pain in the neck: disclosures - · pdf file48 hours after mva. ... xxxx xxxxxx xxx •...
TRANSCRIPT
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Pain in the Neck: Common Problems in the
Cervical Spine
Conor W. O’Neill, M.D.Clinical ProfessorDepartment of Orthopaedic SurgeryNon-operative Spine ServiceUCSF
DisclosuresStock Ownership: Relievant (0.17%), Nocimed (0.70%).
• Functional anatomy• Pathology• Clinical evaluation• Case studies
Outline
MyelopathyRadiculopathyMechanical neck pain
Cervicogenic HACervicobrachial syndrome
• Live exam
Functional Anatomy
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VR
DR
SVN
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Pathology
Disc Herniation
Spondylosis
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48 hours after MVA. T2 image shows focal hematoma (∗), trace prevertebral hemorrhage (thick arrow), linear area of altered signal intensity anterior annulus (long thin arrows), epidural hematoma (short thin arrow).Published in: Suzanne E. Anderson; Chris Boesch; Heinz Zimmermann; André Busato; Jürg Hodler; Roland Bingisser; Erika J. Ulbrich; Andreas Nidecker; Carlos H. Buitrago-Téllez; Harald M. Bonel; Paul Heini; Stefan Schaeren; Matthias Sturzenegger; Radiology 2012, 262, 567-575.
Parasagittal image shows prevertebral soft-tissue hemorrhage (long arrow) and epidural hematoma at the C7 level (short arrows). Published in: Suzanne E. Anderson; Chris Boesch; Heinz Zimmermann; André Busato; Jürg Hodler; Roland Bingisser; Erika J. Ulbrich; Andreas Nidecker; Carlos H. Buitrago-Téllez; Harald M. Bonel; Paul Heini; Stefan Schaeren; Matthias Sturzenegger; Radiology 2012, 262, 567-575.
Transverse STIR image near angle of mandible shows perimuscular hemorrhage (thin arrows), right muscle strain (∗), and left facet asymmetry (thick arrow).Published in: Suzanne E. Anderson; Chris Boesch; Heinz Zimmermann; André Busato; Jürg Hodler; Roland Bingisser; Erika J. Ulbrich; Andreas Nidecker; Carlos H. Buitrago-Téllez; Harald M. Bonel; Paul Heini; Stefan Schaeren; Matthias Sturzenegger; Radiology 2012, 262, 567-575.
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Clinical Evaluation
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Case Studies• Myelopathy• Radiculopathy• Mechanical neck pain• Cervicogenic headache• Cervicobrachial syndrome
66 y/o retired data entry clerk• Line dances, active in church
• Enlarged tonsil on routine exam, cancer workup negative
• Spinal stenosis noted on neck MRI done as part of cancer workup
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44 yr old stay-at-home mom
• Very fit, regular vigorous exercise• No prior neck problems• Woke up with severe pain (8/10)• No myelopathy, 4/5 weakness triceps
and wrist flexors• 6 weeks conservative care
xxx xxxxXxxxxxxxxxxxx6/7
6/7
Left
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Keyhole foraminotomy
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xxx xxxxXxxxxXxxxxxxxxxxxxxxxxxxxx
xx xxx
xxxxxxxxxxxxx
• Nonspecific term describing some combination of pain, numbness, tingling, weakness in the neck and/or upper extremity, without specific pathology
• Diagnosis of exclusion� Cervical radiculopathy� Shoulder and rotator cuff pathology� Peripheral entrapment neuropathies� Parsonage-Turner syndrome (acute brachial radiculitis)
• Probably due to some combination of myofascial pain, neurogenic thoracic outlet syndrome, elevated pain sensitivity
Cervicobrachial syndrome
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76 year old male
• Healthy, active• Chronic stiff neck• 4 month history of severe left sided
neck pain• No better with PT, NSAID’s
xxx
3/4 4/5
5/6 6/7Right Left
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46 y/o anesthesiologist• Healthy, active, master’s
swimmer
• 6 month history of neck pain after sledding injury
• Still working, can’t swim
Right
Left
C3/4 C3
C3
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64 y/o law firm CFO• Passionate hunter (shoots
rhino with long-barreled handgun)
• Freak injury while duck-hunting
• Neck pain with numbness and tingling left shoulder
xxx x
oooo
Left
C4
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56 y/o tech industry executive• Whiplash injury while
traveling in Singapore• 6 month history of neck pain,
minimal response to PT, medications
• Pain radiates into occiput, HA aggravated by neck movement
• Still working, medical care being paid for by Singapore auto carrier
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Woke up during the night with severe pain at the base of her skull after "rickety carnival rides” at the Napa County Fair.
Working, no other activities, VAS=8, occasional pain pills
48 y/o attorney with neck pain
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