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

12/9/2016 Pain in the Neck: Common Problems in the Disclosures Cervical Spine Stock Ownership: Relievant (0.17%), Nocimed (0.70%). Conor W. O’Neill, M.D. Clinical Professor Department of Orthopaedic Surgery Non-operative Spine Service UCSF Outline • Functional anatomy • Pathology • Clinical evaluation • Functional Anatomy Case studies Myelopathy Cervicogenic HA Radiculopathy Cervicobrachial syndrome Mechanical neck pain • Live exam 1

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12/9/2016 Disc Herniation Pathology Spondylosis 6

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12/9/2016 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 Transverse STIR image near angle of mandible shows (long arrow) and epidural hematoma at the C7 level (short perimuscular hemorrhage (thin arrows), right muscle strain ( ∗ ), arrows). 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. 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. Buitrago-Téllez; Harald M. Bonel; Paul Heini; Stefan Schaeren; Matthias Sturzenegger; Radiology 2012, 262, 567-575. 8

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12/9/2016 66 y/o retired data entry clerk Case Studies • Line dances, active in church • Myelopathy • Radiculopathy • Enlarged tonsil on routine exam, cancer workup negative • Mechanical neck pain • Cervicogenic headache • Spinal stenosis noted on neck MRI done as part of cancer workup • Cervicobrachial syndrome 12

12/9/2016 44 yr old stay-at-home mom xxx xxxx Xxxxx • x xxx Very fit, regular vigorous exercise x x 6/7 • x No prior neck problems x Left • Woke up with severe pain (8/10) • No myelopathy, 4/5 weakness triceps 6/7 and wrist flexors • 6 weeks conservative care 13

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12/9/2016 Cervicobrachial syndrome xx xxx xxx • Nonspecific term describing some combination of pain, xxxx Xxxxx Xxxxxxxx numbness, tingling, weakness in the neck and/or upper xxxxxxxxx x x extremity, without specific pathology x x • xxxx Diagnosis of exclusion xxxxxx xxx 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 15

12/9/2016 76 year old male xx x • Healthy, active • Chronic stiff neck • 4 month history of severe left sided neck pain • No better with PT, NSAID’s 3/4 4/5 Right Left 5/6 6/7 16

12/9/2016 46 y/o anesthesiologist • Healthy, active, master’s C3 swimmer • 6 month history of neck pain Right after sledding injury • Still working, can’t swim C3 C3/4 Left 17

12/9/2016 64 y/o law firm CFO • Passionate hunter (shoots rhino with long-barreled xx handgun) x x o o o • o Freak injury while duck- hunting • Neck pain with numbness and tingling left shoulder C4 Left 18

12/9/2016 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 19

12/9/2016 48 y/o attorney with neck pain 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 20

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