Neck pain can have many causes, but is generally due to soft tissue injuries or abnormalities of the cervical spine structures. The cervical spine is comprised of 7 vertebrae, intervertebral discs, and supporting ligaments and muscles. Common causes of neck pain include muscle strains, disc injuries such as herniations or protrusions, arthritis, and fractures or dislocations. Symptoms vary depending on the underlying cause but often include neck pain and tenderness as well as reduced range of motion. Treatment involves physical therapy, medications, and sometimes surgery or injections depending on the severity and nature of the condition causing neck pain.
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.
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.
As part of a class presentation, we attempted to make this to briefly explain what Torticollis meas, the Types of presentation of Torticollis, and Management strategies for a Physiotherapist for Congenital Torticollis especially.
I hope this helps. :)
The pictures and information had been taken from internet, complied to make a brief presentation for the purpose of class presentation.
I do not own any content.
As part of a class presentation, we attempted to make this to briefly explain what Torticollis meas, the Types of presentation of Torticollis, and Management strategies for a Physiotherapist for Congenital Torticollis especially.
I hope this helps. :)
The pictures and information had been taken from internet, complied to make a brief presentation for the purpose of class presentation.
I do not own any content.
What is the spine?
Your body's main supporting structure is your spine, also known as your backbone. It links several musculoskeletal system components. Your spine supports you as you sit, stand, walk, bend, and twist. Back injuries, disorders affecting the spinal cord, and other issues can harm the spine and result in back discomfort.
this is a presentation on atlanto-axial and atlanto-occipital joints. after reading this, most of you will know about atlas and axis, joint type, anatomy of joint, movements allowed by joint and its clinical considerations.
Bones of Trunk (Human Anatomy)
by DR RAI M. AMMAR
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Free Download e Books,PPT's and Lecture notes
Contents
Knee Joint anatomy with Diagrams
Anatomical Components of Knee
Anatomy of Patella
Innervations of the Knee
Knee Movements
Osteoarthritis in the Knee
Management of Disorders in Knee joint
MOVEMENT OF BONES OF AXIAL AND APPENDICULAR SYSTEM.pptxTaniyaMondal6
You can find here about the Movements of Bones of Axial and Appendicular System, Range of Motion, Bones, Joint Movements in Anatomy and Physiology with the help of 3D live images for better understanding and knowledge purpose. This presentation is made considering the new medical and nursing students. explained in an easy wasy. so that you can learn some effective knowledge through this slides.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. DEFINITION:
• Discomfort or more intense forms of pain that
are localized to the cervical region.
• This term generally refers to pain in the
posterior or lateral regions of the neck.
3. The spine has three major
components:
1. The spinal column
(i.e., bones and discs).
2. Supporting structures
(e.g., muscles and ligaments).
3. Neural elements
(i.e., the spinal cord and nerve
roots).
4. The spinal column:
• It is composed of vertebrae that begin in the upper
torso and end at the base of the skull. Seven
vertebrae make up the cervical spine.
• They are smaller in size when compared to other
spinal vertebrae.
5. A typical vertebra consists of:
•Large vertebral body in the front.
•2 strong bony areas (pedicles) connecting the vertebral body &
the posterior arch.
•A posterior arch of bony structures in the back (the spinous process, lamina & the
transverse process).
•The vertebral bodies support 80% of all of the loads applied to the spine.
•Its main purpose is to protect the spinal.
6. Intervertebral discs:
The vertebrae are connected in the front of the spine by IVD. IVD
make up ¼ of the spinal column's length.
Discs are not vascular & depend on the end plates to diffuse
nutrients.
Discs help to support the spine & allow some vertebral motion
(ext & flex). Individual disc movement is very limited – however
considerable motion is possible when several discs combine
forces.
There are no discs between the Atlas (C1), Axis (C2), and
Coccyx.
7. IVD are strong tissues, filled with gel. Composed of an
annulus fibrosus & a nucleus pulposus.
The cartilaginous layers of the end plates anchor the
discs in place.
The intervertebral discs are fibrocartilaginous cushions
serving as the spine's shock absorbing system, which
protect the vertebrae & other structures (i.e. nerves).
9. Ligaments:
Ligaments (which are
comparable to thick
rubber bands) work
to prevent excessive
movement that
could result in
serious injury
(they provide
stability to the
spine).
11. Atlas and Axis Ligament Systems
The Atlas (C1) & Axis (C2) are different from the
other spinal vertebrae. The upper cervical
ligament system is especially important in
stabilizing the UCS from the skull to C2.
1. Occipitoatlantal Ligament Complex.(4)
2. Occipitoaxial Ligament Complex.(4)
3. Altantoaxial Ligament Complex.(4)
4. Cruciate Ligament Complex.
12. Muscles:
• They help to provide spinal balance and
stability, and enable movement.
• There are different types of muscle:
forward flexors, lateral flexors, rotators,
and extensors.
Types of Vertebral Muscles: General Location:
Forward flexors Anterior
Lateral flexors Lateral
Rotators Lateral
Extensors Posterior
13. Muscles of the Posterior Cervical and
Upper Thoracic Spine
Semispinalis Capitus
(head rotation/pulls backward)
Iliocostalis Cervicis
(extends Cv)
Longissimus Cervicus
(extends Cv)
Longissimus Capitus
(head rotation/pulls backward)
Longissimus Thoracis
(ext./lat. Flex. vert column, rib rotation)
Iliocostalis Thoracis
(ext./lat. flexion vert column, rib rotation)
Semispinalis Thoracis
(ext/rotates vert column)
14. Spinal Cord and Cervical Nerve Roots :
There are 8 pairs of cervical nerves.
The PNS is the complex system of nerves that
branch off from the spinal nerve roots.
The cervical nerves control many bodily
functions and sensory activities.
C1: Head and neck C5: Wrist extensors
C2: Head and neck C6: Wrist extensors
C3: Diaphragm C7: Triceps
C4: Upper body muscles C8: Hands
(e.g. Deltoids, Biceps)
15. • The spinal cord is surrounded
by spinal fluid (CSF) and by
several layers of protective
structures, including the dura
mater, the strongest,
outermost layer.
16. Vascular System of the Spine
Arteries Supplying Spinal
Column:
Vertebral
Basilar
Carotid
Veins Supplying Spinal
Column:
Internal Jugular
External Jugular
Superior Vena Cava
17. How the Spinal Column Should Look?
Posterior aspect
-> should be perfectly
straight, with no lateral
curves.
Sagittal view
-> should be inward curves
(lordosis) at the cervical &
lumbar levels outward
curve (kyphosis) at the
thoracic level.
These curves allow the head
to position over the pelvis in
a sitting & standing
position, while allowing for
load bearing and shock
absorption in the spine.
20 to 40˚
18. Facet Joints:(Zygapophyseal or Apophyseal Joints)
Are located at the back of the
spine (posterior).
Each vertebra has 2 sets of facet
joints.
One pair faces upward (superior
articular facet) & one downward
(inferior articular facet).
There is one joint on each side (rt &
lt).
They are synovial hinge–like
joints (surrounded by a capsule
of connective tissue, produces a
fluid to nourish & lubricate the
joint & there surfaces are coated
with cartilage allowing joints to
move or glide smoothly
[articulate] against each other).
19. They allow flexion (bend
forward), extension
(bend backward) and
twisting motion.
Certain types of
movement are restricted.
The spine is made more
stable due to the
interlocking nature to
adjacent vertebrae.
20. ROM of the neck:
The neck has a significant amount of motion (e.g., rotate
side to side, bend forward and backward).
Flexion & extension mainly at occipito-atlantoid j.
may extends throughout cervical spine.
Lateral flexion throughout cervical spine.
Rotation mainly at atlanto-axial j.
may extends throughout cervical spine.
EXTENSION:
55 degree.ROTATION:
30 degree rotation
LATERAL
FLEXION:
40 degree.
FLEXION:
Able to touch
chest with chin.
21. Neck Pain
Neck pain may result from abnormalities in the soft
tissues—the muscles, ligaments, and nerves—as well
as in bones and joints of the spine.
The most common causes of neck pain are soft-tissue
abnormalities due to injury or prolonged wear and
tear.
In rare instances, infection or tumors may cause neck
pain.
In some people, neck problems may be the source of
pain in the upper back, shoulders, or arms.
24. Cervical Disc Disease:
• Most common site C5-6 & C6-7.
• Cause:
– Trauma is a predisposing factor.
• Pathology:
– Disc bulge: generalized symmetric extension of the disc margin.
– Disc protrusion: herniation of nuclear material through a defect in annulus.
– Extrusion: herniation of nuclear material
resulting in an anterior extradural mass
attached to the nucleus of origin(pedicle).
– Disc sequestration:
separation of material from the disc.
Protrusion
Extrusion Sequestration
25. • Clinical features:
– Radicular pain with decreased cervical range of motion
(ROM).
– Discogenic pain without nerve root involvement:
decreased cervical ROM, normal neurologic examination &
possible pain exacerbation with axial compression.
– Myofascial tender or trigger points commonly are
palpable.
– Tenderness with posteroanterior mobilization may suggest
disc pathology.
26.
27. Investigations:
PXR -> narrowing of disc space.
MRI -> modality of choice.
Electrodiagnostic studies .
TREATMENT:
1. Physical Therapy
2. Surgical Intervention
3. MEDICATION
○ NSAIDs are 1st line of R for most cervical conditions.
○ Muscle relaxants to potentiate the NSAID analgesic
effect & not necessarily to control muscle spasm.
○ Oral corticosteroids treat inflammatory cervical
radiculopathy.
Sagittal MRI
demonstrating cervical
intervertebral disc
protrusions at C3-C4 and
C7-T1.
28. Cervical Spondylosis:
Chronic degeneration of the cervical spine that affects the
vertebral bodies, IVD (disk herniation and spur formation), facet
joints, longitudinal ligaments, ligamentum flavum & spinal canal
contents(nerve roots and/or spinal cord).
Pathology:
IVD lose hydration & elasticity with age -> cracks and fissures.
Ligaments lose their elastic properties -> develop traction spurs.
Disk collapses (biomechanical incompetence) -> annulus bulge
outward.
Disk space narrows, annulus bulges & facets override
-> increases motion at that spinal segment & hastens the damage to the
disk.
-> cross-sectional area of the canal is narrowed.
Acute disk herniation may complicate chronic spondylotic changes.
29.
30. Clinical features:
40-60 years of age.
Examination:
Spurling sign - Radicular pain exacerbated by extension and
lateral bending of the neck toward the side of the lesion.
Lhermitte sign - This generalized electrical shock sensation
with neck extension.
Cervical pain with decreased ROM in the cervical spine.
Radiculopathy .
Distal weakness.
Increased reflexes in the lower extremities & upper
extremities below the level of the lesion.
Extensor planter reflex & Hoffman sign in severe
myelopathy.
31. Investigations:
PXR ->
facet joints, the foramen,
intervertebral disk spaces, and
osteophyte formation.
Myelography + CT ->
to assess spinal and foraminal
stenosis. [INVASIVE]
CT with or without intrathecal
dye ->
to estimate the diameter of the
canal, small lateral osteophytes
& calcific opacities in the middle
of the vertebral body.
MRI -> modality of choice.
Electrodiagnostic studies .
32. TREATMENT:
1. Physical Therapy.
2. Surgical Intervention.
3. Injection: Cervical, zygapophyseal, intra-
articular steroid injection
4. MEDICATION:
○ NSAIDs are 1st line of R for most cervical
conditions.
○ Muscle relaxants to control muscle spasm.
○ Oral corticosteroids treat inflammatory
cervical radiculopathy.
33. Cervical Sprain and Strain:
One cause of cervical strain is termed
cervical acceleration-deceleration injury
(whiplash injury).
Causes:
Motor vehicle accidents, lifting or pulling heavy
objects, awkward sleeping positions, unusual
upper-extremity work & prolonged static
positions.
Repetitive or abnormal postures may contribute
to cervical sprains and strains.
34. Pathology:
Cervical strain is produced by an overload injury to the muscle-
tendon unit because of excessive forces on the cervical spine.
->Elongation & tearing of muscles or ligaments.
->Secondary edema, hemorrhage, and inflammation may occur.
Clinical features:
C/O:
Neck pain & headache.
Difficulty sleeping, disturbed concentration & memory due to
pain.
Neurologic symptoms: weakness or heaviness in the
arms, numbness & paresthesia.
Examination:
stiffness of the neck with decreased active & passive ROM.
spasm tightness, muscle hardness.
35. Treatment:
1. Physical therapy.
2. Traction, manipulation or acupuncture.
3. Injection (chronic, persistent neck pain). Types
of injection include epidural, selective nerve
root, or facet block injections.
4. Percutaneous radiofrequency neurotomy of
medial branch nerve to facet joint is effective
for chronic neck pain due to cervical
zygapophysial joint pain.
5. MEDICATION:
○ NSAIDs are 1st line of R for most cervical conditions.
○ Muscle relaxants to control muscle spasm.
○ Oral corticosteroids.
Full recovery within weeks
36. Cervical sublaxation & dislocation:
• Spontaneous or 2ry to injury.
• Types:
1. Cong. failure of fusion of odontoid body with axis
vertebra.
2. Inflammatory softening of trans lig of atlas.
3. Instability dt previous injury or RA.
Displacement
of atlas with
dens
Displacement of atlas
on axis
Sublaxation
of v over 1
below
37. Clinical features:
Discomfort stiffness
& muscle spasm.
Radiology:
Displacment.
Treatment:
According to cause:
Traction or plaster collar
or operative fusion.
38.
39. Tumours in relation to Cx spine:
Site:
1. In the spinal Column.
2. In the meninges or rarely spinal cord.
3. In the fibrous components of PN (neurofibroma).
4. In adjacent soft tissue.
Type:
Malignant > benign.
Usually metastatic.
Examples:
Meningioma -> uncommon to compress the cord.
Neurofibroma in IV foramen -> cord compression.
Clinical features:
Of compression on CORD, interference with BRACHIAL PLEXUS or
local destruction & collapse.
40. Ankylosing spondylitis:
It creeps up the spine from below.
Cause:
Unknown.
Pathology:
Begins with SIJ usually extends upwards to involve lumber, thoracic &
cervical spine, in severe cases hip or shoulder involvement.
Articular cart., synovium & lig. Show ch. Infl changes & then
ossification.
Clinical features:
Men, 16-25 yrs.
Aching pain in low back with increasing stiffness then extends
upwards to neck.
Treatment:
Patient education.
Exercise.
Support cervical spine by plastic collar.
41. Rheumatoid Artheritis:
It is chronic infl of joints associated with mild
constitutional symptoms. Usually affected in
rheumatoid polyartheritis, especially in sero –ve
disease.
Cause:
Unknown. Maybe autoimmune or infection.
Importance:
IVD destruction leads to gradual forward sublaxation.
Risk of atlanto-axial sublaxation dt softening in transverse
lig of atlas.
Radiological:
1-Errosions of IV joints. 2-Sublaxation.
Treatment:
Support cervical spine by plastic collar or in some cases
local IV fusion.
Diagnosis:
1. Simultaneous
involvment of
other joints.
2. Raised ESR.
3. RF +ve.
42. TB of cervical spine
• Less common than in thoracic spine &
lumbar region.
• Pathology:
43. Clinical features:
Child, & young adults.
Pain in neck and occiput, aggravated by motion.
+ 1 of following: diff of
swallowing, abcess, sinus, neurological sympt. from cord
dysfunction (UL before LL)
On examination:
○ Cervical muscle spasm. Prominent 1 or more spinal process.
○ Local tenderness on deep palpation over spinal process. Limited
painful neck ROM.
Investigations:
ESR -> raised. Mantoux test: +ve. Tb bacilli in pus.
Radiological: 1-Dec disc space. 2-Bone destruction.
3-Abscess shadow.
Treatment:
Principle R: Antibacterial therapy.
Local R: support Cv spine (plaster of Paris or plastic collar.
Operative R: drain abscess, decompress spinal
Diagnosis:
1. History(contact or septic focus).
2. Muscle spasm with limited ROM.
3. Radiological findings.
44. Pyogenic infection(Pyogenic cervical spondylosis):
Uncommon in cervical vertebrae or IVD.
Cause:
staph., strept., pneumococci & less commonly salmonella or
brucella.
Pathology:
As TB.
Clinical features:
Acute or subacute with fever.
As TB but more rapid course .
Investigations:
ESR -> raised. PNL-> raised
Radiological: 1-Dec disc space. 2-Bone destruction.
3-Abscess shadow. 4-osteoperosis.
Treatment:
Principle R: Proper a antibaiotic therapy.
Local R: support Cv spine (plaster of Paris or plastic collar.
Operative R: spontaneous fusion usually makes it unnecessary.
45. Infantile torticilis
Tilting & rotation of head by contarctures of
sternomastoid muscle of 1 side.
Causes:
?? Interference in blood supply of sternomastoid muscle, dt
injury during birth.
Pathology:
Muscle fibers replaced by fibrous tissue.
Clinical features:
Child, 6m-3yrs, head held to 1 side.
On examination:
○ Contracted sternomastoid muscle (cord like).
○ In long standing cases: Retarded facial development on same side
(facial asymmetry).
Treatment:
In sternomastoid pseudo-tumour stage: Stretching of
muscle.
In established stage: Surgical division with postoperative
Diagnosis:
1. History.
2. Cord like.
3. Facial asymmetry.
49. ROM
Fix the head with one hand while you examine neck
Inspection
Note the normal concavity of cervical spine
Identify Transverse process of C7
Observe Trapezius and Sternomastoid muscles
Palpation
Feel each spinous process looking for focal areas of tenderness
Joint
○ Feel for crepitus during passive motion
Para spinal muscles
Range of motion
Active
○ Touch chin for flexion
○ Throw head back for extension
○ Touch each shoulder with ears for lateral flexion
○ Touch each shoulder with chin for lateral rotation
Passive
○ Feel for crepitus during passive motion
Normal:
30 degree rotation, able to touch chest with chin, 55 degree extension
and 40 degree lateral bend.
50. CERVICAL MUSCLES FUNCTION NERVE
Sternocleidomastoid
Extends & rotates head, flexes vertebral
column
C2, C3
Scalenus Flexes & rotates neck Lower cervical
Spinalis Cervicis Extends & rotates head Middle/lower cervical
Spinalis Capitus Extends & rotates head Middle/lower cervical
Semispinalis Cervicis Extends & rotates vertebral column Middle/lower cervical
Semispinalis Capitus Rotates head & pulls backward C1 – C5
Splenius Cervicis Extends vertebral column Middle/lower cervical
Longus Colli Cervicis Flexes cervical vertebrae C2 – C7
Longus Capitus Flexes head C1 – C3
Rectus Capitus Anterior Flexes head C2, C3
Rectus Capitus Lateralis Bends head laterally C2, C3
Iliocostalis Cervicis Extends cervical vertebrae Middle/lower cervical
Longissimus Cervicis Extends cervical vertebrae Middle/lower cervical
Longissimus Capitus Rotates head & pulls backward Middle/lower cervical
Rectus Capitus Posterior Major Extends & rotates head Suboccipital
Rectus Capitus Posterior Minor Extends head Suboccipital
Obliquus Capitus Inferior Rotates atlas Suboccipital
Obliquus Capitus Superior Extends & bends head laterally Suboccipital
Muscles of the Spinal Column
51. • However, because it is less protected than the
rest of the spine, the neck can be vulnerable
to injury and disorders that produce pain and
restrict motion.