Latest Treatment of Neck Pain
Chronic neck pain that occurs intermittently with or without radicular symptoms may be seen in cervical osteoarthritis. C. Relief and aggravation of pain. Rest in the supine position usually relieves local neck pain produced by muscle spasm but may have little or no effect on processes primarily involving osseous or ligamentous structures.
Interventional spine injection procedures for the diagnosis and treatment of low back and neck pain play an important role in the management of this common problem. Epidural injections for pain management have been employed since early in the past century.1 Caudal epidural injections were first described in 1901 by Cathelin.2 The midline epidural technique was introduced by Pages in 1921.3 Although the efficacy of these procedures continues to be the subject of debate, a number of studies and clinical experience support their use for the management of spinal origin pain.
The range and severity of symptoms in primary HIV infection varies considerably, with an acute 1-month mononucleosis-like viral syndrome developing in about 40 -60 of patients (Levy 1993). Symptoms can include fever, headache, lymphadenopathy, malaise, myalgia, rash, stiff neck, and other meningeal signs and symptoms, accompanied by transient intense viremia and an acute fall in CD4 T cell count in the peripheral blood from its normal range of 800-1,200 cells per cubic millimeter (Staprans and Feinberg 1997). The more severe this syndrome is, the more likely that the untreated patient will progress rapidly to AIDS (Keet et al. 1993). Clinicians are now hoping to slow down progression to AIDS by initiating
Some rheumatoid patients with sufficiently severe joint destruction to necessitate hip or knee replacement surgery may also have significant involvement of the cervical spine. Atlanto-axial or subaxial subluxation should be ruled out on flexion-extension films in patients with neck pain or crepitus on range of motion, radicular symptoms, or arm or leg weakness. These patients are at increased risk for cord compression during intubation or during uncontrolled neck movement while being positioned for surgery. All such lesions should be well-defined preoperatively and discussed with the anesthesiologist and surgeon. These patients should wear a soft cervical collar in the operating room for immobilization and to warn all involved in their care not to manipulate the neck excessively. If possible, epidural or spinal anesthesia should be used.
The pigments in Xanthophyta are chlorophyll a, possibly chlorophyll e (although there is some uncertainty related to a suspicion that its presence may be connected to limitations in extraction methods), and an abundance of carotenoid pigments. Motile cells have two unequal flagella a tinsel-type flagellum that extends anteriorly and a whiplash flagellum that trails posteriorly. There are approximately 400 species.
Clnlamydomonas is a minute (approximately ten-thousandth of an inch Notes long), single-celled, flagellated green alga. It is round or pear shaped and possesses a rigid cellulose cell wall, contractile vacuoles, a cup-shaped chloro-plast, and a pair of whiplash flagella at the anterior end. The flagella pass through tiny holes in the cell wall. Each, of course, has a cell membrane immediately inside the cell wall. Chlamydomonas also each have a red-pigmented eye spot, or stigma, considered to be light sensitive, and a pyrenoid body that functions as a center for the formation of starch. The starch eventually changes into an oil. Although pyrenoids are widely distributed in algae, they do not occur in most land plants. While Chlamydomonas are green, photosynthetic cells, they may get some of their nutrients ready-made from the surrounding water. The word chlamys is Greek for cloak. The name Chlamydomonas derives from the fact that the chloroplast appears to form a cloak around the...
Subacute or chronic meningitis is characterized by a gradual onset, often without any predisposing factor. These syndromes run their course over weeks, months or years. The clinical signs include headache, fever, stiff neck, and altered consciousness. Lower cranial nerve palsies may accompany basilar meningitis.
Spinal images of an 11-year-old boy who presented with intractable neck pain associated with an aneurysmal bone cyst after a football match. A pre-operative transarterial PVA em-bolization was performed. (A) Lateral plain spine x-ray film shows a sharply demarcated os-teolytic lesion of the posterior part of the C5 vertebral body (arrow) and narrowing of the spinal canal. (B) T1-weighted image shows the C5 lesion with well-defined calcified boundaries (arrow). There is no epidural extension or spinal cord compression visible.
Thus in any patient with neck pain, and especially after trauma, careful enquiry into the distribution of pain and associated upper and lower limb neurological symptoms is essential. Neck pathology should also be considered in any patient complaining of diffuse pain ill the arm (see Disorders box below), head, upper trunk or interscapular region, particularly if associated with sensory or other neurological disturbance.
Parasite, life cycle, and epidemiology (Fig. 10.13). The name whipworm characterizes the form of this 3-5 cm long nematode with a very thin anterior part reminiscent of a whiplash and a thicker posterior handle. The adult nema-todes live in the large intestine, mainly in the cecum. The females lay 200014 000 thick-shelled, yellow-brown eggs per day. The eggs are about 5055 im long and are readily identified by their lemonlike shape and hyaline polar plugs (Fig. 10.1, p. 544). An infective larva develops in the egg within a few weeks. In moist surroundings, Trichuris eggs remain viable for months or even years.
By far the most common indication for spine imaging is to evaluate for degenerative spondylosis as a cause of acute or chronic neck pain, back pain, or symptoms of radiculopathy. For the purposes of this chapter, the discussion on degenerative disease is limited to the lumbar spine. There are innumerable articles and texts on the subject and yet there is no consensus as to the appropriate workup and management of these pain syndromes. Complicating the matter is the relatively high incidence of spinal imaging abnormalities in healthy volunteers. A well known study by Jensen et al. evaluated 98 asymptomatic
Radiographs, when needed, should be taken in anteroposterior, oblique, and lateral views. These films may be supplemented with an open-mouth view of the odontoid or flexion-extension films when instability is suspected. In cases of mild neck pain, a therapeutic trial for osteoarthritis might be tried before radiography is ordered. As symptoms and signs worsen, radiographic procedures become more appropriate. 3. Myelography is indicated in patients with intractable neck pain and radiculopathy to localize spinal cord or nerve root compromise by disk, osteophyte, neoplasm, or other space-occupying process. Originally used in conjunction with plane radiographs, myelography is now often performed along with computed tomography in an effort to visualize the canal better (see section IV B. .2).
These injuries occur when a force moves a joint through an abnormal range of motion. This condition presents with localized neck pain and muscle spasm. The neurologic and radiographic examination findings are usually normal. Treatment consists of immobilization (semirigid collar), local heat, muscle relaxants, antiinflammatory medicines, and restriction of activity. Athletes can return to play when the symptoms resolve.
Acute muscular spasm can produce acute pain and torticollis ( wry neck ). Wry neck may arise after trauma (e.g., whiplash), prolonged exposure to cold, prolonged period in an awkward position, or other activities that strain and require considerable neck rotation or positioning. 5. Surrounding structures. Neck pain may be referred from the shoulder or periscapular structures. Cervical lymphadenopathy, if painful, can produce severe restriction in neck motion. Occipital headaches may produce secondary neck pain and muscle spasm. In addition, trigeminal and glossopharyngeal neuralgias have been described to cause neck pain. B. Neck pain with radiculopathy. Objective neurologic deficit may or may not be present.
The overall complication rate is below 1 in experienced hands (41), but will be higher for the inexperienced operator (11). There are numerous studies that have reported no major complications from ESIs (17,40,4244). The incidence of inadvertent dural puncture has been reported at 2.5 when using the sublaminar approach in the lumbar region and is the most commonly reported complication (45). It has also been reported when performing cervical sublaminar injections (46). The risk of dural puncture has been reported to be less when using the caudal technique (47). Major complications have rarely been reported with the caudal technique. The trans-foraminal route of delivery also has a reported risk of dural puncture, which is lower than the rate reported for the sublaminar approach (39). No major complications have been reported with this technique. The complications specifically related to cervical or thoracic epidural injections have not been studied as extensively. In one series, the...
The presentation is dramatic with clinical manifestations developing over only a few hours to days. High fever, headache, photophobia, stiff neck, and altered mental state are the typical presenting symptoms. Headache and vomiting due to raised intracranial pressure may be a presenting manifestation in young children. Infants, immune suppressed individuals, and the elderly may not develop neck stiffness and hence may lack the cardinal signs of meningeal irritation. Most often other clinical signs or specific predisposing conditions may be absent. However, if present, they may offer important diagnostic clues.
Diatoms are the most diverse and abundant of the photosynthetic heterokonts. They are among the most important aquatic photosynthesizers and are probably the most numerous aquatic eukary-otes. Found as single cells or chains of cells in marine, freshwater, and terrestrial environments, they often dominate the phytoplankton of nutrient-rich waters. The cells are enclosed in a highly ornamented silica box (frustule). These frustules are of either the centric type, with apparent radial symmetry, or of the pennate type, with apparent bilateral symmetry. The chloroplasts of diatoms commonly contain the carotenoid fucoxanthin as an accessory photosynthetic pigment. A single tinsel flagellum, but no whiplash flagellum, is evident in sperm cells of those species in which sexual reproduction is known. A few species have been associated with fish kills, while some species of Pseudo-nitzschia produce the toxin domoic acid, responsible for amnesiac shellfish poisoning in humans. In the newer...
The earliest sauropods occur in the Early Jurassic of Africa and Asia, and from then on are a feature of dinosaurian faunas worldwide until the end of the Cretaceous, when the dinosaurs became extinct. All sauropods were quadrupedal and most were very large. The head was small and lightly built and contained peglike or spoon-shaped teeth that were confined to the front of the mouth, and nostrils that were placed on the top of the head. The neck was long and consisted of up to fifteen vertebrae, which although large were penetrated by many openings, so that they were constructed of struts and laminae providing maximum strength for minimum weight. The tail is also very long, perhaps up to seventy feet in Seismosaurus, and contained up to eighty vertebrae, of which the last forty were reduced to simple rods of bone that formed a whiplash. The limbs and girdles were massively constructed to
Injection studies demonstrate the zygoapophyseal joints are the most common sites of origin for chronic neck pain in WAD. Other possible causes are soft tissue damage, intramuscular bleeding and microinjury to the cord or brain. Intervertebral disc prolapse or end plate avulsion is rare.
The top row shows asexual reproduction, (a) A mitosporangium, which breaks up into a number of biflagellated zoospores, (b), each having a tinsel-type flagellum and a whiplash flagellum, (c). (d) The flagella disappear and new flagella are produced. (e)These flagella are lost when the spore grows new hyphae. The bottom row shows sexual reproduction, (f) An oogonium, consisting of a single cell containing several eggs. An antheridial hypha grows upwardly nearby, producing an antheridium that comes in contact with the oogonium, (g) The wall is broken down, and fertilization produces oospores.
There are both amoeboid and flagellated types of Chrysophyceae. The flagella are two in number and unequal one is pinnate, the other whiplash. The amoeboid forms are quite like the amoebas studied in zoology except that they have chloroplasts. Sexual reproduction is rare and isogamous. Approximately 300 species of Chrysophyceae have been described. Figure 16-5 shows two forms Dinobryon and Distephanus.
Spontaneous carotid artery dissection often is accompanied by a Horners syndrome with ipsilat-eral ptosis and miosis. Dissection of the carotid or vertebral arteries is often accompanied by neck pain and ipsilateral headache. Chiropractic manipulation more often results in vertebral artery dissection and is less commonly responsible for carotid artery dissection 45 .
The term heterokont refers either to the flagellar arrangement of biflagellate cells in which the two flagella differ in length (as in anisokonts), type of motion, or ornamentation, or to those organisms (and organisms evolutionarily derived from such lineages) in which biflagellate cells with heterokont flagella are produced at some point during their life cycle. The most common heterokont flagellar arrangement consists of a posteriorly directed whiplash flagellum and an anteriorly directed tinsel flagellum. The tubular tinsel flagellum characteristically bears two rows of stiff, glycoproteinaceous, tripartite hairs previously referred to as mastigonemes but now increasingly referred to as stramenopili. Such organisms are often referred to as stramenopiles.
Rest is the cornerstone of therapy for patients with neck pain, whether or not radiculopathy is present. 3. Neck pain is usually worse at night because of the positioning during sleep. Avoidance of more than one small pillow or the use of a cervical pillow often helps to decrease pain and spasm. C. Medications may be useful depending on the origin of the neck pain.
Inflammation of the meninges, or meningitis, is usually caused by bacteria that enter through the ear, nose, or throat or are carried by the blood. One of these organisms, the meningococcus (Neisseria meningitidis), is responsible for epidemics of meningitis among individuals living in close quarters. Other bacteria implicated in cases of meningitis include Haemophilus influenzae, Streptococcus pneumoniae, and Escherichia coli. A stiff neck is a common symptom. The presence of pus or lymphocytes in spinal fluid is also characteristic. Fluid is withdrawn for diagnosis by a lumbar puncture (Fig. 17-10), in which a needle is used to remove CSF from the meninges in the lumbar region of the spine. This fluid can be examined for white blood cells and bacteria in the case of meningitis, for red blood cells in the case of brain injury, or for tumor cells. The fluid also can be analyzed chemically. Normally, spinal fluid is clear, with glucose and chlorides but no protein and very few cells.
Cervical spinal instability should be considered in all patients with neck pain, occipital or lower cervical radiculopathy, patient-reported neck crepitation, instability on active motion, or signs of cervical myelopathy. Radiographic signs of cervical spinal instability may be seen in 40 of RA patients, but neurologic symptoms develop in only 10 of these.
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