MEDLINE Abstracts: Cervical Neck Pain
What's new concerning nontraumatic neck pain? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Orthopaedics.
Taimela S, Takala EP, Asklof T, Seppala K, Parviainen S
Spine. 2000;25:1021-1027
Study Design: A randomized comparative study with single-blind outcome assessments.
Objectives: To compare the efficacy of a multimodal treatment emphasizing proprioceptive training (ACTIVE) with activated home exercises (HOME) and recommendation of exercise (CONTROL) in patients with nonspecific chronic neck pain.
Summary Of Background Data: The efficacy of active exercises and passive physiotherapy for neck trouble has been somewhat disappointing in the previous few studies.
Methods: Seventy-six patients (22 men, 54 women) with chronic, nonspecific neck pain participated. Sixty-two participated the 1-year follow-up. Subjective pain and disability, cervical ranges of motion, and pressure pain threshold in the shoulder region were measured at baseline, at 3 months, and at 12 months. The ACTIVE treatment consisted of 24 sessions of proprioceptive exercises, relaxation, and behavioral support. The HOME regimen included a neck lecture and two sessions of practical training for home exercises and instructions for maintaining a diary of progress. The CONTROL treatment included a lecture regarding care of the neck with a recommendation to exercise.
Results: The average self-experienced total benefit was highest in the ACTIVE group, and the HOME group rated over the CONTROL group (P < 0.001). Differences between the groups in favor of the ACTIVE treatment were recorded in reduction of neck symptoms and improvements in general health and self-experienced working ability (P < 0.01-0.03). Changes in measures of mobility and pressure pain threshold were minor.
Conclusions: Regarding self-experienced benefit, the multimodal treatment was more efficacious than activated home exercises that were clearly more efficacious than just advising. No major differences were noted in objective measurements of cervical function between the groups, but the content validity of these assessments in chronic neck trouble can be questioned.
Nastri MV, Taricco MA, Alves VA, Mansur AJ
Clin Cardiol. 2000;23:219-220
Paroxysmal atrial fibrillation (AF) is an arrhythmia usually secondary to autonomic imbalance, and it may occur in the absence of any structural heart disease. The case of a patient with paroxysmal AF, in whom the arrhythmia may have been a presenting symptom of a later diagnosed cervical schwannoma, is reported.
Olson SL, O'Connor DP, Birmingham G, Broman P, Herrera L
J Orthop Sports Phys Ther. 2000;30:13-20
Study Design: Descriptive analysis of impairment and disability measures in subjects with neck pain.
Objectives: To identify discrete tender points and overall pressure sensitivity and assess relationships among palpation tenderness, active cervical range of motion, visual analog scale pain scores, and Sickness Impact Profile disability scores.
Background: Palpation tenderness and cervical range of motion are used to evaluate patients with neck pain, but their ability to predict patient-perceived pain and disability is unknown.
Methods And Measures: We studied 45 women and 15 men with neck pain (mean age, 35 +/- 7 years). Group 1 included 30 persons who had not sought treatment, and group 2 included 30 persons who had just been referred for treatment.
Results: Subjects demonstrated low mean pressure pain thresholds of tender points (2.3 +/- 1.3 kg). Regression analysis showed that only neck flexion predicted pain (R2 = 0.23), with decreased flexion associated with higher pain levels. Sickness Impact Profile total score was predicted by neck rotation (R2 = 0.31), group (R2 = 0.16), tender point pressure pain threshold (R2 = 0.04), and neck retraction (R2 = 0.03). Decreased neck rotation, neck retraction, and pressure pain thresholds were associated with higher disability.
Conclusions: Neither palpation tenderness nor cervical range of motion were strong predictors of pain and disability in subjects with neck pain.
Abdulwahab SS, Sabbahi M
J Orthop Sports Phys Ther. 2000;30:4-9; discussion 10-12
Study Design: Two-group repeated measures.
Objectives: To evaluate the changes in the flexor carpi radialis H reflex after reading and neck retraction exercises and to correlate reflex changes with the intensity of radicular pain.
Background: Repeated neck retraction movements have been routinely prescribed for patients with neck pain.
Methods And Measures: Ten nonimpaired subjects (mean age, 27 +/- 4 years) and 13 patients (mean age, 35 +/- 9 years) with C7 radiculopathy volunteered for the study. The flexor carpi radialis H reflex was elicited by electrical stimulation of the median nerve at the cubital fossa before and after 20 minutes of reading and after 20 repetitive neck retractions. Subjective intensity of the radicular pain was reported before and after each condition using an analog scale.
Results: For patients with radiculopathy, a repeated-measures analysis of variance showed a significant decrease in the H reflex amplitude (from 0.81 +/- 0.4 to 0.69 +/- 0.39 mV), an increase in radicular symptoms after reading (from 4.2 +/- 1.3 to 5.6 +/- 1.4 on the visual analog scale), an increase in the H reflex amplitude (from 0.69 +/- 0.39 to 1.01 +/- 0.49 mV), and a decrease in pain intensity (from 5.6 +/- 1.4 to 1.5 +/- 1.3) after repeated neck retractions. There was an association between cervical root compression (smaller H reflexes) and increased pain during reading and between cervical root decompression (larger H reflex) and reduced pain (r = -0.86 to -0.60). Exacerbation of symptoms was found with a reading posture. There were no significant changes in the H reflex amplitude in the nonimpaired group. No changes were found in reflex latency for either groups.
Conclusions: Neck retractions appeared to alter H reflex amplitude. These exercises might promote cervical root decompression and reduce radicular pain in patients with C7 radiculopathy. The opposite effect (an exacerbation of symptoms) was found with the reading posture.
Samii A, Pal PK, Schulzer M, Mak E, Tsui JK
Can J Neurol Sci. 2000;27:55-59
Objective: The incidence of head/neck trauma preceding cervical dystonia (CD) has been reported to be 5-21%. There are few reports comparing the clinical characteristics of patients with and without a history of injury. Our aim was to compare the clinical characteristics of idiopathic CD (CD-I) to those with onset precipitated by trauma (CD-T).
Methods: We evaluated 114 consecutive patients with CD over a 9-month period. All patients were interviewed using a detailed questionnaire and had a neurological examination. Their clinical charts were also reviewed.
Results: Fourteen patients (12%) had mild head/neck injury within a year preceding the onset of CD. Between the two groups (CD-I and CD-T), the gender distribution (F:M of 3:2), family history of movement disorders (32% vs. 29%), the prevalence of gestes antagonistes (65% vs. 64%), and response to botulinum toxin were similar. There were non-specific trends, including an earlier age of onset (mean ages 43.3 vs. 37.6), higher prevalence of neck pain (86% vs. 100%), head tremor (67% vs. 79%), and dystonia in other body parts (23% vs. 36%) in CD-T.
Conclusions: CD-I and CD-T are clinically similar. Trauma may be a triggering factor in CD but this was only supported by non-significant trends in its earlier age of onset.
Yoshida K, Hanyu T, Takahashi HE
J Orthop Sci. 1999;4:399-406
Cross-sectional and longitudinal studies were conducted to observe progression of rheumatoid arthritis in the cervical spine. Two hundred and ninety-seven patients were enrolled in the cross-sectional study. Both upper and lower cervical spine involvement increased with disease duration. The relationship between atlanto-axial motion and the development of subaxial subluxation was inconclusive. Eighty-seven patients were enrolled in the longitudinal study and were followed for at least 5 years. In about half of these patients, rheumatoid changes started from the upper cervical spine, with rheumatoid changes beginning from the lower cervical spine in about 8% of patients. Neurological deficits were correlated with radiographic changes but neck pain did not correlate with radiographic changes. As to the upper cervical spine, the parameter most influencing neurological deficits was found to be the minimum value of the atlanto-axial angle in flexion, by multivariate analysis using a multiple logistic model. Neurological deficits were seen in more than half the patients when the atlanto-axial angle in flexion was 5 degrees or less.
Jones JA
Mil Med. 2000;165:6-12
In high-performance aircraft, the need for total environmental awareness coupled with high-g loading (often with abrupt onset) creates a predilection for cervical spine injury while the pilot is performing routine movements within the cockpit. In this study, the prevalence and severity of cervical spine injury are assessed via a modified cross-sectional survey of pilots of multiple aircraft types (T-38 and F-14, F-16, and F/A-18 fighters). Ninety-five surveys were administered, with 58 full responses. Fifty percent of all pilots reported in-flight or immediate post-flight spine-based pain, and 90% of fighter pilots reported at least one event, most commonly (> 90%) occurring during high-g (> 5 g) turns of the aircraft with the head deviated from the anatomical neutral position. Pre-flight stretching was not associated with a statistically significant reduction in neck pain episodes in this evaluation, whereas a regular weight training program in the F/A-18 group approached a significant reduction (mean = 2.492; p < 0.064). Different cockpit ergonomics may vary the predisposition to cervical injury from airframe to airframe. Several strategies for prevention are possible from both an aircraft design and a preventive medicine standpoint. Countermeasure strategies against spine injury in pilots of high-performance aircraft require additional research, so that future aircraft will not be limited by the human in control.
Manifold SG, McCann PD
Clin Orthop. 1999;368:105-113
The differentiation of cervical radiculitis from primary shoulder disease at times can be very difficult owing to the close anatomic proximity of the neck and shoulder, overlapping symptoms, and similar patient groups affected by these disorders. A thorough history and detailed physical examination will, in most cases, identify the cervical spine or the shoulder as the primary source of the disease. Radiographic and electrodiagnostic tests and selective anesthetic injections can be used to confirm the diagnosis and thereby indicate appropriate treatment. Patients with concomitant disease of the shoulder and cervical spine may present a considerable diagnostic and therapeutic challenge. Treatment of these patients should be directed at the site of primary disease. Successful results can be achieved after accurate diagnosis and proper treatment.
What's new concerning nontraumatic neck pain? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Orthopaedics.
Taimela S, Takala EP, Asklof T, Seppala K, Parviainen S
Spine. 2000;25:1021-1027
Study Design: A randomized comparative study with single-blind outcome assessments.
Objectives: To compare the efficacy of a multimodal treatment emphasizing proprioceptive training (ACTIVE) with activated home exercises (HOME) and recommendation of exercise (CONTROL) in patients with nonspecific chronic neck pain.
Summary Of Background Data: The efficacy of active exercises and passive physiotherapy for neck trouble has been somewhat disappointing in the previous few studies.
Methods: Seventy-six patients (22 men, 54 women) with chronic, nonspecific neck pain participated. Sixty-two participated the 1-year follow-up. Subjective pain and disability, cervical ranges of motion, and pressure pain threshold in the shoulder region were measured at baseline, at 3 months, and at 12 months. The ACTIVE treatment consisted of 24 sessions of proprioceptive exercises, relaxation, and behavioral support. The HOME regimen included a neck lecture and two sessions of practical training for home exercises and instructions for maintaining a diary of progress. The CONTROL treatment included a lecture regarding care of the neck with a recommendation to exercise.
Results: The average self-experienced total benefit was highest in the ACTIVE group, and the HOME group rated over the CONTROL group (P < 0.001). Differences between the groups in favor of the ACTIVE treatment were recorded in reduction of neck symptoms and improvements in general health and self-experienced working ability (P < 0.01-0.03). Changes in measures of mobility and pressure pain threshold were minor.
Conclusions: Regarding self-experienced benefit, the multimodal treatment was more efficacious than activated home exercises that were clearly more efficacious than just advising. No major differences were noted in objective measurements of cervical function between the groups, but the content validity of these assessments in chronic neck trouble can be questioned.
Nastri MV, Taricco MA, Alves VA, Mansur AJ
Clin Cardiol. 2000;23:219-220
Paroxysmal atrial fibrillation (AF) is an arrhythmia usually secondary to autonomic imbalance, and it may occur in the absence of any structural heart disease. The case of a patient with paroxysmal AF, in whom the arrhythmia may have been a presenting symptom of a later diagnosed cervical schwannoma, is reported.
Olson SL, O'Connor DP, Birmingham G, Broman P, Herrera L
J Orthop Sports Phys Ther. 2000;30:13-20
Study Design: Descriptive analysis of impairment and disability measures in subjects with neck pain.
Objectives: To identify discrete tender points and overall pressure sensitivity and assess relationships among palpation tenderness, active cervical range of motion, visual analog scale pain scores, and Sickness Impact Profile disability scores.
Background: Palpation tenderness and cervical range of motion are used to evaluate patients with neck pain, but their ability to predict patient-perceived pain and disability is unknown.
Methods And Measures: We studied 45 women and 15 men with neck pain (mean age, 35 +/- 7 years). Group 1 included 30 persons who had not sought treatment, and group 2 included 30 persons who had just been referred for treatment.
Results: Subjects demonstrated low mean pressure pain thresholds of tender points (2.3 +/- 1.3 kg). Regression analysis showed that only neck flexion predicted pain (R2 = 0.23), with decreased flexion associated with higher pain levels. Sickness Impact Profile total score was predicted by neck rotation (R2 = 0.31), group (R2 = 0.16), tender point pressure pain threshold (R2 = 0.04), and neck retraction (R2 = 0.03). Decreased neck rotation, neck retraction, and pressure pain thresholds were associated with higher disability.
Conclusions: Neither palpation tenderness nor cervical range of motion were strong predictors of pain and disability in subjects with neck pain.
Abdulwahab SS, Sabbahi M
J Orthop Sports Phys Ther. 2000;30:4-9; discussion 10-12
Study Design: Two-group repeated measures.
Objectives: To evaluate the changes in the flexor carpi radialis H reflex after reading and neck retraction exercises and to correlate reflex changes with the intensity of radicular pain.
Background: Repeated neck retraction movements have been routinely prescribed for patients with neck pain.
Methods And Measures: Ten nonimpaired subjects (mean age, 27 +/- 4 years) and 13 patients (mean age, 35 +/- 9 years) with C7 radiculopathy volunteered for the study. The flexor carpi radialis H reflex was elicited by electrical stimulation of the median nerve at the cubital fossa before and after 20 minutes of reading and after 20 repetitive neck retractions. Subjective intensity of the radicular pain was reported before and after each condition using an analog scale.
Results: For patients with radiculopathy, a repeated-measures analysis of variance showed a significant decrease in the H reflex amplitude (from 0.81 +/- 0.4 to 0.69 +/- 0.39 mV), an increase in radicular symptoms after reading (from 4.2 +/- 1.3 to 5.6 +/- 1.4 on the visual analog scale), an increase in the H reflex amplitude (from 0.69 +/- 0.39 to 1.01 +/- 0.49 mV), and a decrease in pain intensity (from 5.6 +/- 1.4 to 1.5 +/- 1.3) after repeated neck retractions. There was an association between cervical root compression (smaller H reflexes) and increased pain during reading and between cervical root decompression (larger H reflex) and reduced pain (r = -0.86 to -0.60). Exacerbation of symptoms was found with a reading posture. There were no significant changes in the H reflex amplitude in the nonimpaired group. No changes were found in reflex latency for either groups.
Conclusions: Neck retractions appeared to alter H reflex amplitude. These exercises might promote cervical root decompression and reduce radicular pain in patients with C7 radiculopathy. The opposite effect (an exacerbation of symptoms) was found with the reading posture.
Samii A, Pal PK, Schulzer M, Mak E, Tsui JK
Can J Neurol Sci. 2000;27:55-59
Objective: The incidence of head/neck trauma preceding cervical dystonia (CD) has been reported to be 5-21%. There are few reports comparing the clinical characteristics of patients with and without a history of injury. Our aim was to compare the clinical characteristics of idiopathic CD (CD-I) to those with onset precipitated by trauma (CD-T).
Methods: We evaluated 114 consecutive patients with CD over a 9-month period. All patients were interviewed using a detailed questionnaire and had a neurological examination. Their clinical charts were also reviewed.
Results: Fourteen patients (12%) had mild head/neck injury within a year preceding the onset of CD. Between the two groups (CD-I and CD-T), the gender distribution (F:M of 3:2), family history of movement disorders (32% vs. 29%), the prevalence of gestes antagonistes (65% vs. 64%), and response to botulinum toxin were similar. There were non-specific trends, including an earlier age of onset (mean ages 43.3 vs. 37.6), higher prevalence of neck pain (86% vs. 100%), head tremor (67% vs. 79%), and dystonia in other body parts (23% vs. 36%) in CD-T.
Conclusions: CD-I and CD-T are clinically similar. Trauma may be a triggering factor in CD but this was only supported by non-significant trends in its earlier age of onset.
Yoshida K, Hanyu T, Takahashi HE
J Orthop Sci. 1999;4:399-406
Cross-sectional and longitudinal studies were conducted to observe progression of rheumatoid arthritis in the cervical spine. Two hundred and ninety-seven patients were enrolled in the cross-sectional study. Both upper and lower cervical spine involvement increased with disease duration. The relationship between atlanto-axial motion and the development of subaxial subluxation was inconclusive. Eighty-seven patients were enrolled in the longitudinal study and were followed for at least 5 years. In about half of these patients, rheumatoid changes started from the upper cervical spine, with rheumatoid changes beginning from the lower cervical spine in about 8% of patients. Neurological deficits were correlated with radiographic changes but neck pain did not correlate with radiographic changes. As to the upper cervical spine, the parameter most influencing neurological deficits was found to be the minimum value of the atlanto-axial angle in flexion, by multivariate analysis using a multiple logistic model. Neurological deficits were seen in more than half the patients when the atlanto-axial angle in flexion was 5 degrees or less.
Jones JA
Mil Med. 2000;165:6-12
In high-performance aircraft, the need for total environmental awareness coupled with high-g loading (often with abrupt onset) creates a predilection for cervical spine injury while the pilot is performing routine movements within the cockpit. In this study, the prevalence and severity of cervical spine injury are assessed via a modified cross-sectional survey of pilots of multiple aircraft types (T-38 and F-14, F-16, and F/A-18 fighters). Ninety-five surveys were administered, with 58 full responses. Fifty percent of all pilots reported in-flight or immediate post-flight spine-based pain, and 90% of fighter pilots reported at least one event, most commonly (> 90%) occurring during high-g (> 5 g) turns of the aircraft with the head deviated from the anatomical neutral position. Pre-flight stretching was not associated with a statistically significant reduction in neck pain episodes in this evaluation, whereas a regular weight training program in the F/A-18 group approached a significant reduction (mean = 2.492; p < 0.064). Different cockpit ergonomics may vary the predisposition to cervical injury from airframe to airframe. Several strategies for prevention are possible from both an aircraft design and a preventive medicine standpoint. Countermeasure strategies against spine injury in pilots of high-performance aircraft require additional research, so that future aircraft will not be limited by the human in control.
Manifold SG, McCann PD
Clin Orthop. 1999;368:105-113
The differentiation of cervical radiculitis from primary shoulder disease at times can be very difficult owing to the close anatomic proximity of the neck and shoulder, overlapping symptoms, and similar patient groups affected by these disorders. A thorough history and detailed physical examination will, in most cases, identify the cervical spine or the shoulder as the primary source of the disease. Radiographic and electrodiagnostic tests and selective anesthetic injections can be used to confirm the diagnosis and thereby indicate appropriate treatment. Patients with concomitant disease of the shoulder and cervical spine may present a considerable diagnostic and therapeutic challenge. Treatment of these patients should be directed at the site of primary disease. Successful results can be achieved after accurate diagnosis and proper treatment.