Unrecognized Shoulder Disorders in Treatment of Cervical Spondylosis Presenting Neck and Shoulder Pain

조현진,신명훈,허정우,김진성,류경식,박춘근 대한척추신경외과학회 2012 Neurospine Vol.9 No.3

Objective: Cervical spondylosis and shoulder disorders share with neck and shoulder pain. Differentiating between the two can be challenging and patient with combined pathologies is less likely to have pain improvement even after successful cervical operation. We investigated clinical characteristics of the patients who were diagnosed as cervical spondylosis however, were turned out to have shoulder disorders or the patients whose pain was solely originated from shoulder. Methods: Between January 2008 and October 2009, the patients presenting neck and shoulder pain with diagnosis of cervical spondylosis were enrolled. Among them, the patients who met following inclusion criteria were grouped into shoulder disorder group and the others were into cervical spondylosis group. Inclusion criteria were as follows. (1) To have residual or unresponsive neck and shoulder pain despite of optimal surgical treatment due to concomitant shoulder disorders. (2) When the operation was cancelled for the reason that shoulder and neck pain was proved to be related with unrecognized shoulder disorders. The authors retrospectively reviewed and compared clinical characteristics, level of pathology, diagnosis of cervical spondylosis and shoulder disorders. Results: A total of 96 patients were enrolled in this study. Shoulder disorder group was composed of 15 patients (15.8%) and needed additional orthopedic treatment. Cervical spondylosis group was composed of 81 patients (84.2%). There was no significant differences in mean age, sex ratio and major diagnosis in both shoulder disorder and cervical spondylosis group (p=0.33, 0.78, and 0.68 respectively). However, the distribution of pathologic levels was found to be significantly different(p=0.03). In shoulder disorder group, the majority of lesions (15 of 19 levels, 78.9%) were located at the level of C4-5(36.8%) and C5-6 (42.1%). On the other hand, in cervical spondylosis group, C5-6 (39.0%) and C6-7 (37.1%) were the most frequently observed level of lesions (80 of 105 levels, 16.1%). Conclusion: It is very important for spine surgeons to perform a complete history taking and physical examination using the special tests, and to discover the underlying shoulder disorders causing of symptom in treatment of cervical spondylosis presenting neck and shoulder pain. Objective: Cervical spondylosis and shoulder disorders share with neck and shoulder pain. Differentiating between the two can be challenging and patient with combined pathologies is less likely to have pain improvement even after successful cervical operation. We investigated clinical characteristics of the patients who were diagnosed as cervical spondylosis however, were turned out to have shoulder disorders or the patients whose pain was solely originated from shoulder. Methods: Between January 2008 and October 2009, the patients presenting neck and shoulder pain with diagnosis of cervical spondylosis were enrolled. Among them, the patients who met following inclusion criteria were grouped into shoulder disorder group and the others were into cervical spondylosis group. Inclusion criteria were as follows. (1) To have residual or unresponsive neck and shoulder pain despite of optimal surgical treatment due to concomitant shoulder disorders. (2) When the operation was cancelled for the reason that shoulder and neck pain was proved to be related with unrecognized shoulder disorders. The authors retrospectively reviewed and compared clinical characteristics, level of pathology, diagnosis of cervical spondylosis and shoulder disorders. Results: A total of 96 patients were enrolled in this study. Shoulder disorder group was composed of 15 patients (15.8%) and needed additional orthopedic treatment. Cervical spondylosis group was composed of 81 patients (84.2%). There was no significant differences in mean age, sex ratio and major diagnosis in both shoulder disorder and cervical spondylosis group (p=0.33, 0.78, and 0.68 respectively). However, the distribution of pathologic levels was found to be significantly different(p=0.03). In shoulder disorder group, the majority of lesions (15 of 19 levels, 78.9%) were located at the level of C4-5(36.8%) and C5-6 (42.1%). On the other hand, in cervical spondylosis group, C5-6 (39.0%) and C6-7 (37.1%) were the most frequently observed level of lesions (80 of 105 levels, 16.1%). Conclusion: It is very important for spine surgeons to perform a complete history taking and physical examination using the special tests, and to discover the underlying shoulder disorders causing of symptom in treatment of cervical spondylosis presenting neck and shoulder pain.

8주간의 경추 운동과 교정치료과 목 관절 가동범위, 근력, 근지구력 및 통증-장애지수에 미치는 영향

김용주,박원일,양지혜,백형진 중앙대학교 학교체육연구소 2022 Asian Journal of Physical Education of Sport Scien Vol.10 No.1

The purpose of this study was to investigate the effects of cervical spine correction and exercise on the range of motion, muscle strength, endurance, pain and neck disability in males and females aged 20 to 40 years. Thirty adult male and female subjects were divided into three groups of cervical spine correction group, cervical spine exercise group, and cervical spine correction and exercise. The cervical spine exercise group performed a total of 60 minutes twice a week for 8 weeks, and the group who performed both cervical spine correction and cervical spine exercise performed twice a week for 8 weeks. The subjects of this study consisted of people with neck pain in their daily lives, and 30 subjects were randomly assigned to the correction group (10), the exercise group (10), and the correction and exercise group (10). It was. The study subjects were thoroughly explained for 8 weeks after the composition, procedure, purpose of study, and precautions related to the program. The test was done in the order of arrival at the experimental site, and the test was performed in order of range of motion, strength, endurance, pain, and neck disability index. After 8 weeks of cervical exercise with cervical spine correction, there was a significant improvement in the range of joint mobility, endurance, pain, and neck disability in all groups. In the right flexion, the numerical change improved, but there was no significant increase in the correction and exercise group. In the comparison between the groups, the cervical flexion, muscular endurance, pain, and neck disability index showed a significant increase and decrease in the correction and exercise group than the other groups. There was also a change in the range of motion, muscular endurance, pain, and neck disability index. There was also a numerical change in the range of motion, muscle endurance, pain, and neck disability index even with cervical spine exercise alone. However, when the correction and exercise were combined, the numerical change was larger and significantly improved. Therefore, a program that combines cervical spine correction and exercise may be recommended for trainers who exercise adults with neck pain.

경추부 견인이 경추부 통증 환자의 증세 및 통증에 미치는 영향

김성호,김명준 대한정형물리치료학회 2001 대한정형도수물리치료학회지 Vol.7 No.1

The purpose of this study was to investigate the influence of cervical pain and radiating pain after cervical traction for patients with cervical pain. This evaluation was made 81 persons who cervical pain or radiating pain. The result of this study were as following : 1. There were statistically significant decrease in cervical pain and radiating pain after cervical traction. 2. A type group(only neck pain ; n=5) and B type group(neck to elbow radiating pain ; n=11), there were pain decreased but there were not significant difference(p>0.05), C type group(neck to shoulder radiating pain group ; n=14) and D type group(neck to hand radiating pain group ; n=50), there were pain decreased before test then after test by VAS and significant difference (p<0.05).

Association between Postoperative Neck Pain and Intraoperative Transcranial Motor-Evoked Potential Waveforms of the Trapezius Muscles in Patients with Cervical Myelopathy Who Underwent Cervical Laminoplasty

Ito Sadayuki,Sakai Yoshihito,Ando Kei,Nakashima Hiroaki,Machino Masaaki,Segi Naoki,Tomita Hiroyuki,Koshimizu Hiroyuki,Hida Tetsuro,Ito Kenyu,Harada Atsushi,Imagama Shiro 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.2

Study Design: Retrospective study.Purpose: Cervical laminoplasty is safe and effective for treating cervical myelopathy but has a higher frequency of postoperative axial pain compared to other methods. Several studies have reported on the causes of postoperative axial pain, but none have fully elucidated them. This study aimed to investigate the association between postoperative neck pain and intraoperative transcranial motor-evoked potential (MEP) waveforms of the trapezius muscles using transcranial MEPs.Overview of Literature: Few studies have investigated the association between postoperative neck pain and intraoperative transcranial MEP waveforms of the trapezius muscles in patients with cervical laminoplasty.Methods: A total of 79 patients with cervical myelopathy who underwent cervical laminoplasty at our facility between June 2010 and March 2013 were included in this study. Intraoperative control and final waveform were evaluated based on the trapezius muscle MEPs by measuring the latency and amplitude. A neck pain group comprised patients with higher neck pain Visual Analog Scale scores from preoperative value to 1 year postoperatively. The cross-sectional areas of the trapezius muscles and the MEP latencies and amplitudes were compared between patients with and without neck pain.Results: The latency and amplitude of the control waveforms were not significantly different between groups. The neck pain group had a significantly shorter final waveform latency (neck pain: 23.6±2.5, no neck pain: 25.8±4.5; p =0.019) and significantly larger amplitude (neck pain: 2,125±1,077, no neck pain: 1,630±966; p =0.041) than the no neck pain group.Conclusions: Postoperative neck pain was associated with the final waveform latency and amplitude of the trapezius muscle MEPs during cervical laminoplasty. Intraoperative electrophysiological trapezius muscle abnormalities could cause postoperative neck pain.

턱관절장애 환자의 목뼈 뒤굽음 각과 통증 및 기능장애 수준 간에 상관성 연구

In-su Lee,김선엽 한국전문물리치료학회 2020 한국전문물리치료학회지 Vol.27 No.2

Background: There is an opinion that improper postures of the head and cervical spine are associated with temporomandibular joint (TMJ) disorders (TMDs). Objects: The aim of this study was to investigate the proportions among the cervical kyphotic angle, physical symptoms including the pain intensity level of the TMJ, and severity of TMD disability in patients diagnosed with TMD. Methods: Sixty-two subjects participated in the study. The evaluation tools included mea-surements of the cervical kyphotic angle based on the Ishihara index, pressure pain threshold (PPT) on the TMJ, maximal mouth opening (MMO) without pain, current pain intensity level of the TMJ measured using the Quadruple Visual Analogue Scale (QVAS), Korean TMD (KTMD) disability index, KTMD Symptom Frequency/Intensity Scales (SFS/SIS), and Korean Headache Impact Test-6. Correlation analysis was conducted to investigate the correlations between the cervical kyphotic angle and parameters related to TMJ symptoms. Results: Variables that were significantly correlated with the cervical kyphotic angle were the PPT around the TMJ (r = 0.259, p < 0.05), current pain intensity level of the TMJ based on the QVAS (r = –0.601, p< 0.01), and usual pain intensity level based on the SIS (r = –0.379, p < 0.01). The level of TMD functional disability was significantly correlated with the degree of headache (r = 0.551, p < 0.01), level of PPT of the TMJ (r = –0.383, p < 0.01), pain-free MMO (r = –0.515, p < 0.01), pain intensity level of the TMJ based on the QVAS (r = 0.393, p < 0.01), TMD symptom frequency (r = 0.739, p < 0.01), usual pain intensity of the TMJ (r = 0.624, p < 0.01), and most severe pain intensity of the TMJ (r = 0.757, p < 0.01). Conclusion: There is a positive correlation between the cervical kyphotic angle and PPT and a negative correlation between the current and usual pain intensity levels of the TMJ. The cervical kyphotic angle was a predictor of the pain level, tenderness threshold, and intensity of pain in the TMJ.

Cervical Arthroplasty in the Treatment of Cervical Angina: Case Report and Review of the Literature

Omar M. Al Jammal,Luis Daniel Daz-Aguilar,Shanmukha Srinivas,Jillian Plonsker,Ronald Sahyouni,Martin H. Pham 대한척추신경외과학회 2020 Neurospine Vol.17 No.4

Cervical angina is an often-overlooked etiology of noncardiac chest pain that may mimic true angina pectoris but is due to cervical spine disease. Diagnosis can be difficult, and treatment ranges from conservative therapy to surgical management. However, of patient’s refractory to conservative therapy, approximately ninety percent experience postoperative relief of angina symptoms. Here, we present a case report on cervical angina and performed a systematic review of the literature. A 34-year-old male with prior surgery for thoracic outlet syndrome presented with persistent anterior neck and chest pain as well as posterior left scapular and upper lateral arm pain. The pain was refractory to 12 months of conservative therapy. Cardiac workup was negative and cervical spine imaging revealed a C6–7 herniation with neuroforaminal stenosis. A systematic literature search was conducted in PubMed, Web of Science, and Cochrane databases from database inception to April 2020. Studies reporting cervical level, average symptom duration, location of pain, and postoperative pain improvement were included. The patient's atypical symptoms were completely resolved after C6–7 anterior cervical discectomy and arthroplasty. To our knowledge, this is the first study which reports on the use of arthroplasty in the treatment of cervical angina. The systematic review included 11 articles from 1989–2020 consisting of 1,186 total patients and 109 patients (age range, 36–84 years; 60.7% male) meeting inclusion criteria. Symptom duration range was 2 days to 90 months, with the most common location of pain being localized to the anterior chest wall (66.7% of patients). All patients (100%) had postoperative resolution of their pain symptoms. The most common herniation level was C6–7 (87.3% of patients). We conclude that a broad and multidisciplinary approach is necessary for the diagnosis and management of noncardiac chest pain. When cervical disease is identified as the underlying cause for the angina-like pain, conservative therapy should be sought. Refractory cases should be treated surgically depending on the cervical pathology.

반복적으로 시행한 온천요법이 경항통에 미치는 영향

이옥진 ( Yu Chen Li ),최보미 ( Bo Mi Choi ),장선정 ( Sun Jeong Jahng ),안택원 ( Taek Won Ahn ),이정민 ( Jung Min Lee ) 한방재활의학과학회 2013 한방재활의학과학회지 Vol.23 No.3

ObjectivesThe purpose of this study was to investigate the clinical effects of repeatedly performed of balneotherapy on cervical pain. MethodsWe investigate 19 cervical pain subjects in this study. Subjects took 5 session of balneotherapy once a week during 5 weeks. Each session consisted of 15 minutes of high pressure underwater shower (32~36oC) and another 15 minutes of whole body bathing (32~40oC). To evaluate the efficiency of balneotherapy visual analogue scale (VAS) and pain threshold were applied before treatment and after 1st, 2nd, 3rd, 4th, 5th treatment. Then the results were analysed. Results1) The average of VAS significantly decressed from 59.11±14.67 to 33.95± 20.988 after 5 weeks of balneothreapy treatment (p<0.001). 2) The average of pain threshold significantly increased from 5.76±1.294 lbf to 8.74±1.126 lbf after 5 weeks of balneothreapy treatment (p<0.001). ConclusionsBalneotherapy has clinical effscts of pain reduction on cervical pain subjects. Balneotherapy can be used in addition to the Oriental physiotherapy for high effective treatment on cervical pain. Further clinical studies are required to verify these findings. (J Korean Med Rehab 2013;23(3):141-148) ObjectivesThe purpose of this study was to investigate the clinical effects of repeatedly performed of balneotherapy on cervical pain. MethodsWe investigate 19 cervical pain subjects in this study. Subjects took 5 session of balneotherapy once a week during 5 weeks. Each session consisted of 15 minutes of high pressure underwater shower (32~36oC) and another 15 minutes of whole body bathing (32~40oC). To evaluate the efficiency of balneotherapy visual analogue scale (VAS) and pain threshold were applied before treatment and after 1st, 2nd, 3rd, 4th, 5th treatment. Then the results were analysed. Results1) The average of VAS significantly decressed from 59.11±14.67 to 33.95± 20.988 after 5 weeks of balneothreapy treatment (p<0.001). 2) The average of pain threshold significantly increased from 5.76±1.294 lbf to 8.74±1.126 lbf after 5 weeks of balneothreapy treatment (p<0.001). ConclusionsBalneotherapy has clinical effscts of pain reduction on cervical pain subjects. Balneotherapy can be used in addition to the Oriental physiotherapy for high effective treatment on cervical pain. Further clinical studies are required to verify these findings. (J Korean Med Rehab 2013;23(3):141-148)

Cervical Angina: A Literature Review on Its Diagnosis, Mechanism, and Management

Feng Fan,Chen Xiuyuan,Shen Hongxing 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.4

Cervical angina has been defined as chest pain that resembles true cardiac angina but originates from the disorders of the cervical spine. Thus, physicians and spine surgeons alike should raise awareness of this unusual condition for diagnosis and treatment. Particularly when neurologic signs and symptoms are present, there should be a strong suspicion for cervical angina in any patient with inadequately explained noncardiac chest pain. Cervical angina can be diagnosed according to negative cardiac workups, positive neurologic examination, and cervical radiographic findings (herniated disk, spinal cord compression, or foraminal encroachment). However, the mechanisms of pain production in cervical angina remain unclear. Previous studies attributed the pain to cervical nerve root compression, cervical sympathetic afferent fibers, referred pain, or lesions of the posterior horn of the spinal cord. Conservative treatments, which include neck collar fixation, head traction, and nonsteroidal anti-inflammatory drugs, have been determined to be successful in most patients with cervical angina. But when conservative treatment fails, anterior cervical surgery with complete decompression of the spinal cord and/or nerve root has been identified to effectively relieve cervical angina symptoms.

경항통과 척추 시상균형 및 만곡의 상관관계에 대한 임상적 연구

이원일,고필성,권신애,이정우,서병관,우현수,조병진,송지연,백용현,박동석,남상수 대한침구의학회 2010 대한침구의학회지 Vol.27 No.2

Objectives : The authors aimed to determine the presence of relationships between cervical pain and cervical curvature, lumbar curvature, sacral slope and sagittal spinal balance. Methods : Medical records of outpatients who made their first visits to the Department of Acupuncture and Moxibustion in the Spine center at Kyung Hee East-West Neo Medical Center between September 1, 2008 and October 31, 2009 were evaluated. A total of 50 patients visiting within the time period had visited with a chief complaint of cervical pain, and had lateral entire spine X-rays taken. After excluding patients with previous spine operations, 46 patients were selected for the final analysis. The cervical lordotic angle(CLA), lumbar lordotic angle(LLA), Ferguson’s angle(FA), and sagittal vertical axis(SVA) were measured on the lateral entire spine X-ray cuts, and the relationships between these values and patient gender, age, chief complaint, and duration of symptoms were assessed. Results : No significant difference was found in relationships between gender and measured values. SVA showed statistically significant correlation between age, but CLA, LLA, and FA was not. There was a significant difference in SVA between patients with only cervical pain and those with both cervical pain and low back pain. Patients with a duration of symptoms longer than 6 months showed a statistically significant difference in SVA with those who had shorter symptoms. Correlation analysis between measured values was statistically significant only between LLA and FA. Conclusions : Evaluation and treatment of sagittal imbalance should be considered in patients presenting with cervical pain if symptoms have persisted for over 6 months or have accompanying low back pain.

Influence of Pain Neuroscience Education Combined with Cervical and Thoracic Mobilization on Pain and Kinesiophobia for Forward Head Posture with Chronic Neck Pain

안호정 국제물리치료연구학회 2022 Journal of International Academy of Physical Ther Vol.13 No.2

Background: Pain neuroscience education (PNE) with other therapeutic approaches can reduce pain intensity in patients with Chronic musculoskeletal pain and chronic spine pain by improving quality of life and disability. However, in various clinical trials and reviews, the optimal dose of an intervention combined with PNE is still an area to be studied. Objectives: To investigated the effect of forward head posture (FHP) with chronic neck pain on the PNE combined with cervical and thoracic mobilization. Design: A non-randomized, controlled intervention study. Methods: Thirty-two subjects were allocated to pain neuroscience education combined with cervical and thoracic mobilization group (PCTMG, n=17) and cervical and thoracic mobilization with TENS group (CTMG, n=15). For 6 weeks, the PCTM group applied PNE and cervical and thoracic mobilization and the CTM group applied cervical and thoracic mobilization and TENS. Changes in intervention pre-post pain and kinesiophobia were observed. Results: Results from the study indicated that statistically significant decrease in VAS and TSK-11 in PCTMG. In CTMG, there was a statistically significant decrease in VAS. And in PCTMG, there was a statistically significant decrease in VAS and TSK-11 than in CTMG.. Conclusion: Therefore, this study confirmed that PNE combined with cervical thoracic mobilization is an effective intervention compared to ervical thoracic mobilization alone in reducing pain and kinesiophobia in FHP with chronic neck pain.