Neck Pain Holistic Treatments

New Type Of Exercises Quickly Heal Neck Pain

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New Type Of Exercises Quickly Heal Neck Pain Summary

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Spinal Immobilization

Carrying boarded patients takes a heavy toll on the backs of EMTs and paramedics. Evaluation of the boarded patient is expensive and time-consuming in the emergency department because of the need to clear the spine. Not all trauma victims require spinal immobilization for transport. The medical director should develop protocols or guidelines to avoid unnecessary field immobilization. 18 For example, a patient with no neck pain or tenderness (neck pain must be defined liberally and includes stiffness or feels funny), not in the extremes of age (below 10 or above 65), with no altered sensorium (no drugs or alcohol present and no head injury), and with no distracting injuries (e.g., long bone fracture or abdominal or chest injury) does not routinely require immobilization because there is an extraordinarily low probability of neck injury. Ideal guidelines for prehospital personnel necessarily would have virtually 100 percent sensitivity with acceptable specificity for cervical spine...

Radioactive Iodine Therapy

Radioactive iodine has been used for the treatment of toxic goiter, however its use in the management of the patients with a non-toxic goiter is a recent event. In 1964 Keiderling first reported the benefits of radioactive iodine therapy in non-toxic goiter in 400 patients. Since then there have been sporadic reports of similar use. Its use in substernal goiter had not been evaluated until 1994 when Huysmans et al reported a prospective study of patients with large compressive goiters.11 Nine of their 19 patients had intrathoracic extension for more than 2 cm. Using MRI they were able to demonstrate a 40 reduction in the volume of the goiter. They also showed a 10 decrease in both the tracheal narrowing and deviation in three-quarters of their patients. Unfortunately, one-third of their patients did not experience any improvement in their symptoms of dyspnea. Radiotherapy is not without its potential complications. Radiation induced thyroiditis and a transient increase in volume may...

H 11313 Technique in Acute Vascular Access

The cutdown technique is described in the Technical Tips box and displayed in Fig. 11.1. Note that the technique is identical to that used for implanting permanent venous infusion ports and other central venous catheters. A surgeon experienced in such procedure can perform a cutdown and catheterization rapidly and effectively. For the same reason, cutdown is probably an underestimated and underused alternative. Central catheterization is performed in Scandinavia mostly by anesthesiologists and with great skill. This alternative for access in trauma has the disadvantage of long catheters with a relatively small caliber, making rapid infusion of large volumes difficult. Direct puncture in the neck region can be difficult and even dangerous in an anxious and hypoxic patient. In a patient wearing a stiff neck collar it is almost impossible. A central venous catheter allows objective measurement of central venous pressure (CVP), but its value in managing acute trauma is hard to appreciate,...

Clinical Features

Symptoms and signs of bacterial meningitis depend on patient age and duration of illness. No single complaint or physical finding is specific. However, the findings of fever associated with altered mental status constitutes a reasonable basis for suspicion for meningitis. Infants typically present with nonspecific symptoms including decreased responsiveness, poor feeding, and vomiting. Although common, fever is not universally present at the time of diagnosis. Signs of paradoxical irritability despite parental comforting attempts decreased responsiveness to visual, verbal, and painful stimuli hypotonia bulging fontanelle or respiratory distress may be seen. Older children will usually complain of headache, photophobia, nausea, and vomiting. As for infants, signs of lethargy and confusion are primary indicators for suspicion of meningitis, and fever may not be consistently present. Nuchal rigidity and the classic findings of the Kernig sign (neck pain elicited with passive knee...

Supportive Treatments

The patient decided on treatment with BoNT injections, and responded very well. After 6 months, during which she underwent treatment sessions, she was able to return to work as a part-time secretary. Approximately 3 to 4 days following each treatment, her symptoms improved. The effects would begin to wear off by about 10 weeks she returned for repeat treatment at the end of 12 weeks. She remained stable for 2 years, until a motor vehicle accident in which she sustained a whiplash injury. She had severe neck pain following the injury and felt that the BoNT injections were not as effective as before.

Causes of Traumatic Subdural Hematoma

Direct trauma or impact causes deformation of the skull, with or without fractures, contusion, and epidural and subdural hemorrhage. Angular or rotational acceleration or deceleration of the head on the neck occurs in whiplash and shaking injuries, although there also is a rotational element in most falls as a result of hinging of the head on the neck. These forces are more likely to cause shearing injuries of the intracranial structures.148 149 However, all mechanisms - translational, rotational, and angular - can cause subdural hematoma.

Sequence of Spinal Immobilization

If a patient is walking at the scene when EMS personnel arrive but complains of neck pain, the patient should be boarded from a standing position. If the patient is lying on the ground when the EMTs arrive, the patient should be carefully logrolled by several attendants onto a long backboard.

Evaluation of rear limbs tail and anus

Biceps reflex (depressed or absent if lesion C6-C7 hyperactive above C6) Triceps reflex (depressed or absent if lesion C7-T2 hyperactive above C7) Flexor reflex (depressed or absent if lesion C7-T2) Crossed extensor (present if lesion above C7) Deep pain (present if nerve and spinal cord, brainstem and cerebrum intact) Superficial sensation (local nerves, spinal cord, brainstem) Neck pain (cervical lesion)

TABLE 2445 Spinal Column Differences in Children

In alert unintoxicated adult blunt trauma patients without neck symptoms, cervical spine radiographs can be forgone and cervical spine immobilization can be released. Because children have a much lower frequency of cervical spine fractures, following this algorithm in children is appropriate. Any child with neurologic complaints, neck pain, limited neck movement, neck tenderness, or evidence of neck trauma, must have plain films consisting of at least three views lateral, anteroposterior, and odontoid. The single lateral cervical spine radiograph has been shown to miss fractures and result in a delay in diagnosis. 21 If the child has neck pain but no neurologic symptoms, plain radiography is generally all that is required to clear the cervical spine. Occult fractures and misinterpretation of plain films do occur, so if there is any doubt, a CT scan should be obtained. If the child had paresthesias, numbness, or weakness or currently has neurologic symptoms, a CT scan is also...

Diffuse Axonal Injury

Diffuse axonal injury (DAI) is the disruption of axonal fibers in the white matter and brainstem. Shearing forces on the neurons generated by sudden deceleration cause DAI. A relationship exists between the force of sudden deceleration and the amount of DAI observed in all cases of TBI except for assaults and whiplash. The classic cause of DAI is an MVC. In infants, the shaken baby syndrome is a well-described tragic cause.

Subarachnoid haemorrhage

SAH commonly presents with a thunderclap headache - a distinct, sudden, severe headache. It need not be in any location neck pain or vomiting may predominate. The first episode of severe headache cannot be classified as migraine or tension headache (International Headache Society). The

TABLE 2731 Signs and Symptoms of Cervical Radiculopathy

Early cervical spinal myelopathies can only be recognized if the examiner looks for them, so a full neurologic examination that includes the lower extremities is needed to evaluate neck pain. Common signs and symptoms include hyperreflexia, a positive Babinski sign, gait disturbance, lower extremity weakness, impaired fine hand movement, or upper and lower extremity spasticity.

Secondary Causes of Headache

Clinical Features At the time of presentation, almost half of patients with SAH have normal findings on neurologic examination, including normal vital signs, normal level of consciousness, and no neck stiffness.22 The headache of SAH is most commonly severe and of sudden onset, but it may also be more subtle. The most common location for the headache is occipitonuchal.8 Many presentations are atypical and may mislead the clinician. For example, sudden-onset intense neck pain may be mistakenly attributed to radiculopathy. Also, resolution of the pain even without treatment does not exclude the diagnosis. Beware of radiation of pain down along the spine, since this suggests tracking of subarachnoid blood down the spinal canal. INTERNAL CAROTID AND VERTEBRAL ARTERY DISSECTION While rare, dissection of the internal carotid or vertebral artery is frequently associated with headache. Dissection may be spontaneous or the result of trauma and generally occurs in younger patients (median age,...

TABLE 342 Signs and Symptoms of Chronic Pain Syndromes

MYOFASCIAL HEADACHES AND TRANSFORMED MIGRAINE Myofascial headache is a variant of tension headache and is characterized by the presence of trigger points on the scalp constant, squeezing pain and occasionally shooting pain. Nausea, vomiting, neck pain, and neck tenderness may be present. It is important to differentiate this disorder from common tension headache because myofascial headache may benefit from referral for injection of trigger points. Transformed migraine is a syndrome in which classic migraine headaches change over time and develop into a chronic pain syndrome. One cause of this change is frequent treatment with narcotics.8 In this regard, patients who initially have vascular symptoms eventually have predominantly muscular symptoms nonthrobbing, squeezing, bandlike pain associated with muscle tenderness and tension. Nausea and vomiting or failure of oral antimigraine medications often prompts an ED visit.

Retropharyngeal Abscess

Signs and symptoms include fever, dysphagia, neck pain, limitation of cervical motion, cervical lymphadenopathy, sore throat, poor feeding, muffled voice, and difficulty breathing. Symptoms in children less than 1 year of age are more likely to include stridor and neck swelling. The intense inflammation and swelling associated with a retropharyngeal abscess can lead to inflammatory torticollosis, which is unilateral spasm of the sternocleidomastoid muscle, causing posturing of

Acute Spinal Cord Compression

The single most important approach to the diagnosis of spinal cord compression is for the emergency physician to recognize the significance of persistent, progressive unexplained back or neck pain in a patient with known malignancy. Symptoms suggestive of cord compression include decreased sensation, urinary retention, lower extremity weakness, and difficulty with walking. Pain of involved vertebrae may be localized and or intensified with percussion during physical examination. The neurologic examination should assess reflexes, motor and sensory function, rectal sphincter tone, and gait. A major exception to the nearly routine presence of pain is in lymphoma if lytic bony metastases are absent, the patient may have a diminished sensory level or flaccid paralysis with absent or minimal pain. Plain radiographs should be obtained in any patient having a history of malignancy who presents with persistent, progressive back or neck pain. In the absence of

Sequelae of Anaesthesia

Backache and neck pain can occur from poor patient positioning and as a result of stretched ligaments and relaxed skeletal muscle. Arms and legs can slip off operating tables or trolleys, if inadequately secured, with the potential for ligament and bony injuries. Nerve injuries have been extensively reported and are a result of direct compression or stretching of the nerve. Correct patient positioning and extensive padding of exposed sites are mandatory. The brachial plexus can be damaged if there is excessive abduction of the arm (> 90 degrees) with the humeral head impinging on the axillary neurovascular bundle. The radial nerve, as it runs down the lateral border of the arm 3-5 cm above the lateral epicondyle, is at risk of being damaged by a blood pressure cuff. Radial nerve palsy is associated with wrist drop, weakness of finger extension, and loss of sensation in the first web space. The ulnar nerve is exposed at the elbow and can be damaged by direct trauma or the blood...

Spinal cord compression

In the cervical region, compression expresses itself as sensory and motor symptoms and signs of numbness and weakness in the upper limbs, which may be flaccid or spastic depending on the level, and weakness of the trunk and lower limbs, which will have increased tone or even spasticity. If vertebrae are involved in the pathological process, there is often neck pain (or referred interscapular pain), but intradural lesions are often painless.

Food Borne Infections during Pregnancy

Monocytogenes leads to flu-like symptoms, such as fever, muscle aches, and sometimes nausea or diarrhea. If the infection spreads to the nervous system, it may also cause headaches, stiff neck, confusion, loss of balance, or convulsions. The bacterium has been found in a variety of raw foods, including unpasteurized (raw) milk, uncooked meats, and vegetables, and in processed foods that become contaminated after processing, such as soft cheeses and cold cuts of meat. According to the Centers for Disease Control and Prevention, pregnant women in the United States are approximately 20 times more likely than other healthy adults to get lister-iosis and approximately one-third of listeriosis cases occur during pregnancy. The fetus and newborn are at greatest risk of this infection and its consequences can be severe, leading to miscarriage, stillbirth, and premature delivery or to meningitis in the newborn infant. When infection occurs during pregnancy, antibiotics given promptly to the...

Spinal injury

Most spinal injuries are caused by road traffic accidents, falls or during sport. Many patients sustain a whiplash injury to the soft tissues and ligaments following road accidents, but bony and neurological injuries are more likely when the occupant has been ejected from the vehicle or suffered head injury. Falls from a height, either onto the head or feet, can cause spinal injury, whilst swimming (particularly diving) and horse riding, in addition to contact sports, give rise to a significant number of spinal injuries each year.

Freeliving Amoebae

Naegleria, Acanthamoeba, and Balamuthia have been identified in the central nervous system of humans and other animals. Acanthamoeba can also cause keratitis, and both Acanthamoeba and Balamuthia madrillaris may cause cutaneous infection in humans. Naegleria fowleri and Acanthamoeba spp. are commonly found in soil, water, sewage, and sludge. These amoebae feed on bacteria and multiply in the environment. They may harbor pathogenic bacteria to humans such as Legionella, Mycobacterium avium, Listeria, etc. Whether Acanthamoeba serves as a reservoir for human pathogens is unknown. Meningoencephalitis caused by Naegleria has been coined primary amebic meningoencephalitis. It is an acute and fulminant disease that can occur in previously healthy children and young adults who have been in contact with freshwater about 7-10 days prior to development of clinical signs. It is characterized by severe headache, spiking fever, stiff neck, photophobia, and coma, leading to death within 3-10 days...

Signs and Symptoms

The symptoms most commonly found in patients with retropharyngeal abscess are, individually, not specific for this disease, but, taken together, they point toward the correct diagnosis. Although the symptoms are not commonly recognized in preverbal children, older children will complain of sore throat and most have a history of high fever. Other symptoms include dysphagia, decreased oral intake, and stiff neck.

Lyme Disease

This tick-borne illness presents with systemic manifestations including those of the dermatologic, rheumatologic, neurologic, and cardiac systems. The best clinical marker is erythema migrans, the initial skin lesion that occurs in 60 to 80 percent of patients. Other acute symptoms include fatigue, fever, headache, mildly stiff neck, arthralgias, and myalgias. Late manifestations are variable and are best discussed by system

Chlorophyta

Asexual Reproduction Chlorophyta

The genus usually chosen to illustrate the unicellular condition in chlorophytes is Chlamydomonas (Figure 9.5). This has a single chloroplast, similar in structure and shape to that of a higher plant, and containing a pyrenoid. Situated together at the anterior end is a pair of smooth or whiplash flagella, whose regular, ordered contractions propel it through the water. A further structural feature found in Chlamydomonas and other motile forms of green algae is the stigma or eye-spot this is made up of granules of a carotenoid pigment and is at least partially responsible for orienting the cell with respect to light.

Shaking

However, there is one further suggested mechanism by which a baby's brain may be damaged by shaking or whiplash. The pathologic studies of Geddes et al.144145 showed that most infants with inflicted traumatic brain injury had suffered lack of blood or oxygen supply to the brain. One third had torn nerve fibers in the part of the brainstem (craniocervical junction) where the respiratory control centers are found. The authors suggested that damage here would cause a baby to stop breathing, which would lead to a cascade of events resulting in brain swelling and retinal and possibly subdural hemorrhages. However, this mechanism depends on producing apnea (cessation of breathing) and subsequent severe brain swelling. This hypothesis has been rejected by some155 and further emphasizes the importance of careful examination of the spinal cord and craniocervical junction in all infants with SDH. Readers are drawn to the Court of Appeal transcripts related to R v Harris, Rock, Cherry and...

Horners Syndrome

Controlling the Mueller muscle in the upper eyelid and the iris dilators cause these classic findings. Interruption can occur anywhere along the pathway from the brain stem to the sympathetic plexus surrounding the carotid artery (Fig 230-21). It is very important to determine whether this syndrome is acute or chronic. Patients with chronic disease can be evaluated on an outpatient basis, but all cases of acute disease require a full emergent evaluation. Workup includes a chest x-ray, CT of the brain and cervical region, and a carotid angiogram if a carotid dissection is suspected (acute Horner's syndrome with neck pain).

Diagnostic Imaging

Plain x-rays are clearly indicated in all patients with neck pain or cervical tenderness. The presence of pain or tenderness has over an 80 percent sensitivity for cervical spine injury. Cervical spine injury is very unusual in patients without pain or tenderness but may occur in approximately 1 percent. 19 Thus, the mechanism of injury should also be taken into account when the decision is made whether to image a patient's cervical spine. In a study of 233 patients, nine variables correlated significantly with cervical spine injury. They were falls, symptoms of numbness, sensory loss, weakness, neck spasm, neck tenderness, objective sensory and motor loss, and weakness or loss of anal sphincter tone. Correlation of cervical injury with involvement in a motor vehicle crash approached statistical significance. 21 Unfortunately, there are significant limitations to the study that do not allow accurate assessments. Apart from a paucity of patient-related information, the study appears to...

Complete Evaluation

A complete history and thorough physical examination are performed. Information obtained from pre-hospital personnel should include mechanism of injury, symptoms, hemodynamic stability, and amount of blood loss at the scene. Once in the Emergency Department, if possible, the patient should be questioned about neck pain, difficulty breathing, dysphagia, odynophagia, hoarseness, hematemesis, hemoptysis, and any neurologic deficits. Examination of the neck requires a search for clinical signs of vascular, aerodigestive, and neurologic injuries. These include arterial bleeding, large or expanding hematomas, diminished pulses or bruits, lateralizing signs, tracheal deviation, air-bubbling through the wound, saliva in the wound, subcutaneous emphysema, and evidence of cranial nerve injuries.

Resuscitation

Injuries to the spine and spinal cord are frequently associated with other injuries. Initial resuscitation of the patient with multiple injuries from trauma focuses on airway, breathing, and circulation (the ABCs). The patient with a potential spine injury should undergo immobilization to prevent deterioration during resuscitation. Patients who are at risk for spine injury include those who have had automobile and motorcycle accidents, falls, and diving accidents. Any patients complaining of neck pain, weakness, parethesias, or paralysis should be considered to have a spinal cord injury. A patient with a history of trauma and an altered level of consciousness should always be treated as if a spinal cord injury were present.

Thyroiditis

Subacute thyroiditis, also known as de Quervain's, granulomatous, or giant cell thyroiditis, is an acute, self-limited inflammatory condition of the thyroid gland. It is characterized by neck pain, fever, myalgias, malaise, mild to moderate thyroid enlargement, exquisite neck tenderness and symptoms of thyrotoxicosis which occur during the initial phase of inflammation. Most patients have a history of an antecedent flu-like or upper respiratory illness. The cause for subacute thyroiditis is multifactorial. It appears that a viral infection triggers an abnormal cell mediated immune response directed at the thyroid follicular cells causing follicular cell destruction and release of preformed thyroid hormone. In addition to infection and autoimmune factors, a genetic predisposition may also be important in the patho-genesis as suggested by the association of the HLA BW35 haplotype with subacute thyroiditis in certain patients.9 The diagnosis is supported by the presence of a markedly...

Viral Encephalitis

Viral encephalitis is a viral infection of brain parenchyma that produces an inflammatory response. It is distinct from, although often coexists with, viral meningitis, in which the infectious agent and inflammatory response are in the subarachnoid space. Clinically the distinction is made by the presence of neurologic abnormality in encephalitis, whereas only meningeal symptoms and signs (e.g., photophobia, headache, and stiff neck) occur in meningitis. The true incidence of viral encephalitis is difficult to estimate because of the variability of clinical expression, ranging from profound neurologic involvement to clinically silent cases, as well as variability in reporting policies. Several thousand cases are reported yearly in the United States.

Vascular Injury

There are several cases in the literature of vertebral injury following chiropractic neck manipulation. Cases of severe neurologic deficit following vertebral artery injury have also been reported with Yoga exercises, calisthenics, archery, and painting a ceiling. 2122 All mechanisms of injury involve either cervical hyperextension, excessive contralateral rotation, or, most commonly, both. The vertebral arteries are susceptible to mechanical injury because of their relationship to neighboring bony structures and ligaments. Traumatic intimal disruption may lead to complete thrombotic occlusion, subintimal hematoma, dissection, or pseudoaneurysm formation. Distal branch occlusions may result from dissecting aneurysms, thrombus propagation from the neck, or thromboembolism. Patients may be asymptomatic, or they may have transitory or delayed neurologic symptoms. Symptoms vary from neck pain and occipital headache to Wallenberg's syndrome and lethal stroke. Wallenberg's syndrome (lateral...

Nematodes Roundworms

TRICHINELLA SPIRALIS Trichinosis is common in Mexico and the United States and results from the consumption of infected pork and, less commonly, bear and walrus meat. In the early stages of infection with Trichinella spiralis, the patient may present with acute myocarditis, nonsuppurative meningitis, bronchopneumonia, or catarrhal enteritis. The primary lesions are in striated muscle. Clinical symptoms depend on the site of invasion. Patients may present with nausea and vomiting, diarrhea, fever, urticaria, periorbital edema, (pathognomonic) splinter hemorrhages, myalgia, muscle spasm, stiff neck, headache, and psychiatric disturbances. Laboratory manifestations of trichinosis include leukocytosis, eosinophilia, elevated creatine phosphokinase and electrocardiographic changes. The diagnosis can be confirmed with latex agglutination, skin test, and a bentonite flocculation test. Biopsy of tender muscle may be helpful after the fourth week. Since T. spiralis encysts in striated muscle,...

Neurologic Problems

With atlantoaxial instability, the spinal cord is vulnerable to compression between the odontoid process anteriorly and the arch of the atlas posteriorly when the neck is flexed. Spinal cord compression may also occur during neck extension when there is atlantoaxial subluxation and or dislocation. Intubation, cardiac catheterization, laryngoscopy, bronchoscopy, tracheal suctioning, sedation for neuroimaging, auditory- and visual-evoked potential studies, and dental work all involve positions with extreme neck extension and may be dangerous. The neurologic manifestations of atlantoaxial instability may be relatively subtle and include easy fatigability, difficulties in walking, neck pain, limited neck mobility, torticollis, incoordination and clumsiness, sensory deficits, problems with incontinence, and spasticity. These symptoms may progress to paraplegia, hemiplegia, quadriplegia or even death. Most individuals have had symptoms for more than a month prior to their diagnosis and many...

Halo Devices

Ring migration and or loss of immobilization occurs in 10 to 13 percent of patients.56 Suspect loss of immobilization in patients complaining of neck pain and or mobility, and change in fit or position of the ring or vest. Immediately immobilize the cervical spine using an alternative technique (e.g., hard collar plus backboard). Obtain plain films to assess for changes in alignment and neurosurgical consultation for reapplication of the Halo.

Down Syndrome

Atlantoaxial instability and dislocation have been identified and are felt to be related to joint laxity. Spinal cord compression may develop, with neck pain, head tilt, torticollis, frequent staggering or falling, increased deep tendon reflexes, clonus, limb weakness, paresthesias, or hemi- or quadriplegia. Symptomatic children require immediate surgical stabilization.

Hydrocephalus

Hydrocephalus is present in 70 to 90 percent of children with thoracic or lumbar level defects and in substantial numbers of those with sacral level defects. It is routinely treated with shunt placement early in life. Concerns regarding shunt function are common in patients presenting to the acute care setting. Signs and symptoms of shunt malfunction are lethargy, irritability, nausea, vomiting, visual problems, cognitive changes, neck pain, headache, swelling along the shunt path, or seizure.9 0 Not all symptoms need be present to indicate malfunction of the shunt. The symptomatology is nonspecific and can easily be due to a variety of other problems such as sepsis, urinary tract infection, otitis media, gastroenteritis, sinus infection, or viral syndromes. A number of children with massive constipation and a shunt may complain of similar symptomatology, which resolves when the fecal backup is relieved. Evaluation for shunt malfunction should proceed only after infectious and other...