Why is my neck always sore
Neck Pain Causes and Treatment - Everything You Need To Know - Dr. Nabil Ebraheim
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neck pain causes and treatment
patients can complain of neck pain from
variety of reasons and in this video i'm
gonna try to outline the most common
causes of neck pain and how you can
treat it
the first thing you want to identify if
the patient has a neck pain or shoulder
pain
shoulder pain and neck pain problems
overlap
you need to know if the origin of the
pain at the cervical spine or if the
shoulder itself is the origin of the
pain
that the patient symptoms improve by
shoulder abduction and placing the hand
over the head then the pain is cervical
spine origin
shoulder abduction test lifting the arm
above the head usually relieves the
symptoms because it decreases tension on
the affected
nerve
it the pain more when you move the
shoulder
then the shoulder itself is the source
of the pain
an important cause of neck pain is disc
herniation
the patient will complain of numbness
paresthesia radiculopathy which is
shooting pain that radiates from the
neck to the arm
so the patient will have unilateral arm
pain
numbness tingling in a specific
dermatome in the hand
as you see here in this diagram
and weakness in a specific muscle group
in cervical radiculopathy the pain is
sudden and goes to the arm
radiculopathy occurs due to compression
of the nerve root either by a disc
herniation or by arthritis that narrows
the foramen
cervical disc herniation occurs most
frequently at the level of c6 c7 and it
will affect the c7 nerve root
it can also occur at c5 c6 and in this
case it will affect the c-sex nerve root
how do you test for cervical spine disc
herniation you test the motor the
sensory and the reflexes
this is how you test the motor strength
of the nerve roots from c5 to t1
this is how you test the sensation as
you see here in this diagram
this is how you test the reflexes as you
can see here in this diagram
a spelling test for cervical spine
radiculopathy
what is the spurling test
the spelling test is considered positive
when neck extension and rotation towards
the painful side reproduces symptoms in
the epsilateral arm
the natural history of cervical
radiculopathy is favorable with the
resolution of the symptoms in most cases
in cervical radiculopathy patients will
have 70 to 80 percent successful outcome
after two to three months with
conservative treatment
how do you really treat the cervical
disc herniation
so you're gonna start
non-surgical treatment first
we will use anti-inflammatory medication
isometric exercises physiotherapy muscle
relaxant
then get an mri if the symptoms does not
improve after six weeks of conservative
treatment
the mri result should be correlated with
the clinical symptoms false positive
rate of the mri is high
28
of asymptomatic patients less than 40
years old will have findings of a
herniated disc or foraminal stenosis
in asymptomatic patients older than 40
years old you will find that 57
of these patients will have at least one
degenerated disc on the mri
so the mri may show you a problem with
the disc in patients that are not
complaining of any neck pain
therefore
use the result of the mri wisely and
don't scare the patient because what you
find in the mri could be a normal
process
persistent disabling pain for six to
twelve weeks despite non-operative
treatment can be an indication for
surgery the surgery is usually anterior
and it involves decompression and fusion
of the involved disc space
ask the patient if the patient has gait
disturbance unstable gait when walking
wide-based gait
or hand clumsiness it may indicate
cervical myelopathy due to compression
of the spinal cord which is a serious
condition
the patient may have decreased manual
dexterity and difficulty in manipulating
fine objects such as buttoning and
unbuttoning shirts
the patient may have occipital headache
and sense of discomfort in the neck the
patient may not have severe neck pain
in general in cervical myelopathy the
onset of pain is insidious gradual
poorly characterized and localized
cervical myelopathy is a slowly
progressive process with stepwise
progression and deterioration over time
in cervical myelopathy the mri will show
compression of the spinal cord
in cervical myelopathy you will find
upper motor neuron signs including a
positive huffman sign
this is how you will see a positive
huffman sign
what are other upper motor neuron signs
you will find the patient will have
hyperreflexia
positive babiness heat test and clonus
test
early recognition and early surgery is
important for a good outcome
the severity of the symptoms and early
treatment is most important to the
outcome
surgery is done for any functional
impairment of the gate or the hands
usually the treatment in this situation
is surgery by decompression and fusion
asking the patient if he or she was
involved in a car accident the patient
may have a whiplash injury
so the patient will complain of pain in
the neck after a car accident it may be
referred pain in the head shoulder and
arm
usually there is no neurological deficit
the patient will have the soft tissue
injury and the x-ray will show loss of
cervical lordosis due to muscle spasms
treatment aggressive physiotherapy and
early mobilization
asking the patient is the pain connected
to activity or is independent of
activity and if the pain is worse at
night and not relieved by rest or
immobilization
this pain may be coming from a tumor or
infection
asking the patient about history of
weight loss or previous history of
cancer or if the patient is getting
fever and shells these are very rare
situations
in a patient that have tingling or
numbness in the hand you can consider
double crush which means the patient
will have two problems to the nerves
one problem comes from the neck another
problem comes from compression of the
nerves in the elbow like glutatal tunnel
syndrome or around the rest like carpal
tunnel syndrome
ask the patient if he had any diagnosis
of carpal tunnel syndrome or cubital
tunnel syndrome and you may need to get
image and nervous studies to the upper
extremity from the neck all the way down
the patient may have a cervical nerve
root compression and a distal nerve
compression
another cause of neck pain is cervical
spondylosis which is arthritis of the
spine it is a natural degenerative
process of the cervical spine
the x-ray will show the arthritis
treatment usually use miracle management
and surgery is done if there is
instability or neurological deficit
in general the typical patient that we
will see
is the patient with neck pain and no
injury the pain in the posterior part of
the neck which is tender to palpation
and no radiation to the arm no sensory
or motor deficit no neurological deficit
and the xa will show mild arthritis so
you're going to give the patient
physiotherapy
and anti-inflammatory medication
you very much i hope that was helpful
you
