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Neck Pain: A Practical Approach
S Jai Shanthini, Waleed Al Busairi, AJ Rajendran
PART 1: APPLIED ANATOMY AND DIAGNOSIS OF NECK PAIN
CHAPTER 1:
Applied Anatomy
ANATOMY OF CERVICAL VERTEBRA
Uncovertebral Joints of Luschka (Figs 1.2 and 1.3)
Foramen in the Cervical Spine
Intervertebral Foramen (Fig. 1.4)
Foramen Transversorium (Fig. 1.5)
C7 Vertebra
Cervical Spinal Canal (Fig. 1.12)
MOVEMENTS OF THE NECK
MUSCLES OF THE NECK
Anterior Neck Muscles
Posterior Neck Muscles
Deep Posterior Muscles
SPINAL CORD
CRANIAL NERVES
V Nerve (Fig. 1.19)
XI Nerve
Craniovertebral junction
CHAPTER 2:
History Taking
WHO IS COMPLAINING?
WHERE IS THE PAIN?
WHERE ELSE DOES IT HURT?
WHAT MAKES THE PAIN WORSE/LESSER?
OCCUPATIONAL RISK FACTORS
NEUROLOGICAL SYMPTOMS (MOTOR, SENSORY AND SPHINCTERS, VERTIGO)
Motor Symptoms
Sensory Symptoms
Sphincters
Vertigo
Past History
Treatment History
Comorbid Illness
Review of Investigations
CHAPTER 3:
Examination
POSTURE
Tender Points Palpation
Posterior (Fig. 3.4)
Anterior (Fig. 3.5)
Examination in Prone Position
Cervicothoracic Junction
Movements of Cervical Spine
Lateral Flexion
Examination of Upper Limbs
FUNCTIONAL SCREENING
Upper Limb Functional Screening
Overhead Reach (Fig. 3.11)
Reaching the Opposite Shoulder (Fig. 3.12)
Grasp (Fig. 3.13)
Prehension (Fig. 3.14)
Lateral Pinch
Lower Limb Functional Screening
Toe Walk (Fig. 3.15)
Heel Walking (Fig. 3.16)
Squatting (Fig. 3.17)
Neurological Examination
Examination of Motor System
Nutrition
Tone
Reflex
EXAMINATION OF C1-C7 CERVICAL NERVES
C1-C4
Motor
C2-C4
C5
Motor
Reflex
Sensory
C6
Motor
Elbow Flexion (Biceps)
Sensory
C7
Motor
Reflex
Sensory
C8
Motor
Sensory (Fig. 3.31)
T1
Motor
Sensory
UPPER MOTOR NEURON SIGNS
CRANIAL NERVES
Check for Rhombergism and Observe Tandem Walking
Tandem Walking (Fig. 3.38)
Fukuda Test (Fig. 3.39)
Caution
SPECIAL TESTS FOR ROOT COMPRESSION IN THE FORAMEN
Spurling's Test (Fig. 3.40)
Caution
Foraminal Distraction Test (Fig. 3.41)
SPECIAL TEST FOR (POSTERIOR) CORD COMPRESSION
EXAMINATION OF STRUCTURES IN THE ANTERIOR NECK
EXAMINATION OF UPPER LIMBS: DIFFERENTIATING THE BRACHIALGIAS
EXAMINATION OF UPPER LIMB NERVES: ENTRAPMENT NEUROPATHIES
Median Nerve at the Wrist: Carpal Tunnel Syndrome
Flick Test
Phalen's Test (Fig. 3.48)
Tinel's Sign
Ulnar Nerve at Wrist: Guyon's Canal Syndrome
Ulnar Nerve at the Elbow: Cubital Tunnel Syndrome
Positive Tinel's Sign
Posterior Interosseus Nerve (PIN): Radial Tunnel Syndrome
EXAMINATION OF THE UPPER LIMB FOR REGIONAL SOFT TISSUE DISORDERS
Shoulder Impingement Syndrome
Tennis Elbow
VASCULAR EXAMINATION OF UPPER LIMB
CHAPTER 4:
Pathophysiology and Differential Diagnosis of Neck Pain
APPROACH TO A PATIENT WITH NECK PAIN (TABLES 4.1 TO 4.4)
Characteristic of Pain
Age
Trauma
Cancer
Fever
Steroids
Inflammatory Arthritis
Deformity
Endemicity
Cervical Spine Surgery
RED FLAG CONDITIONS: WHAT IS TO BE DONE?
CHAPTER 5:
Investigations for the Diagnosis of Neck Pain
INDICATIONS FOR X-RAY
X-RAY VIEWS
WHAT TO LOOK FOR IN AN X-RAY?
Check the Alignment
Body of Vertebra
Uncovertebral Joint
Spinous Process
Pedicle
Facets
Intervertebral Space
MAGNETIC RESONANCE IMAGING (MRI)
Indications for MRI
What to Look for in MRI? (Figs 5.6A to C)
Intervertebral Disc
Vertebral Body (Fig. 5.6A)
Spinal Cord
Computerized Tomography (CT)
Indications for CT
Other Imaging Procedures
Lab Tests
Electromyogram (EMG)
PART 2: MANAGEMENT OF NECK PAIN AND CASE STUDIES
CHAPTER 6:
Management of Neck Pain
MUSCLE PAIN
Treatment of Fibromyalgia (Table 6.2)
Management of Myofascial Pain and Trigger Points (Table 6.3)
Local Infiltration of Anesthetic
Vapocoolant Spray
Acupuncture Over the Trigger Point
NEUROPATHIC PAIN
Treatment of Neuropathic Pain
Drugs used in Neuropathic Pain (Table 6.4)
Topical or Regional Therapies
Tricyclic Antidepressants
Anticonvulsants
Opioid analgesics
Corticosteroids
Baclofen
Transcutaneous Electrical Nerve Stimulation
INFLAMMATORY OR NOCICEPTIVE PAIN
Treatment of Inflammatory Pain (Table 6.5)
Choice of NSAIDs
CHECKLIST BEFORE PRESCRIBING NSAIDs (TABLE 6.6)
ANALGESICS
Cautions in the Application of Rubifacients
Mechanical or Compressive Pain (Table 6.7)
Treatment of Mechanical Pain
INTERVENTIONAL PROCEDURES
CHAPTER 7:
Pharmacological Notes
MUSCLE RELAXANTS (TABLE 7.1)
Diazepam
Tizanidine
Baclofen
Other Muscle Relaxants
Methocarbamol
Orphenadrine
ANTIDEPRESSANTS
Amitriptyline/Nortriptyline
Preparation
Citalopram
ANTICONVULSANTS
Gabapentin
Pregabalin
OPIOID ANALGESICS
Tramadol
NSAIDs
Ibuprofen
Other Propionic Acid Derivatives
Naproxen
Fenoprofen
Flurbiprofen
Diclofenac Sodium and Potassium
Diflunisal
Indomethacin
Mefenamic Acid
Meloxicam
Piroxicam
NSAIDs—COX-2 INHIBITORS
Etoricoxib
Celecoxib
ASPIRIN (ACETYL SALICYLIC ACID)
PARACETAMOL (ACETAMINOPHEN)
NSAIDs: TOPICAL APPLICATIONS
Other Topical Applications
CHAPTER 8:
Nonpharmacological Management of Neck Pain
LIFESTYLE CHANGES AND PATIENT EDUCATION
Relaxation and Destressing Exercises
Mobilization Exercises
Stretching Exercises
Stretching Exercise—Patient Education
Strengthening Exercises
Endurance Exercise
Isometric Exercises—Patient Education
Theraband Exercises
PATIENT EDUCATION FOR GOOD POSTURE
Sitting (Fig. 8.17)
Standing (Fig. 8.18)
Sleeping (Fig. 8.19)
Driving (Fig. 8.20)
Lifting and Bending (Fig. 8.21)
Working
Rest
Destressing
ACUPUNCTURE AND DRY NEEDLING
LOW LEVEL LASER THERAPY (LLLT) OR COLD LASER
MAGNETOTHERAPY
HEAT THERAPY
COLD THERAPY
ELECTROTHERAPY
MASSAGE
TRACTION
NON-SURGICAL SPINAL DECOMPRESSION TREATMENT
HEALTH SPA THERAPY
COLLAR
Types of Collar
Indications for Collar (Red Flags)
PILLOWS
CHAPTER 9:
Complementary and Alternative Medicine
MANUAL THERAPY
Mechanism of Pain Relief or Effects of Manual Therapy
Contraindications for Manual Procedures
Muscle Energy: Self Techniques
ISLAMIC MEDICINE
COMPLEMENTARY/ALTERNATIVE MEDICINE (CAM) IN INDIA
SOUND THERAPY
CHAPTER 10:
Case Illustrations and Discussions
ACUTE TORTICOLLIS
MYOFASCIAL PAIN SYNDROME: TRIGGER POINTS
DIAGNOSTIC CRITERIA FOR MYOFASCIAL TRIGGER POINTS
FIBROMYALGIA
BENIGN JOINT HYPERMOBILITY SYNDROME
Diagnosis of BJHS
CERVICOTHORACIC SYNDROME
THE LEVATOR SCAPULAE SYNDROME
INTERSCAPULAR PAIN
METABOLIC
CERVICAL SPONDYLOSIS
Symptoms and Signs
CERVICAL DISC PROLAPSE
Case Study 1
Investigations
Case Study 2
Discussion
Clinical Features
TRAUMA
Trauma: Spinal Cord Injury
Case Study 1
Case Study 2
Discussion
Trauma: Whiplash Injury
Mechanism of Whiplash
WAD: Whiplash Associated Disorders
SYRINGOMYELIA
Case Report
SEVERELY ILL PATIENT
Infections of Cervical Spine
Infections can be Bacterial or Viral
Tuberculosis of the Cervical Spine
Herpes Zoster
Inflammatory Conditions of Cervical Spine
SLE—Vasculitis
RA—Atlantoaxial Instability
AS—Poker's Neck
PMR—Polymyalgia Rheumatica
Tumors of the Cervical Spine (Table 10.2)
Subarachnoid Hemorrhage
DEMYELINATION
Case Study
MOTOR NEURON DISEASE
Signs and Symptoms
CONGENITAL CAUSES OF NECK PAIN
Case Study
Case Study
Thoracic Outlet Syndrome
How to perform Adson's Test? (Fig. 10.22)
EAST test is 3 min Elevated Arm Stress Test with Light Exercises
REPETITIVE STRAIN INJURY
Individual Factors
Physical Factors
Psychosocial Factors
The Following are the Clinical Presentations of Common RSI
Radiating Neck Complaints
Shoulder Disorders
Elbow Disorders
Wrist/Hand Disorders
Non-specific Forearm Pain
ENTRAPMENT NEUROPATHIES IN UPPER LIMB—DOUBLE CRUSH
Median Nerve at the Wrist: Carpal Tunnel Syndrome
Ulnar Nerve at Wrist: Guyon's Tunnel Syndrome
Posterior Interosseous Nerve (PIN): Radial Tunnel Syndrome
Ulnar Nerve at the Elbow: Cubital Tunnel Syndrome
Suprascapular Nerve
Greater and Lesser Occipital Nerve
CERVICOGENIC HEADACHE
VERTIGO (TABLE 10.3)
Cervical Reflexes
VERTEBROBASILAR INSUFFICIENCY
INDEX
TOC
Index
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