Disclosures Cervical Spine Stock Ownership: Relievant (0.17%), - - PowerPoint PPT Presentation

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Disclosures Cervical Spine Stock Ownership: Relievant (0.17%), - - PowerPoint PPT Presentation

Jun 12, 2023 279 likes •496 views

12/9/2016 Pain in the Neck: Common Problems in the Disclosures Cervical Spine Stock Ownership: Relievant (0.17%), Nocimed (0.70%). Conor W. ONeill, M.D. Clinical Professor Department of Orthopaedic Surgery Non-operative Spine Service

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Pain in the Neck: Common Problems in the Cervical Spine

Conor W. O’Neill, M.D. Clinical Professor Department of Orthopaedic Surgery Non-operative Spine Service UCSF

Disclosures

Stock Ownership: Relievant (0.17%), Nocimed (0.70%).

  • Functional anatomy
  • Pathology
  • Clinical evaluation
  • Case studies

Outline

Myelopathy Radiculopathy Mechanical neck pain Cervicogenic HA Cervicobrachial 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 xxxx Xxxxx xxx x x x x x 6/7 6/7 Left

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Keyhole foraminotomy

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xxx xxxx Xxxxx Xxxxxxxx xxxxxxxxx x x x x xx xxx xxxx xxxxxx xxx

  • 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

xx x

3/4 4/5 5/6 6/7 Right 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

xx x x

  • 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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