 Posterior occipital headaches, temporal pain - -
C3 Occipital headache, retro-orbital or retroauricular pain - -
C4 Base of neck, trapezial pain - -
C5 Lateral arm Deltoid Biceps
C6 Radial firearm, thumb and index fingers Biceps, wrist extension Brachioradialis
C7 Middle finger Triceps, wrist flexion Triceps
C8 Ring and little fingers Finger flexors -
T1 Ulnar forearm Hand intrinsics -
16. Referred Pain Pattern
• Occiput: C1-2, C2-3
(Headache: C3-4, C4-5, C5-6)
• Face: C1-2, C2-3, C3-4
• Posterior Neck: C3-4 & C4-5
• Supraspinatus fossa of scapula: C5-6
• Periscapular / trapezi: C4,5
• Lower end of scapula: C6-7,
C7,8.
• To Arm: C5
• To forearm & hand: C6,7,8.
17. Investigations
• Short lived neck pain and no
red flags – no tests needed
• Systemic disease
– Rheumatology screen
– Metabolic screen
• Ca/ Phosphate/ ALP
– Infection/ inflammatory
screen
• ESR/ CRP/ FBC/ cultures
• Neurological symptoms/ signs
– NCS/ EMG
• Radiological
– X-ray; dynamic views (as long
as stable)
– CT scan;
– MRI scan;
– Bone scan/ CT-SPECT scan
– Shoulder and upper limb
investigations
• X-ray/ Ultrasound/ MRI
– TOS investigations
• Doppler studies
18. X-RAY
• Plain radiographs evaluate chronic degenerative
changes, metastatic disease, infection, spinal
deformity, and stability.
• Use 7 views
– Flexion-extension views identify subluxations or
cervical spine instability.
– Open-mouth views evaluate the odontoid process and
C1-C2 stability.
– AP views identify tumors, osteophytes, and fractures.
– Lateral views assess stability and spondylosis (ie,
spurring, disc space narrowing).
– Oblique views reveal DDD, as well as foraminal
encroachment by uncovertebral or z-joint
osteophytes.
19. Computed Tomography
• Delineates cervical spine fracture and is used extensively
in trauma cases.
• CT-myelography
– A myelogram followed by CT scan may be obtained prior to
cervical decompressive spinal cord or nerve root surgery.
– This study evaluates the spinal canal, its relationship to the
spinal cord, and nerve root impingement from disc, spur, or
foraminal encroachment.
– CT-myelography, still the criterion standard, remains superior to
MRI in detecting lateral and foraminal encroachment, despite
greater expense and morbidity. Consequently, CT-myelography
is not the initial imaging study to evaluate cervical spine and is
reserved for complicated cases.
20. MRI
• MRI remains the imaging modality of choice to evaluate
cervical disk disease due to its low morbidity.
– Advantages include soft tissue definition (eg, cervical discs, spinal
cord), cerebrospinal fluid visualization, noninvasiveness, and lack of
patient radiation exposure.
– disadvantages include expense, inability of claustrophobic patients to
tolerate the procedure, dependence on patient cooperation to
minimize artifact, high false-positive rate, and insensitivity compared
to CT scan in evaluating bony structures.
– MRI appears inferior in differentiating cervical disc prolapse (ie, soft
cervical disc) from spondylitic osteophytic compression (ie, hard
cervical disc).
• Contraindications to MRI include patients with
embedded metallic objects, such as pacemakers, surgical
clips, spinal cord stimulators, or prosthetic heart valves
that may be dislodged by MRI magnets
22. ELECTRODIAGNOSTIC STUDIES
• Electrodiagnostic studies continue to be standard
for evaluating neurologic function of the cervical
spine.
– Needle EMG: detect acute and chronic radicular features.
– A diagnosis of radiculopathy is apparent when needle EMG
reveals abnormal spontaneous potentials and/or certain changes
in motor unit action potentials, in 2 or more muscles innervated
by the same nerve root but different peripheral nerves. Ideally,
EMG abnormalities also should be demonstrated in the
paraspinal muscles to confirm the diagnosis of radiculopathy.
– CMAP amplitude drop of 50% or more indicates significant axonal
loss.
– NCS/EMG is especially helpful to differentiate cervical
radiculopathy from confounding neuropathic conditions (eg, ulnar
nerve entrapment, carpal tunnel syndrome, peripheral
neuropathy, plexopathy).
Can J Neurol Sci. Hassan A et al, 2013 Mar;40(2):219-24.
Clinical predictors of EMG-confirmed cervical and lumbosacral radiculopathy.
23. Clinical Maneuvers
• Spurling’s maneuver - Axial loading of the neck while
the head is extended and rotated will often provoke
radicular pain.
• Abduction Relief sign - Placing the affected hand on
top of the head takes stretch off of the affected nerve
root and may decrease or relieve radicular symptoms
• Lhermitte sign - An electric shock sensation down
the center of the back after neck flexion is indicative
of cervical spinal cord pathology such as cervical
myelopathy.
27. Clinical Tests
• Adson’s test – for thoracic outlet syndrome.
• Roos test – done in surrender position, to r/o thoracic outlet
syndrome..
• Hoffmann’s test – rapidly extend distal phalanx of middle finger
by flicking its ant surface. Test is +ve if it results in flx of IP jts of
thumb & index finger.
• Dynamic Hoffmann’s test – rpt while the pt flx / ext neck,
which often facilitates the response.
• Inverted radial reflex - +ve if fingers flex during brachioradial
reflex.
32. Hand: Clinical signs are useful in
detecting subtle myelopathy in the
upper extremities
33. Patient Outcome Assessment
• Disability
• Neck Disability Index (NDI)
• Neck and Arm Pain
• NRS
• Function - HRQol
• SF-12®V2
34. Each section is scored on a 0–5 scale,
5 representing the greatest disability.
(Vernon H, Mior S. "The Neck Disability Index: a study of
reliability and validity." J Manipulative Physiol Ther. 1991
Sep;14(7):409-15.)
35. RTA & Whiplash
• Whiplash is an acceleration-deceleration mechanism of energy
transfer to the neck. It may result from “...motor vehicle collisions...”.
The impact may result in bony or soft tissue injuries which in turn may
lead to a variety of clinical manifestations (Whiplash-associated
disorders).
Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, et al. Scientific
Monograph of the Quebec Task Force on Whiplash-Associated Disorders, Redefining
Whiplash and its Management. Spine 1995;20(8 Suppl):1S-73S.
• 62% of RTA victims have whiplash
• 33-66% develop symptoms within 24 hours
• 30-42% have intermittent pain at 1 year
• 6% have continuous pain at 1 year
• 28% have chronic pain
36. Specific…..
– Myelopathy
• LMN signs in the upper limbs at the level of
compression (flaccid paralysis, muscle atrophy,
absent reflexes)
• UMN signs below the level of the lesion,
mainly evident in the lower limbs.
(hypertonicity, hyperreflexia, clonus, Babinskis
sign)
• Sensory deficit is non dermatomal involving
large areas e.g. whole arm/forearm/wrist
• Bladder involvement may be present
• Funicular pain (burning pain)
37. Other signs of myelopathy
• Hoffman's test/dynamic Hoffmann's test
• Lhermittes sign
• Inverted supinator jerk/inverted radial reflex
• Clonus
• Myelopathy hand
• Gait abnormalities such as ataxic broad based
shuffling gait
39. UNCOVERTEBRAL JOINT
• Lower cervical vertebrae (C3-7) have unique
synovial joint-like articulations called
uncovertebral joint or joints of Luschka
• These joints commonly develop OA changes
• Proximity of UV joint to spinal nerve roots can
cause compression due to degenerative
change.
40. Neck Pain or injury
Immediate cervical radiographs indicate
diagnosis?
Red Flags present? Cervical injury risk factors ?
Diagnosis life-threatening or requiring referral
Referral to specialist
Begin diagnostic workup it surgery would be
considered Cervical films negative or show
spondylosis?
Symptomatic treatment 4 more weeks Continued pain
and disability?
Evaluate for complications or occult disease
(Basic lab tests)
Unsure of diagnostic course of action?
Referral to specialist Treatment
successful?
No further Treatment
Chronic neck pain
Confirming or unsure
Cervical films as needed:
MRI Cervical spine CT Cervical spine
Myelogram or
Electromyelography
Symptomatic treatment 2 more weeks Continued pain and Disability?
Symptomatic treatment for 2 weeks Continued pain and Disability?
Cervical radiculopathy or myelopathy Cervical neck strain, or cervical
spondylosis
Radicular pain and/or pattern?
Yes
No
Yes
Yes
Yes
Yes
No
No Diagnosis
Yes
Yes
OR
Yes No
No
No Yes
No
No
No
No
42. Acute Neck pain
• NSAIDs
• Exercise groups performed better compared to Rest groups (Rest
makes Rusty)
Chronic Neck pain
• Educational efforts & exercise rehabilitation programme helped
majority of patients in relieving psychological distress, pain and
helped patients to return to work
• Drug therapy may not be very useful in non specific chronic neck
pain
• Limited evidence of efficacy of Radiofrequency neurotomy for
facet joint pain
Neck Pain – Treatment
Ferrari R Best practice & Research Clinical Rheumatology 2003; 17(1): 57 - 70
43. Treatment Options
• Medications
– NSAID, COX-2 inhibiters
– Muscle relaxants – used to aid sleep if disrupted by muscular
guarding.
– Tricyclic antidepressants like amitryptiline / nortryptiline
prescribed at 10-25mg at bedtime can be beneficial in relieving
pain.
– Gabapentin & pregabalin 300-900mg/ day can be effective in
modulating pain.
– Other drugs are tiagabine, oxcarbamazepine , opiate analgesics
for resistant cases.
• Surgery:
– Diskectomy, Laminoforaminectomy, cervical arthroplasty
44. Radiculopathy: Medical vs. Surgical
management
Carette S et. al. N Engl J Med 2005;353:392-9.
• Few good-quality studies comparing surgical and non-surgical
treatments for cervical radiculopathy
• A significantly greater reduction in pain at 3 months in
surgical group than the patients who were assigned to
receive physiotherapy or who underwent immobilization in a
hard collar (reductions in VAS for pain: 42 %, 18 % & 2 %,
respectively).
• No difference among the 3 treatment groups in any of the
outcomes measured, including pain, function, and mood at 1
year follow up.
45. Neck Pain : Algorithm for management
History / physical examination
Whiplash
associated
disorder
Radiculopathy Axial Neck
pain
Suspected
infection /
neoplasm
Suspected
myelopathy
X-ray MRI/Labs
Confirmed
NSAID ± Muscle
Relaxant + early
return to usual activities
GIII/IV
GI/II
If -ve
If -ve
Consultation
Grade IV
confirmed
Immobilize /
Consultation
Opioid, Anticonvulsant or antidepressant
If not resolved
Investigate further
If not resolved
* Douglass AB et. al. J. Am. Board
Fam Pract 2004;17: S13-22
46. Recommendations for Diagnosis and Imaging
• RECOMMENDATION: It is suggested that the diagnosis of cervical radiculopathy be
considered in patients with arm pain, neck pain, scapular or periscapular pain, and
paresthesias, numbness and sensory changes, weakness, or abnormal deep
tendon reflexes in the arm. These are the most common clinical findings seen in
patients with cervical radiculopathy. Grade of Recommendation: B
• RECOMMENDATION: It is suggested that the diagnosis of cervical radiculopathy be
considered in patients with atypical findings such as deltoid weakness, scapular
winging, weakness of the intrinsic muscles of the hand, chest or deep breast pain,
and headaches. Atypical symptoms and signs are often present in patients with
cervical radiculopathy, and can improve with treatment. Grade of
Recommendation: B
• RECOMMENDATION: Provocative tests including the shoulder abduction and
Spurling’s tests may be considered in evaluating patients with clinical signs and
symptoms consistent with the diagnosis of cervical radiculopathy. Grade of
Recommendation: C
• RECOMMENDATION: Because dermatomal arm pain alone is not specific in
identifying the pathologic level in patients with cervical radiculopathy, further
evaluation including CT, CT myelography, or MRI is suggested prior to surgical
decompression. Grade of Recommendation: B
North American Spine Society Evidence-Based Clinical Guidelines for
Multidisciplinary Spine Care 2010
47. Recommendations for Diagnosis and
Imaging
• RECOMMENDATION: MRI is suggested for the confirmation of correlative
compressive lesions (disc herniation and spondylosis) in cervical spine
patients who have failed a course of conservative therapy and who may be
candidates for interventional or surgical treatment. Grade of
Recommendation: B
• RECOMMENDATION: CT myelography is suggested for the evaluation of
patients with clinical symptoms or signs that are discordant with MRI
findings (eg, foraminal compression that may not be identified on MRI). CT
myelography is also suggested in patients who have a contraindication to
MRI. Grade of Recommendation: B
• RECOMMENDATION: In the absence of reliable evidence, it is the work
group’s opinion that CT may be considered as the initial study to confirm a
correlative compressive lesion (disc herniation or spondylosis) in cervical
spine patients who have failed a course of conservative therapy, who may
be candidates for interventional or surgical treatment and who have a
contraindication to MRI. Work Group Consensus Statement
North American Spine Society Evidence-Based Clinical Guidelines for
Multidisciplinary Spine Care 2010
48. Outcome Measures for Medical/Interventional
and Surgical Treatment
• RECOMMENDATION: The Neck Disability Index (NDI), SF-
36, SF-12 and VAS are recommended outcome measures
for assessing treatment of cervical radiculopathy from
degenerative disorders. Grade of Recommendation: A
• RECOMMENDATION: The Modified Prolo, Patient Specific
Functional Scale (PSFS), Health Status Questionnaire,
Sickness Impact Profile, Modified Million Index, McGill
Pain Scores and Modified Oswestry Disability Index are
suggested outcome measures for assessing treatment of
cervical radiculopathy from degenerative disorders.
GRADE OF RECOMMENDATION: B
North American Spine Society Evidence-Based Clinical Guidelines for
Multidisciplinary Spine Care 2010
49. Medical and Interventional Treatment
• RECOMMENDATION: Emotional and cognitive factors (e.g., job dissatisfaction) should be
considered when addressing surgical or medical/interventional treatment for patients with cervical
radiculopathy from degenerative disorders. GRADE OF RECOMMENDATION: I (Insufficient
Evidence)
• RECOMMENDATION: As the efficacy of manipulation in the treatment of cervical radiculopathy
from degenerative disorders is unknown, careful consideration should be given to evidence
suggesting that manipulation may lead to worsened symptoms or significant complications when
considering this therapy. Pre-manipulation imaging may reduce the risk of complications. Work
Group Consensus Statement
• RECOMMENDATION: Transforaminal epidural steroid injections using fluoroscopic or CT guidance
may be considered when developing a medical/interventional treatment plan for patients with
cervical radiculopathy from degenerative disorders. Due consideration should be given to the
potential complications. GRADE OF RECOMMENDATION: C
• RECOMMENDATION: Ozone injections, cervical halter traction and combinations of medications,
physical therapy, injections and traction have been associated with improvements in patient
reported pain in uncontrolled case series. Such modalities may be considered recognizing that no
improvement relative to the natural history of cervical radiculopathy has been demonstrated.
Work Group Consensus Statement
North American Spine Society Evidence-Based Clinical Guidelines for
Multidisciplinary Spine Care 2010
50. EBM of Acute Cervical Pain
• There is both a lack of evidence (i.e. few
or no scientific studies conducted) and a
lack of high quality studies on pain-
relieving treatments in this area
• Not effective
– There is scientific evidence that
collars are not effective for acute
neck pain
• Effective Measures
• Measures that are effective for relieving
acute neck pain are:
– Staying active and keeping the neck
moving;
– gentle neck exercises (these can be
started soon after the pain starts);
– combined (or ‘multi-modal’)
treatments involving cervical passive
mobilisation with exercises, or
– exercises with other types of
treatments;
– and pulsed electromagnetic therapy
(reduces pain in the short term).
www.nhmrc.gov.au
51. EBM of Acute cervical Pain
• Inconclusive Studies on
– TENS,
– electrotherapy and
– micro-breaks (small breaks from
computer work) for acute neck
pain
• have not tested these
treatments against placebo.
• No studies done to prove is work or not
• There are no studies that have looked at:
– acupuncture,
– pain-relieving medication
(analgesics), anti-inflammatory drugs
(NSAIDs),
– Cervical manipulation, cervical
passive mobilisation,
– multi-disciplinary treatment in the
workplace,
– Muscle relaxants,
– neck school,
– patient education,
– spray and stretch therapy and
– traction for the treatment of acute
neck pain.
www.nhmrc.gov.au
52. Neck pain with radiculopathy
• There is little credible evidence to
support one best course of
treatment for neck pain with
radiculopathy
• One non-blinded randomized trial of
patients with more than 3 months of
radicular pain compared surgery
with physical therapy or
immobilization in a collar.
The long-term result was no
difference in pain, although the
surgery group had a greater short-
term reduction in pain, and a large
proportion of patients in all groups
eventually had surgery
• One very real problem in the study of
the treatment of radicular symptoms is
that the natural history of symptomatic
radiculopathy is not known.
The belief that untreated patients will
develop progressive disability is not
supported by reliable evidence. The
reported death rates from surgical
procedures are 0% to 1.8%, and the rate
of non-fatal complications is reported as
1% to 8% .
Therefore, there are no clear
indications for which patients with neck
pain and radiculopathy should be
referred for surgery and the choice of
surgical procedure has not been
established by appropriately designed
studies.
www.nhmrc.gov.au
53. Pain Physician. Kaye AD et al; 2015
Nov;18(6):E939-1004.
Efficacy of Epidural Injections in Managing
Chronic Spinal Pain: A Best Evidence Synthesis.
CONCLUSION:
This systematic review, with an assessment of the quality of
manuscripts and outcome parameters, shows the efficacy of
epidural injections in managing a multitude of chronic spinal
conditions.
Data sources included relevant literature identified through searches of PubMed for a
period starting in 1966 through August 2015; Cochrane reviews; and manual searches
of the bibliographies of known primary and review articles.
A systematic review of randomized controlled trials of epidural injections in
managing chronic spinal pain.
54. Strong Evidence of Treatment Effect
Moderate Evidence of Treatment Effect (2)
1. Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P, Bronfort G, Cervical overview group, The Cochrane Collaboration. Manipulation
and mobilization for mechanical neck disorders (Review).
2. Gross AR, Goldsmith, C, Hoving, JL, Haines T, Peloso P, Aker P, Santaguida P, Myers C, and the Cervical Overview Group. Con-servative
Management of Mechanical Neck Disorders: A Systematic Review. The Journal of Rheumatology 2007; 34:3, 1083-102.
3. Gross AR, McLaughlin L, Cervical Overview Group. Lecture notes from HaNSA meeting, McMaster University, 2008.
4.Sterling M, Jull G, Wright A. Cervical Mobilisation: concurrent effects on pain, sympathetic nervous system activity, and motor activ-ity. Manual
Therapy 2001 6(2), p.72-81.
55. Gross A, Kay TM, Paquin J, Blanchette S, Lalonde P, Christie T, Dupont G,
Graham N, Burnie SJ, Gelley G, Goldsmith CH, Forget M, Hoving JL,
Brønfort G, Santaguida PL; 28 January 2015
Cochrane
No high quality evidence was found, indicating that there is still uncertainty about
the effectiveness of exercise for neck pain. Using specific strengthening exercises as
a part of routine practice for chronic neck pain, cervicogenic headache and
radiculopathy may be beneficial. Research showed the use of strengthening and
endurance exercises for the cervico-scapulothoracic and shoulder may be beneficial
in reducing pain and improving function. However, when only stretching exercises
were used no beneficial effects may be expected. Future research should explore
optimal dosage.
56. ISRN Pain. Pia Damgaard et al,Volume 2013 (2013), 23
pages; Evidence of Physiotherapy Interventions for
Patients with Chronic Neck Pain: A Systematic Review
of Randomised Controlled Trials
Review Article
Only exercise therapy, focusing on strength and endurance training, and multimodal
physiotherapy, cognitive-behavioural interventions, massage, manipulations, laser
therapy, and to some extent also TNS appear to have an effect on CNP.
However, sufficient evidence for application of a specific physiotherapy modality or
aiming at a specific patient subgroup is not available.
57. Take home message…
• Thorough evaluation and assessment is
essential for proper diagnosis & management
• Significant patients are looking around for
specific diagnosis which may reduce their
anxiety
• The clinical picture is often non-specific
• Beware of alerts in evaluation & treatment