Neck pain

Harrison's Internal Medicine Chapter 16. Back and Neck Pain Back and Neck Pain: Introduction The importance of back and neck pain in our society is underscored by the following: (1) the cost of back pain in the United States is ~$100 billion annually, including direct health care expenses plus costs due to loss of productivity; (2) back symptoms are the most common cause of disability in those

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Other Causes of Neck Pain Rheumatoid arthritis (RA) (Chap. 314) of the cervical apophyseal joints produces neck pain, stiffness, and limitation of motion. In advanced RA, synovitis of the atlantoaxial joint (C1-C2; Fig. 16-2) may damage the transverse ligament of the atlas, producing forward displacement of the atlas on the axis (atlantoaxial subluxation). Radiologic evidence of atlantoaxial subluxation occurs in 30% of patients with RA. Not surprisingly, the degree of subluxation correlates with the severity of erosive disease.

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Shoulder Pain arising from the shoulder can on occasion mimic pain from the spine. If symptoms and signs of radiculopathy are absent, then the differential diagnosis includes mechanical shoulder pain (tendonitis, bursitis, rotator cuff tear, dislocation, adhesive capsulitis, and cuff impingement under the acromion) and referred pain (subdiaphragmatic irritation, angina, Pancoast tumor). Mechanical pain is often worse at night, associated with local shoulder tenderness and aggravated by abduction, internal rotation, or extension of the arm.

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The phenomenon known as the McKenzie Method has helped millions of people with chronic back and neck pain. In 7 Steps to a Pain-Free Life, its founder, world-renowned physical therapist Robin McKenzie, shares the innovative program that can save you from a life of pain. 7 Steps to a Pain-Free Life combines and enhances McKenzie's back and neck books that have sold more than 5.5 million copies worldwide.

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Local pain is caused by stretching of pain-sensitive structures that compress or irritate sensory nerve endings. The site of the pain is near the affected part of the back. Pain referred to the back may arise from abdominal or pelvic viscera. The pain is usually described as primarily abdominal or pelvic but is accompanied by back pain and usually unaffected by posture. The patient may occasionally complain of back pain only. Pain of spine origin may be located in the back or referred to the buttocks or legs. Diseases affecting the upper lumbar spine tend to refer pain to the lumbar...

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Neoplasms (See also Chap. 374) Back pain is the most common neurologic symptom in patients with systemic cancer and may be the presenting symptom. The cause is usually vertebral metastases. Metastatic carcinoma (breast, lung, prostate, thyroid, kidney, gastrointestinal tract), multiple myeloma, and non-Hodgkin's and Hodgkin's lymphomas frequently involve the spine. Cancer-related back pain tends to be constant, dull, unrelieved by rest, and worse at night. By contrast, mechanical low back pain usually improves with rest.

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The neurologic examination includes a search for focal weakness or muscle atrophy, focal reflex changes, diminished sensation in the legs, and signs of spinal cord injury. The examiner should be alert to the possibility of breakaway weakness, defined as fluctuating strength during muscle testing. Breakaway weakness may be due to pain or a combination of pain and underlying true weakness. Breakaway weakness without pain is due to lack of effort. In uncertain cases, electromyography (EMG) can determine whether or not true weakness is present.

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Psychiatric Disease CLBP may be encountered in patients who seek financial compensation; in malingerers; or in those with concurrent substance abuse, chronic anxiety states, or depression. Many patients with CLBP have a history of psychiatric illness (depression, anxiety, substance abuse) or childhood trauma (physical or sexual abuse) that antedates the onset of back pain. Preoperative psychological assessment has been used to exclude patients with marked psychological impairments that predict a poor surgical outcome. Unidentified The cause of low back pain occasionally remains unclear.

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Trauma to the Cervical Spine Trauma to the cervical spine (fractures, subluxation) places the spinal cord at risk for compression. Motor vehicle accidents, violent crimes, or falls account for 87% of spinal cord injuries (Chap. 372). Immediate immobilization of the neck is essential to minimize further spinal cord injury from movement of unstable cervical spine segments. A CT scan is the diagnostic procedure of choice for detection of acute fractures.

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Degenerative Conditions Lumbar spinal stenosis describes a narrowed lumbar spinal canal. Neurogenic claudication is the usual symptom, consisting of back and buttock or leg pain induced by walking or standing and relieved by sitting. Symptoms in the legs are usually bilateral. Lumbar stenosis, by itself, is frequently asymptomatic, and the correlation between the severity of symptoms and degree of stenosis of the spinal canal is poor. Unlike vascular claudication, symptoms are often provoked by standing without walking.

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Referred Pain from Visceral Disease Diseases of the thorax, abdomen, or pelvis may refer pain to the posterior portion of the spinal segment that innervates the diseased organ. Occasionally, back pain may be the first and only manifestation. Upper abdominal diseases generally refer pain to the lower thoracic or upper lumbar region (eighth thoracic to the first and second lumbar vertebrae), lower abdominal diseases to the midlumbar region (second to fourth lumbar vertebrae), and pelvic diseases to the sacral region.

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MRI of lumbar herniated disk; left S1 radiculopathy. Sagittal T1weighted image on the left with arrows outlining disk margins. Sagittal T2 image on the right reveals a protruding disk at the L5-S1 level (arrows), which displaces the central thecal sac. The mechanism by which intervertebral disk injury causes back pain is controversial. The inner annulus fibrosus and nucleus pulposus are normally devoid of innervation. Inflammation and production of proinflammatory cytokines within the protruding or ruptured disk may trigger or perpetuate back pain.

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Algorithms for management of acute low back pain, age ≥18 years. A. Symptoms

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Chronic Low Back Pain CLBP, defined as pain lasting 12 weeks, accounts for 50% of total back pain costs. Risk factors include obesity, female gender, older age, prior history of back pain, restricted spinal mobility, pain radiating into a leg, high levels of psychological distress, poor self-rated health, minimal physical activity, smoking, job dissatisfaction, and widespread pain. Combinations of these premorbid factors have been used to predict which individuals with ALBP are likely to develop CLBP. The initial approach to these patients is similar to that for ALBP.

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Congenital Anomalies of the Lumbar Spine Spondylolysis is a bony defect in the pars interarticularis (a segment near the junction of the pedicle with the lamina) of the vertebra; the etiology may be a stress fracture in a congenitally abnormal segment. The defect (usually bilateral) is best visualized on oblique projections in plain x-rays, CT scan, or single photon emission CT (SPECT) bone scan and occurs in the setting of a single injury, repeated minor injuries, or growth.

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Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Process evaluation of a participatory ergonomics programme to prevent low back pain and neck pain among workers

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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Relative effectiveness and adverse effects of cervical manipulation, mobilisation and the activator instrument in patients with sub-acute non-specific neck pain: results from a stopped ...

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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Altered postural sway in patients suffering from non-specific neck pain and whiplash associated disorder - A systematic review of the literature...

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Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài: A novel method for neck coordination exercise – a pilot study on persons with chronic non-specific neck pain

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Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài: A rare differential diagnosis to occupational neck pain: bilateral stylohyoid syndrome

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