STUDY - Technical - New Dacian's Medicine
Cervical
and Back Pain (4)
Translation Draft
I'm able to move on to cervical and shoulder pain now.
Cervical pain commonly occurs in disorders of the cervical spine and soft tissues of the neck. Cervical pain and low back pain have many common clinical traits. Pain in the cervical spine can be triggered by neck movements and may be accompanied by local spinal sensitivity and limitation of movements. Pain that occurs in the brachial plexus, shoulder or peripheral nerves can sometimes be confused with cervical spinal disease, but anamnesis and clinical examination usually identify a place of pain located distal.
The first source of cervical pain is trauma to the cervical spine. Unlike lumbar lesions, trauma to the cervical spine (fractures, subluxations) are at risk of compression of the spinal cord. Bladder dysfunction, tetraparesis and respiratory failure resulting from compression of the upper cervical marrow can be very serious. Neck immobilization is an absolute priority to minimize subsequent medullary damage caused by the movements of unstable cervical vertebral segments. The patient may also present combined medullary and root elements (myeloridiculardisease).
Flexion-extension lesion is caused by trauma (usually car accidents), which causes muscle-ligamentary cervical sprains and stretching due to hyperflexion or hyperextension. This diagnosis excludes patients with fractures, herniated disc, cephalic lesions or altered state of consciousness. A prospective study of patients with such injury found that 18% had persistent trauma-related symptoms 2 years after the car accident.
These patients were generally older, had a higher incidence of the inclined or rotated position of the head on impact, a higher intensity of initial cephalic or cervical pain, a high number of initial symptoms and more background osteoarthritis radiological changes of the cervical spine compared to patients in remission. objective data of anatomological changes in soft tissues are missing. In general, patients with severe initial injury are at increased risk for poor long-term development.
Cervical discopathy mainly represented by acute or subacute lower cervical disc hernia is a common cause of cervical, shoulder, arm and hand pain. As a rule there is cervical pain (accentuated by neck movements), stiffness and limitation of the amplitude of movements.
Compression of nerve roots can cause pain to be irradiated in the shoulder or arm. The extension and lateral rotation of the neck (the Spurling sign) may narrow the neural orifice and reproduce the root symptoms.
Acute compression of the cervical nerve root by a herniated disc is often posttraumatic in young people and is less common than acute compression of the lumbar nerve root. Subacute radiculopathy is less likely to be linked to a traumatic incident and may involve both cervical disc disease and spondylosis.
Cervical disc hernias are usually posterolateral, near the lateral recess us and intervertebral hole. The usual pattern of reflex, sensory and motor changes, as well as the distribution of pain in the most common lesions of cervical nerve roots is multiple. Nerve root function varies from patient to patient, normally, and overlapping functions of different nerve roots is common.
Including the anatomical distribution of pain is the most variable clinical element. The distribution of signs and symptoms frequently occupies only part of the territory of the affected nerve root.
But let's move on to concrete "stuff" like cervical spondylosis. Arthrosis of the cervical spine can cause cervical pain that radiates occipital, in the shoulders and arms. Arthritis or other pathological conditions of the upper cervical spine can cause headache in the occipital region (innervated by nerve roots C2 - C4). Cervical spondylosis with osteophyte formation in the lateral recess or hypertrophy of the articular facets may cause monoradiculopathy.
Narrowing of the vertebral canal by the formation of osteophytes, ossification of the posterior longitudinal ligament or herniation of a large central disc can cause medullary compression, with symptoms in the bladder and sensory, motor and reflex changes. A feeling of electrocution caused by the flexion of the neck that radiates down the spine (The symptom of Lhermitte) shows medullary damage. When the pain accompanying the medullary compression is small or absent, the diagnosis can be confused with amyotrophic lateral sclerosis, multiple sclerosis, tumors of the spinal cord or syringomye.
Consideration should be given to the possibility of treatable cervical medullary disease even when patients show symptoms only in the lower spine. In some patients, a combination of spondylitis changes causes spinal stenosis with myeloridiculopathy.
Lumbar vertebral stenosis may mask elements associated with coexisting cervical myelopathy. MRI or myelography TC will show all anatomical abnormalities in cervical spondylosis. EMG and nerve conduction studies are useful for quantifying severity and locating the level of nerve root injury.
Among other causes of cervical pain we can remember rheumatoid arthritis (AR) of the joints of cervical apophyses that cause cervical pain, redness and limitation of movements. Diagnosis of AR is safe in typical cases with symmetrical inflammatory arthritis. In advanced AR, the synovitis of the atlanto-axial joint (C1 - C2) can affect the transverse ligament of the atlas, producing the anterior displacement of the attract on the axis (atlanto-axial subluxation) that occurs radiographically in 30% of patients with AR, and the degree of subluxation correlates with the severity of erosive lesions.
When subluxation exists, neurological examinations, MRI and TC are useful for assessing the presence and clinical importance of associated medullary compression. Some patients develop high medullary compression, resulting in tetraparesis, respiratory failure and death. Although low back pain is common in patients with AR, the frequency of facet damage, fractures and spondylolyesthesis is no higher than in patients of the same age and sex with mechanical low back pain.
From AR we move to ankylosing spondylitis. It can cause cervical pain and sometimes atlanto-axial subluxation with medullary compression. Herpes zoster can give cervical and occipital posterior pain in the territory of C2 - C3 before the appearance of vesicles.
Neoplastic metastases in the cervical spine, infections (osteomyelitis and epidural abscess) and metabolic bone diseases can also cause cervical pain. Diagnostic considerations are similar to those previously described for low back pain. Cervical pain can be irradiated from the heart into coronary ischemia (cervical angina syndrome).
The thoracic aperture is an anatomical region containing the first rib, artery and subclavian vein, brachial plexus, clavicle and pulmonary apex. Damage to these structures can cause thoracic aperture syndrome (SAT), characterized by pain around the shoulder and supraclavicular region, induced by certain movements and positions. There are at least three types of SAT.
Neurogenic thoracic aperture syndrome is the result of compression of the lower torso of the plexus by an abnormal band of tissue that joins C7's elongated transverse apophysis with the first rib. Neurological deficits include weakness of the intrinsic muscles of the hand and decreased sensitivity on the palmar face of fingers 4 and 5. The diagnosis is confirmed by EMG and nervous driving studies.
Arterial thoracic aperture syndrome results from compression of the subclavian artery by a cervical rib, compression causes a poststenotic dilation of the artery and the formation of thrombus. Decreased blood pressure in the affected limb may be accompanied by signs of embolism in the hand. Neurological signs are missing and the diagnosis is confirmed by non-invasive Doppler techniques.
The questionable upper thoracic aperture syndrome includes a large number of patients with chronic arm or shoulder pain of unknown origin. The lack of sensitivity and specificity of changes in objective examination or laboratory results often leads to an uncertain diagnosis, and the treatment of this SAT firm is frequently to no avail.
Let's move on to the nerves and the brachial plexus. Pain through damage to the brachial plexus or peripheral nerves can sometimes be confused with pain of cervical origin. Neoplastic infiltration of peripheral nerves may occur in the lower torso of the brachial plexus and cause irradiated shoulder pain along the arm, paralysis of fingers 4 and 5 and weakness of the intrinsic muscles of the hand innervated by the ulnar and radial plexus.
Similar elements can be produced by post-irradiation fibrosis (most commonly in breast carcinoma) or Pancoast lung tumour (two thirds of these patients are also present horner syndrome). Scapular neuropathy can cause severe shoulder pain, weakness and atrophy of the supraspinous and infraspinous muscles.
Acute brachial neuritis is commonly confused with radiculopathy. The acute onset of severe shoulder or scapular pain is followed within a few days or weeks by weakness of the proximal part of the arm and the scapular belt, corresponding to the muscles innervated by the upper torso of the plexus. Previous infections or vaccinations have been associated with acute brachial neuritis, but the causal link is random.
Identification of this syndrome is important because slow, complete recovery occurs in 75% of patients after 2 years and 89% after 3 years. Some cases of carpal tunnel syndrome cause extensive pain and paresthesia in the forearm, arm and shoulder, similar to damage to the C5 and C6 roots. lesions of the ulnar or radial nerve can mimic a radiculopathy C7 and C8 respectively. EMG and nerve conduction studies can accurately locate nerve, brachial plexus or nerve damage.
And, there's something else to present about the shoulder. Pain in the shoulder region can be difficult to separate the cervical pain. if the signs and symptoms of radiculopathy are missing, then the differential diagnosis includes mechanical pain (tendinitis, bursitis, rotary muscle tea lesions, partial tec lesions, adhering capsulitis and catching the tea under acromion) and irradiating pain (subdiaphragmatic irritation, Pancoast tumor).
Mechanical pain often worsens at night and is associated with local shoulder sensitivity and is etched by abduction, internal rotation or arm extension. Pain in shoulder disorders can sometimes irradiate the arm or forearm, but there are no reflex changes, motor changes and sensitivity indicating damage to nerve roots, plexus or peripheral nerves.
Offf, it is a very long road, the one to which I subscribe by presenting the signs of the disease, but be patient, it will be worth it (even if I chose this boring way, to start with the signs of the disease from the point of view of current, traditional medicine - my main effort being oriented towards "wake up" and consider all the weapons available to eliminate diseases from your life, possibly to collaborate with the efforts of your doctors with the compensatory efforts of the new knowledge you have)
It's the day of our Mothers, Ladies and Girlfriends...
I'm able to move on to cervical and shoulder pain now.
Cervical pain commonly occurs in disorders of the cervical spine and soft tissues of the neck. Cervical pain and low back pain have many common clinical traits. Pain in the cervical spine can be triggered by neck movements and may be accompanied by local spinal sensitivity and limitation of movements. Pain that occurs in the brachial plexus, shoulder or peripheral nerves can sometimes be confused with cervical spinal disease, but anamnesis and clinical examination usually identify a place of pain located distal.
The first source of cervical pain is trauma to the cervical spine. Unlike lumbar lesions, trauma to the cervical spine (fractures, subluxations) are at risk of compression of the spinal cord. Bladder dysfunction, tetraparesis and respiratory failure resulting from compression of the upper cervical marrow can be very serious. Neck immobilization is an absolute priority to minimize subsequent medullary damage caused by the movements of unstable cervical vertebral segments. The patient may also present combined medullary and root elements (myeloridiculardisease).
Flexion-extension lesion is caused by trauma (usually car accidents), which causes muscle-ligamentary cervical sprains and stretching due to hyperflexion or hyperextension. This diagnosis excludes patients with fractures, herniated disc, cephalic lesions or altered state of consciousness. A prospective study of patients with such injury found that 18% had persistent trauma-related symptoms 2 years after the car accident.
These patients were generally older, had a higher incidence of the inclined or rotated position of the head on impact, a higher intensity of initial cephalic or cervical pain, a high number of initial symptoms and more background osteoarthritis radiological changes of the cervical spine compared to patients in remission. objective data of anatomological changes in soft tissues are missing. In general, patients with severe initial injury are at increased risk for poor long-term development.
Cervical discopathy mainly represented by acute or subacute lower cervical disc hernia is a common cause of cervical, shoulder, arm and hand pain. As a rule there is cervical pain (accentuated by neck movements), stiffness and limitation of the amplitude of movements.
Compression of nerve roots can cause pain to be irradiated in the shoulder or arm. The extension and lateral rotation of the neck (the Spurling sign) may narrow the neural orifice and reproduce the root symptoms.
Acute compression of the cervical nerve root by a herniated disc is often posttraumatic in young people and is less common than acute compression of the lumbar nerve root. Subacute radiculopathy is less likely to be linked to a traumatic incident and may involve both cervical disc disease and spondylosis.
Cervical disc hernias are usually posterolateral, near the lateral recess us and intervertebral hole. The usual pattern of reflex, sensory and motor changes, as well as the distribution of pain in the most common lesions of cervical nerve roots is multiple. Nerve root function varies from patient to patient, normally, and overlapping functions of different nerve roots is common.
Including the anatomical distribution of pain is the most variable clinical element. The distribution of signs and symptoms frequently occupies only part of the territory of the affected nerve root.
But let's move on to concrete "stuff" like cervical spondylosis. Arthrosis of the cervical spine can cause cervical pain that radiates occipital, in the shoulders and arms. Arthritis or other pathological conditions of the upper cervical spine can cause headache in the occipital region (innervated by nerve roots C2 - C4). Cervical spondylosis with osteophyte formation in the lateral recess or hypertrophy of the articular facets may cause monoradiculopathy.
Narrowing of the vertebral canal by the formation of osteophytes, ossification of the posterior longitudinal ligament or herniation of a large central disc can cause medullary compression, with symptoms in the bladder and sensory, motor and reflex changes. A feeling of electrocution caused by the flexion of the neck that radiates down the spine (The symptom of Lhermitte) shows medullary damage. When the pain accompanying the medullary compression is small or absent, the diagnosis can be confused with amyotrophic lateral sclerosis, multiple sclerosis, tumors of the spinal cord or syringomye.
Consideration should be given to the possibility of treatable cervical medullary disease even when patients show symptoms only in the lower spine. In some patients, a combination of spondylitis changes causes spinal stenosis with myeloridiculopathy.
Lumbar vertebral stenosis may mask elements associated with coexisting cervical myelopathy. MRI or myelography TC will show all anatomical abnormalities in cervical spondylosis. EMG and nerve conduction studies are useful for quantifying severity and locating the level of nerve root injury.
Among other causes of cervical pain we can remember rheumatoid arthritis (AR) of the joints of cervical apophyses that cause cervical pain, redness and limitation of movements. Diagnosis of AR is safe in typical cases with symmetrical inflammatory arthritis. In advanced AR, the synovitis of the atlanto-axial joint (C1 - C2) can affect the transverse ligament of the atlas, producing the anterior displacement of the attract on the axis (atlanto-axial subluxation) that occurs radiographically in 30% of patients with AR, and the degree of subluxation correlates with the severity of erosive lesions.
When subluxation exists, neurological examinations, MRI and TC are useful for assessing the presence and clinical importance of associated medullary compression. Some patients develop high medullary compression, resulting in tetraparesis, respiratory failure and death. Although low back pain is common in patients with AR, the frequency of facet damage, fractures and spondylolyesthesis is no higher than in patients of the same age and sex with mechanical low back pain.
From AR we move to ankylosing spondylitis. It can cause cervical pain and sometimes atlanto-axial subluxation with medullary compression. Herpes zoster can give cervical and occipital posterior pain in the territory of C2 - C3 before the appearance of vesicles.
Neoplastic metastases in the cervical spine, infections (osteomyelitis and epidural abscess) and metabolic bone diseases can also cause cervical pain. Diagnostic considerations are similar to those previously described for low back pain. Cervical pain can be irradiated from the heart into coronary ischemia (cervical angina syndrome).
The thoracic aperture is an anatomical region containing the first rib, artery and subclavian vein, brachial plexus, clavicle and pulmonary apex. Damage to these structures can cause thoracic aperture syndrome (SAT), characterized by pain around the shoulder and supraclavicular region, induced by certain movements and positions. There are at least three types of SAT.
Neurogenic thoracic aperture syndrome is the result of compression of the lower torso of the plexus by an abnormal band of tissue that joins C7's elongated transverse apophysis with the first rib. Neurological deficits include weakness of the intrinsic muscles of the hand and decreased sensitivity on the palmar face of fingers 4 and 5. The diagnosis is confirmed by EMG and nervous driving studies.
Arterial thoracic aperture syndrome results from compression of the subclavian artery by a cervical rib, compression causes a poststenotic dilation of the artery and the formation of thrombus. Decreased blood pressure in the affected limb may be accompanied by signs of embolism in the hand. Neurological signs are missing and the diagnosis is confirmed by non-invasive Doppler techniques.
The questionable upper thoracic aperture syndrome includes a large number of patients with chronic arm or shoulder pain of unknown origin. The lack of sensitivity and specificity of changes in objective examination or laboratory results often leads to an uncertain diagnosis, and the treatment of this SAT firm is frequently to no avail.
Let's move on to the nerves and the brachial plexus. Pain through damage to the brachial plexus or peripheral nerves can sometimes be confused with pain of cervical origin. Neoplastic infiltration of peripheral nerves may occur in the lower torso of the brachial plexus and cause irradiated shoulder pain along the arm, paralysis of fingers 4 and 5 and weakness of the intrinsic muscles of the hand innervated by the ulnar and radial plexus.
Similar elements can be produced by post-irradiation fibrosis (most commonly in breast carcinoma) or Pancoast lung tumour (two thirds of these patients are also present horner syndrome). Scapular neuropathy can cause severe shoulder pain, weakness and atrophy of the supraspinous and infraspinous muscles.
Acute brachial neuritis is commonly confused with radiculopathy. The acute onset of severe shoulder or scapular pain is followed within a few days or weeks by weakness of the proximal part of the arm and the scapular belt, corresponding to the muscles innervated by the upper torso of the plexus. Previous infections or vaccinations have been associated with acute brachial neuritis, but the causal link is random.
Identification of this syndrome is important because slow, complete recovery occurs in 75% of patients after 2 years and 89% after 3 years. Some cases of carpal tunnel syndrome cause extensive pain and paresthesia in the forearm, arm and shoulder, similar to damage to the C5 and C6 roots. lesions of the ulnar or radial nerve can mimic a radiculopathy C7 and C8 respectively. EMG and nerve conduction studies can accurately locate nerve, brachial plexus or nerve damage.
And, there's something else to present about the shoulder. Pain in the shoulder region can be difficult to separate the cervical pain. if the signs and symptoms of radiculopathy are missing, then the differential diagnosis includes mechanical pain (tendinitis, bursitis, rotary muscle tea lesions, partial tec lesions, adhering capsulitis and catching the tea under acromion) and irradiating pain (subdiaphragmatic irritation, Pancoast tumor).
Mechanical pain often worsens at night and is associated with local shoulder sensitivity and is etched by abduction, internal rotation or arm extension. Pain in shoulder disorders can sometimes irradiate the arm or forearm, but there are no reflex changes, motor changes and sensitivity indicating damage to nerve roots, plexus or peripheral nerves.
Offf, it is a very long road, the one to which I subscribe by presenting the signs of the disease, but be patient, it will be worth it (even if I chose this boring way, to start with the signs of the disease from the point of view of current, traditional medicine - my main effort being oriented towards "wake up" and consider all the weapons available to eliminate diseases from your life, possibly to collaborate with the efforts of your doctors with the compensatory efforts of the new knowledge you have)
It's the day of our Mothers, Ladies and Girlfriends...
Happy
birthday!
Dorin, Merticaru