Worry and stress also cause muscle tension and lead to chronic neck and shoulder pain
NECK AND SHOULDER PAIN
NECK AND SHOULDER PAIN
Worry and stress also cause muscle tension and lead to chronic neck pain,which is often burning in quality.Spondylosis seen on X-ray increases after the age of 40 years ,but it is not always causal ,as the pain often settles whilst the radiological changes persist.Spondylosis can ,however cause stiffness and increases the risk of mechanical or muscular neck pain .Muscle spasm can be palpable ,is tender and may lead to abnormal neck posture ( e.g acute torticollis ) . Muscular pattern neck pain is not localized but affects the trapezius muscle, the C7 spinous process ,the paracervical musculature or all three .It is also called shoulder girdle pain.Pain often radiates to the occiput but rarely beyond the tip of the shoulder .It is commonly associated with unilateral or bilateral tension headaches ,pain radiating over the head to the temple and eye ,described as like a pressure or tight band .These features are also seen in fibromyalgia.
ETIOLOGYTRAUMA TO THE CERVICAL SPINE
Whiplash injury is due to tauma ( usually automobile accidents ) causing cervical musculoligamental sprain or strain due to hyperflexion or hyperextension.This diagnosis should not be applied to patients with fractures ,disk herniation ,head injury ,or altered consciousness.In one study ,18% of patients with hiplash injury had persistent injury-related symptoms 2 years after the car accident.
CERVICAL DISK DISEASE
Herniation of a lower cervical disk is a common cause of neck ,shoulder ,arm,or hand pain.Neck pain ( worse with movements\ ),stiffness ,and limited range of neck motion are common.With nerve root compression ,pain may radiate into a shoulder or arm.Extension and latera rotation of neck narrows he intervertebral foramen and may reproduce radicular ymptoms ( Spurling's sign ).In young individuals ,acute radiculopathy from a ruptured disk is pften traumatic .Subacute radiculopathy is less likely to be related to a specific traumatic incident and may involve both disk disease and spondylosis.
CERVICAL SPONDYLOSIS
Osteoarthritis of the cervical spine may produce neck pain that radiates into the back of the head ,shoulders, or arms ,can also be source of hedaches in the posterior occipital region.A combined radiculopathy and myelopathy may occur.An electrical sensation elicited by neck flexion and raiating down the spine from the neck ( Lhermitte's symptoms ) usually indicates cervical or upper thoracic spinal cord involvement.MRI or CT -myelography can define the anatomic abnormalities,and EMG and nerve conduction studis can quality the severity and localize the levels of nerve root injury.
OTHER CAUSES OF NECK PAIN
Includes rheumatoid arthritis of the cervical apophyseal joints,ankylosing spondylitis ,herpes zoster ( shingles ),neoplasm metastatic to the cervical spine,infection ( osteomyelitis and epidural abscess ), nd metabolic bone disease.Neck pain may also be reffered from the heart with coronary artery ischemia ( cervical angina syndrome ).
THORACIC OUTLET
An anatomic region containing the first rib ,the subclavian artery and vein ,the brachial plexus ,the clavicle ,and the lung apex.Injury may result in posture -or task related pain around the shoulder and supraclavicular region.True neurogenic thoracic outlet syndrome results from compression of the lower trunk of the brachial plexus by an anomalus band of tissue ,tratment consists of surgical division of the band.Arterial thoracic outlet syndrome results from compression of the subclavian artery by a cervical rib ,treatment is with thrombolysis or anticoagulation ,and surgical excision of the cervical rib.Disputed thoracic outlet syndrome includes a large number of patients with chronic arm and shoulder pain of unclear cause ,surgery is controversial and treatment often unsuccessful.
BRACHIAL PLEXUS AND NERVES
Pain from injury to the brachial plexus or arm peripheral nerves can mimic pain of cervical spine origin.Neoplastic infiltration can produce this syndrome ,as can postradiation fibrosis ( pain less often present ). Acute brachial neuritis consist of acute onset of severe shoulder or scapular pain followed over days by weakness of proximal arm and shoulder girdle muscles innevated by the upper brachial plexus ,onset often preceded by an infection or immunization .Complete recovery occurs in 75% of patients after 2 years and in 89% after 3 years.
SHOULDER
If sign of radiculopathy are absent ,differential diagnosis includes mechanical shoulder pain ( tendonitis ,bursitis ,rotator cuff tear ,dislocation ,adhesive capsulitis and cuff impingement under the acromion ) and reffered pain ( subdiaphramatic irritation ,angina ,Pancoast tumor ).Mechanical pain is often worse at night ,associated with shoulder tenderness and aggravated by abduction ,internal rotation or extension of arm.
TREATMENT
Symptomatic treatment of neck pain includes analgesic medication and /or a soft cervical collar.Indications for cervical disk and lumbar disk surgery are similar ,however with cervical disease an aggressive approach is indicated if spinal cord injury is threatened.Surgery of cervical herniated disks consists of an anterior approach with diskectomy followed by anterior interbody fusion ,a simple posterior patial laminectomy with diskectomy is an acceptable alternative .The cumulative risk of subsequent radiculopathy or myelopathy at cervical segments adjacent to the fusion is 3% per year and 26% per decade.Nonprogressive cervical radiculopathy ( associated with a focal neurologic deficit ) due to a herniated cervical disk may be treated conservatively with a high rate of success.Cervical spondylosis with bony,compressive cervical radiculopathy is generally treated with surgical decompression to interrupt he progression of neurologic signs ,spondylotic myelopathy is managed with anterior decompression and fusion or laminectomy.
