Cervical radiculopathy is caused by spinal nerve root dysfunction resulting in dermatomal pain, parasthesias, myotomal weakness, and impaired deep tendon reflexes. It is commonly caused by herniated discs or bony spurs compressing nerve roots. Diagnosis involves history, physical exam testing dermatomes and myotomes, and imaging such as MRI. Treatment includes immobilization, traction, medications, injections, and sometimes surgery for severe or progressive cases.
Frozen shoulder, also known as adhesive capsulitis, is an inflammation condition of the shoulder characterized by progressive pain and stiffness leading to loss of motion. It affects 2-5% of the population between ages 40-65, more commonly in women. The condition involves three stages - a freezing phase with pain and loss of motion, a frozen phase with more stiffness, and a thawing phase where motion gradually returns over 1-3 years. Diagnosis is based on the clinical presentation of pain and reduced range of motion on physical exam. Treatment involves physical therapy, injections, medications and possibly surgery if conservative treatments fail to provide relief after 4 months.
Dr. Orakwele Arinze presented on cervical spondylosis. The presentation included an introduction to cervical spondylosis, relevant anatomy, epidemiology, etiology, pathophysiology, clinical features, diagnosis, differential diagnosis, management, physiotherapy management, and a case study. Cervical spondylosis is an age-related degeneration of the cervical spine that can lead to nerve root or spinal cord compression. Symptoms include neck and arm pain, weakness, and sensory changes. Physiotherapy is an effective treatment and includes modalities like TENS, traction, exercises and lifestyle advice. The case study demonstrated improvement in a patient's neck pain, range of motion and strength following physiotherapy
Tarsal tunnel syndrome involves compression of the tibial nerve as it passes beneath the flexor retinaculum in the ankle. It causes pain, numbness and tingling in the foot. Non-surgical treatments include orthotics, stretching, weight loss and activity modification. Surgery to release the flexor retinaculum may be considered if non-surgical options fail. Anterior tarsal tunnel syndrome is a similar condition affecting the deep peroneal nerve. Risk factors include ankle injuries and activities that put repetitive stress on the ankle.
This document discusses carpal tunnel syndrome, which is caused by compression of the median nerve as it passes through the carpal tunnel of the wrist. It can cause numbness, tingling, and weakness in the hand. The presentation outlines the causes, clinical features, diagnosis, and treatment options for carpal tunnel syndrome, which include wrist splints, oral anti-inflammatory medications, local steroid injections, and carpal tunnel release surgery if conservative measures fail. The document provides details on physical exam findings and special tests like Tinel's and Phalen's maneuvers used to diagnose carpal tunnel syndrome.
This document discusses the assessment of the cervical spine. It begins with an introduction to the anatomy and biomechanics of the cervical spine. It then describes taking a patient history, including questions about pain and symptoms. The examination involves observation, palpation, range of motion testing, muscle strength testing, sensory testing, and special tests like Spurling's test. Diagnostic imaging options like x-rays, CT scans, and MRI are also discussed.
Parkinson's disease is a chronic, progressive neurological disorder characterized by rigidity, bradykinesia, tremor, and postural instability. It is caused by the loss of dopamine-producing neurons in the substantia nigra. Symptoms worsen over time and can include impaired motor skills and coordination, speech and swallowing difficulties, sensory changes, and cognitive impairment. Physiotherapy aims to improve mobility, balance, and function through exercises targeting flexibility, strength, posture, gait, and functional skills.
De Quervain's tenosynovitis is an inflammation of the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis muscles in the wrist. It commonly affects women ages 30-50 and is caused by repetitive motions like knitting or computer use that strain the thumb and wrist. Symptoms include pain on the radial side of the wrist worsened by thumb movement. Conservative treatment involves splinting, anti-inflammatories, corticosteroid injections, and physical therapy exercises. Surgery may be considered if symptoms persist after several weeks of conservative care.
Hierachical theory- says that higher centers control on lower center; but when higher center damage then this inhibitory control from the higher center is loss which leads to exageration of the movt.
In normal individual, these occur a smooth, rhythmic movt. Because there is a presence of control from higher center on lower center.
Cerebral Palsy: PT assessment and ManagementSurbala devi
Cerebral palsy (CP) is a group of disorders caused by damage to the developing brain before, during or after birth. It affects movement and posture, and can cause physical disability. The main types are spastic, athetoid, ataxic and hypotonic CP. Symptoms vary depending on the type and severity. CP is diagnosed based on signs of impaired motor development and abnormal muscle tone or movement. There is no cure for CP, but treatment aims to improve ability and quality of life through therapies and medications.
This document discusses spasticity management. It defines spasticity as a hypertonic motor disorder caused by injury to the corticospinal pathways. Signs of upper motor neuron syndrome include hyperactive stretch reflexes and involuntary flexor/extensor spasms. Spasticity is assessed using measures like the modified Ashworth scale and is treated using a multidisciplinary approach including oral medications, injections, surgery, and physiotherapy. Treatment aims to reduce spasticity and improve function and range of motion.
This document discusses various special tests used to evaluate the shoulder joint. It provides details on range of motion tests and impingement tests for the rotator cuff as well as tests for the acromioclavicular joint, bicep tendon, and shoulder instability. Impingement is classified based on the cause and grade. Specific tests described include Neer's impingement test, Hawkins-Kennedy test, empty can test, and others. Tests for the acromioclavicular joint, biceps tendon, and shoulder instability include the painful arc test, Yergason test, anterior apprehension test, and more.
Chondromalacia patellae, also known as runner's knee, is a softening and roughening of the cartilage under the kneecap caused by mechanical overload of the patellofemoral joint. Symptoms include pain in front of or beneath the kneecap that is aggravated by activity like climbing stairs. Examination may reveal tenderness under the kneecap edge or crepitus with knee movement. Conservative treatments include rest, ice, strengthening exercises, and anti-inflammatory medication. Surgery to realign or elevate the patella may be considered if conservative treatments fail after 6 months.
This document summarizes tabes dorsalis, a condition caused by untreated syphilis infection that results in demyelination of the dorsal columns of the spinal cord. It affects males more than females and symptoms onset typically in mid-life. Symptoms include weakness, diminished reflexes, pains, impaired sensation, coordination and gait issues. Diagnosis involves CSF and imaging tests. Treatment focuses on antibiotics while physiotherapy aims to improve strength, balance, mobility and coordination through exercises like Frenkel's exercise which focuses on precision and repetition to compensate for lost sensory function.
Plantar fasciitis is an inflammation of the plantar fascia in the foot that causes heel pain. It is caused by overuse from activities like long-distance running or tight calf muscles limiting the foot's range of motion. Symptoms include pain, swelling, and warmth in the heel area. Conservative treatments include stretching exercises, orthotics, night splints, taping, and manual therapies to increase flexibility and support the arch. Treatment may last several months to two years and surgery is an option for severe cases that do not improve.
Cervical pain is a common musculoskeletal problem. It can be caused by injuries or conditions affecting the cervical spine joints, ligaments, muscles or nerves. Clinical evaluation involves assessing the pain characteristics, neurological examination and diagnostic imaging when needed. The majority of acute cervical pain resolves within weeks with conservative treatment, but some may become chronic. Cervical myelopathy presents with signs of damage to the spinal cord like lower motor neuron signs in the upper limbs and upper motor neuron signs below the level of lesion.
Pp for lumbarization and sacralization by Dr Dhruv Taneja Assistant ProfessorDhruv Taneja
Lumbarization is a condition where the first sacral vertebra appears like a lumbar vertebra rather than being fused with the sacrum. This occurs when the first and second sacral segments fail to fuse during development. A lumbarized S1 vertebra may have its own disc or an underdeveloped disc space, making it difficult to accommodate and more prone to injury with age. Sacralization is a related condition where the fifth lumbar vertebra fuses with the sacrum, reducing mobility and increasing stress on the L4 vertebra. Both conditions can potentially lead to back pain and disc problems.
Syringomyelia is a condition where a cyst, called a syrinx, develops in the spinal cord. It most commonly affects the lower cervical spine. It is often associated with abnormalities of the skull or spinal column. The majority of cases are linked to Chiari malformation type 1, where the cerebellar tonsils are displaced into the spinal canal. Symptoms vary depending on the location of the syrinx but can include pain, loss of sensation, muscle weakness or atrophy, and autonomic dysfunction. Diagnosis is made using imaging like MRI. Treatment involves surgery to decompress pressure on the spinal cord like laminectomy with the goal of resolving the syrinx.
Cauda equina syndrome is a surgical emergency that occurs when the spinal canal is significantly narrowed, compressing the spinal cord and nerves below. It causes a variety of symptoms like leg and bladder problems. Early diagnosis and treatment are crucial, as waiting over 24 hours or symptoms worsening requires immediate surgery to decompress the spine. Prognosis depends on the severity and extent of symptoms, with bilateral leg pain or complete groin numbness indicating a poorer prognosis.
Neck Pain and Arm Pain : Cervical Radiculopathy by Pablo Pazmino MDPablo Pazmino
This video explains Cervical Radiculopathy and Cervical Herniations. When herniations begins to affect the nerves and spinal cord this is called Cervical Radiculopathy. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Cervical Herniation/Radiculopathy feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1
This document provides information to help differentiate between cervical radiculopathy and peripheral neuropathy.
Cervical radiculopathy usually involves one spinal nerve root and follows myotomal and dermatomal patterns, with proximal pathology like a disc or osteophyte. Peripheral neuropathy usually involves one peripheral nerve branch with distal entrapment. Key differences are seen on neurologic examination, with radiculopathy showing reflex changes and neuropathy typically not. Supplementing with tests like electrodiagnostic studies can help determine the level and location of pathology.
Case examples demonstrate how to distinguish between C8 radiculopathy and an ulnar neuropathy based on the patterns of motor weakness, sensory loss, presence of pain, and
This document discusses electrodiagnostic techniques for evaluating radiculopathy. It covers nerve conduction studies including SNAPs, CMaps, H-reflexes and F-waves. It also discusses needle EMG findings including fibrillations, positive sharp waves and complex repetitive discharges. The advantages and disadvantages of each technique are provided for assessing different nerve roots involved in radiculopathy.
This document provides an overview of techniques for evaluating injuries to the pelvis and thigh. It discusses the importance of obtaining a thorough history and details key components of the history including location of symptoms, onset, training factors, and prior medical conditions. It then outlines the process of inspection, palpation of various anatomical structures, and assessment of range of motion including specific tests like Thomas test and Trendelenburg's test. It concludes by describing special tests for ligaments, joints, and neurovascular assessment of the pelvis and thigh region.
Cervical spondylosis is a common cause of neck pain, radiculopathy, and myelopathy. It involves chronic degenerative changes in the cervical discs and vertebrae due to aging. Common symptoms include neck pain, headaches, and radiating arm pain. Diagnosis involves clinical exam showing signs of radiculopathy or myelopathy as well as imaging like x-rays, CT, and MRI to identify areas of nerve root or spinal cord compression. Treatment options include conservative measures or surgery to decompress the spinal cord if conservative treatment fails.
This document provides an overview of musculoskeletal trauma, including:
1) Musculoskeletal injuries occur in 70-80% of multi-trauma patients and can range from minor impairments to life-threatening injuries like pelvic or femur fractures.
2) A thorough musculoskeletal assessment involves evaluating the six P's (pain, pallor, paresthesia, pulses, paralysis, pressure) as well as inspection and palpation of injuries.
3) Initial management of musculoskeletal trauma focuses on immobilization, hemorrhage control, and splinting fractures to prevent further injury while stabilizing the patient for transport.
The document discusses goniometry, which is the measurement of joint angles using a goniometer. It outlines what goniometry is, the importance and types of goniometers, how to measure range of motion for various joints including the shoulder, wrist, hip and hand, and considerations for validity and reliability when performing goniometric measurements. Proper procedures and positioning for accurate goniometric assessment of different joints are described.
MULTTTOCAL MoTOR NtUuOpArHy (MMN) is an autoimmune disorder that causes progressive weakness due to demyelination of motor nerves. It presents with asymmetric weakness and cramps in specific nerve distributions without sensory symptoms. Diagnosis is based on clinical findings and electrodiagnostic testing showing conduction block. Treatment involves immunotherapy such as intravenous immunoglobulin (IVIg) or cyclophosphamide. Prognosis is improved compared to ALS as MMN often responds well to treatment.
The document discusses the examination of cervical disorders. It begins with an introduction to the anatomy of the cervical spine and then describes the various functions of the spine. The document outlines the process for examining the cervical spine, including obtaining a history, inspecting for abnormalities, palpating the spine, and performing special tests to assess range of motion and potential nerve impingement. Common cervical conditions like herniated discs and bone spurs are also summarized. The examination techniques are explained in detail with diagrams to illustrate proper procedures like compression, distraction, and rotation tests.
This document summarizes information about neuropathic pain, including its classification, mechanisms, signs and symptoms, types, and current treatment options. It begins with definitions of neuropathic pain and its classification by the International Association for the Study of Pain. It then discusses the mechanisms, development, and pathophysiology of neuropathic pain. Following sections provide details on the signs and symptoms, types (peripheral vs central neuropathy), most common conditions, and current treatment options including tricyclic antidepressants, anticonvulsants, opioids, gabapentin, and pregabalin. It highlights the mechanisms, pharmacokinetics, dosing, and clinically proven efficacy of pregabalin for treating neuropathic pain conditions like diabetic peripheral neuropathy and fibromyalgia.
The document discusses various chronic pain syndromes including low back pain, sciatica, complex regional pain syndrome, trigeminal neuralgia, and cancer pain. It provides details on the definition, causes, symptoms, diagnostic tools and treatment options for low back pain and sciatica, which are the most commonly discussed chronic pain conditions. The treatment sections cover medications, physical therapy, injections including epidural steroid injections, radiofrequency ablation, and other minimally invasive procedures.
This document discusses a surgeon's experience treating neck pain and related issues over the course of a year. It provides data on the number of cases handled by the surgeon and other surgeons. It discusses topics like acute neck pain, cervical radiculopathy, cervical myelopathy, and various surgical and non-surgical treatment options. It also presents three case studies, including one on cervical spondylotic myelopathy and two on cervical fusion and adjacent segment deterioration. Outcome data is presented comparing anterior cervical discectomy and fusion to cervical arthroplasty.
Assessment of the cervical spine in degenerative pathologiesSpinePlus
This document discusses the assessment and treatment of cervical spine degenerative pathologies and cervical myelopathy. It outlines how to examine the cervical spine by looking for deformities, feeling for masses or tenderness, moving to assess pain and stiffness, and testing neurology. Imaging options like x-rays, CT, and MRI are mentioned. The timing of surgery is discussed as well as the advantages and disadvantages of anterior versus posterior surgical approaches for conditions like radiculopathy, myelopathy, and cervical fusion versus disc replacement. Key factors in the choice of surgical approach include the number of levels involved and the cervical lordosis.
The document provides guidance on performing a musculoskeletal examination, including general considerations, inspection, palpation, range of motion testing, and examination of specific areas like the shoulder, elbow, and hand/wrist. Key steps include inspection for deformities, discoloration, palpation for temperature changes and tenderness, assessing active and passive range of motion, and performing special tests if abnormalities are suspected. The exam should be compared between sides.
Este documento presenta información sobre la imagenología de la columna cervical. Explica cómo leer e interpretar radiografías cervicales, identificando estructuras anatómicas, procesos degenerativos, lesiones y estenosis. También cubre la tomografía computarizada y resonancia magnética, indicando los cortes y estructuras que muestran. El objetivo es que los kinesiólogos comprendan la importancia de estas imágenes para el diagnóstico y tratamiento de disfunciones cervicales.
Cervical spondylosis is a degenerative condition affecting the cervical spine that is common in individuals over age 40. It involves the aging and dehydration of spinal discs along with bone spur formation, which can compress the cervical nerve roots or spinal cord. Symptoms may include neck pain, stiffness, muscle spasms, or neurological issues like numbness and weakness. Non-surgical treatments include medications, physical therapy, and injections. Surgery options include anterior cervical decompression and fusion or posterior cervical fusion to decompress the neural elements and stabilize the spine, promoting fusion and preventing further bone spur growth. Early referral for neurological evaluation is important as outcomes depend on symptom duration.
This document outlines the components and purpose of a scanning examination performed in physical therapy. The scanning exam is used to ensure issues are within the scope of physical therapy and rule out serious pathology. It involves observation of gait and posture, vital signs, functional movement testing, tissue tension testing, palpation, neurological exams, and special tests. The purpose is to detect gross loss of function and movement control in order to guide further physical therapy diagnosis and treatment.
This document discusses cervical spine injuries, their classification, mechanisms of injury, diagnosis, and management. Some key points:
1. Cervical injuries can be caused by traction, direct impact, or indirect forces like flexion, compression, or rotation. Imaging helps classify injuries and assess stability.
2. Unstable injuries with neurological deficits or multiple injuries may require urgent surgical stabilization. Otherwise, initial treatment focuses on immobilization using rigid collars, braces, halo traction, or halo vests.
3. Common injuries include fractures of C1-C2 and the odontoid process. Type II odontoid fractures are prone to displacement and non-union, so may need open reduction and fusion
Cervical disc disorders include cervical spondylosis, radiculopathy, and myelopathy. Cervical spondylosis is a general term referring to degenerative changes in the cervical spine. It commonly causes neck pain but can also cause radiculopathy or myelopathy. Cervical radiculopathy involves compression of a cervical nerve root, causing pain and weakness along the nerve distribution. Cervical myelopathy refers to compression of the spinal cord, which can cause gait abnormalities, leg weakness, and hand/arm symptoms. Management involves conservative treatments like physical therapy initially, with surgery considered for worsening or persistent symptoms.
This document discusses low back pain, sciatica, and lumbar disc prolapse. It provides details on the anatomy of the lumbar discs and describes how disc prolapses typically occur at the L4/L5 and L5/S1 levels. Clinical features of disc prolapses are outlined for different levels. Conservative and surgical treatment options are discussed. Cervical disc prolapse is also covered, including typical levels of involvement, clinical presentations, and management approaches.
This document provides an overview of cervical spine anatomy, cervical spondylosis, grading systems for cervical spine injuries, and treatment approaches. It defines cervical spondylosis as a widespread age-related degenerative condition affecting the cervical spine. Symptoms can include neck pain and neurological deficits. Treatment involves conservative approaches like physical therapy or surgical options like laminectomy, laminoplasty, or anterior cervical discectomy and fusion. Whiplash injuries and spinal cord injuries without radiographic abnormality (SCIWORA) are also discussed.
This document discusses the anatomy, types of injuries, clinical presentation, investigations and classification of brachial plexus injuries.
It describes the formation of the brachial plexus from the cervical nerve roots and its divisions. Injuries can be preganglionic or postganglionic, and include traction injuries, avulsions or lacerations. Clinical exam focuses on assessing motor and sensory deficits. Investigations include imaging like MRI/CT, myelography and EMG/NCV to localize the lesion. Seddon's classification is used to describe the severity of injury.
Neurology 12th disorders of the spine and spinal cordRamiAboali
The document discusses disorders of the spine and spinal cord. It describes the anatomy of the spinal cord and its blood supply. It then outlines the main spinal cord syndromes including spinal cord transection, hemisection, central cord syndrome, and anterior spinal artery syndrome. Specific disorders of the cervical and lumbar spine are also discussed such as cervical spondylosis, cervical and lumbar disc herniation, and lumbar canal stenosis. Clinical features, investigations, and management are provided for each condition. Spinal cord compression is also covered, noting the importance of early diagnosis and treatment to prevent permanent neurological damage.
Entrapment Neuropathies in Upper Limb.pptxNeurologyKota
This presentation is about the entrapment syndrome of upper limb giving an insight regarding diagnosis clinically as well as electrophysiologically and
its management.
Degenerative disc disease is a condition characterized by changes in the discs between vertebrae. As discs degenerate they lose water content and height. Fissures can form in the annulus fibrosus and the nucleus pulposus loses structure. This can lead to bulging of the disc and potentially protrusion or extrusion of disc material. Kirkaldy-Willis divided the process into three stages: dysfunction, instability, and stabilization. Symptoms include back pain and pain that may radiate into the legs. Diagnostic imaging includes x-rays, CT, MRI, and discography which can help identify problematic discs.
The document provides information on neurologic localization including:
1. It describes lesions of the central nervous system (CNS) like the brain and spinal cord can result in cognitive disorders, spasticity, and sensory alterations while peripheral nervous system (PNS) lesions result in weakness and loss of reflexes.
2. Common sites of lesions in the brain are described like the frontal lobe where strokes, tumors, and trauma can cause cognitive disorders, gaze deviations, and hemiparesis.
3. Imaging modalities for the nervous system are discussed including CT scans, MRI, MRA and their strengths and weaknesses in evaluating conditions.
The document provides information on neurologic localization including:
1. It describes lesions of the central nervous system (CNS) like the brain and spinal cord can result in cognitive disorders, spasticity, and sensory alterations while peripheral nervous system (PNS) lesions result in weakness and loss of reflexes.
2. Common sites of lesions in the brain are described like the frontal lobe where strokes, tumors, and trauma can cause cognitive disorders, gaze deviations, and hemiparesis.
3. Imaging modalities for the nervous system are discussed including CT scans, MRI, MRA and their strengths and weaknesses in evaluating different neurologic conditions.
1) The document discusses lumbar and cervical disc prolapses, with a focus on the anatomy, clinical presentation, examination, investigations, and treatment options.
2) It notes that 90% of lumbar disc prolapses occur at the L4/L5 and L5/S1 levels, while cervical disc prolapses usually occur in a posterolateral direction due to the strong posterior longitudinal ligament.
3) Conservative treatment is effective for many cases, while indications for surgery include incapacitating pain, neurological deficits, or motor/sphincter issues. Surgical options include discectomy with minimal bone removal or laminectomy.
The document discusses various tests used to investigate neurological diseases, including imaging tests like CT, MRI, X-rays; lumbar puncture to examine cerebrospinal fluid; nerve conduction and electromyography tests; evoked potentials; and specialized blood and biopsy tests. CT is useful for detecting tumors, hemorrhages, and fractures but has limitations. MRI provides better soft tissue contrast and avoids radiation. Lumbar puncture examines CSF for signs of infection or inflammation.
This document discusses somatosensory evoked potentials (SEPs), which are electrical signals generated in the nervous system in response to sensory stimuli. SEPs reflect the activation of neural structures along somatosensory pathways. They are recorded using electrodes on the scalp and spine in response to electrical stimulation of peripheral nerves. SEP waves are labeled according to their polarity and latency. Clinical uses of SEPs include evaluating peripheral nerves and central somatosensory pathways, localizing lesions, and monitoring patients in intensive care and during surgery. Abnormal SEPs can indicate disorders of the peripheral or central nervous system.
The document discusses the anatomy of the cervical spine. It notes that the cervical spine has 7 vertebrae and 6 intervertebral discs, with 8 pairs of exiting nerve roots. It describes the typical structure of the vertebrae in this region, including features like the odontoid process. The document also outlines various ligaments in the cervical spine and its circulatory and neural elements.
This document discusses the anatomy, clinical evaluation, and management of brachial plexus injuries. It begins with the anatomical components of the brachial plexus including roots, trunks, divisions, cords, and branches. It then covers the clinical evaluation including history, physical exam findings, and investigations like imaging and electrodiagnostic studies. Key aspects of the physical exam are described for assessing specific nerves and muscles. The document concludes with classifications of brachial plexus injuries and considerations for non-operative versus operative management.
This document provides an overview of common nerve entrapments around the shoulder, including the axillary nerve, suprascapular nerve, long thoracic nerve, spinal accessory nerve, and dorsal scapular nerve. It discusses the anatomy and pathways of each nerve, potential causes of entrapment including repetitive microtrauma and compression, characteristic clinical presentations such as localized pain and muscle weakness, diagnostic techniques including electromyography and magnetic resonance imaging, and potential treatment approaches including injections and surgical decompression.
This document discusses lumbar intervertebral disc prolapse, including its clinical features, investigations, and management. It notes that the condition most commonly affects people aged 30-40 and occurs at the L4-L5 level. Clinical features include back pain radiating into the leg. Investigations include physical exam, plain radiography, CT, MRI, myelography, and electrodiagnostic studies. Management involves non-operative options like medications and injections initially, with surgery considered if conservative measures fail.
Cervical radiculopathy is the clinical description of when a nerve root in the cervical spine becomes inflamed or damaged, resulting in a change in neurological function. Neurological deficits, such as numbness, altered reflexes, or weakness, may radiate anywhere from the neck into the shoulder, arm, hand, or fingers. Pins-and-needles tingling and/or pain, which can range from achy to shock-like or burning, may also radiate down into the arm and/or hand.
1) Entrapment neuropathies occur when nerves are injured by chronic compression, angulations, or stretching forces, causing mechanical damage. Carpal tunnel syndrome is an example where the median nerve is compressed as it passes through the wrist.
2) Clinical features of entrapment neuropathies include pain, numbness, tingling, burning, and weakness in the affected area. Electrodiagnostic tests like nerve conduction studies and electromyography are important diagnostically.
3) Treatment involves conservative measures like splinting, steroid injections, and physical therapy. Surgery is considered if conservative treatment fails or for severe cases. Proper identification of the site of nerve entrapment is key to determining appropriate treatment
The document provides information on the assessment and management of head and spinal trauma. It outlines the ABC approach for head trauma and emphasizes preventing secondary brain injury. It describes evaluating the Glasgow Coma Scale and pupillary responses. For spinal trauma, it stresses immobilization and protecting the spine during transport. Key factors include preventing further neurological injury and addressing airway, breathing, circulation issues.
Patients with spinal cord injury face a number of challenges, with continence being a top priority. For those affected by neurogenic bladder and bowel, there are various management options available. To help understand these options, study notes in this area can be useful. These notes, which are similar to index cards, can highlight key information related to the management of neurogenic bladder and bowel in spinal cord injury patients.
This document contains summaries of 4 research studies:
1. A randomized controlled trial that found suprascapular nerve blocks were no more effective than saline injections for treating subacute adhesive capsulitis.
2. A study that found intra-articular injections of hyaluronic acid plus dextrose for knee osteoarthritis resulted in greater improvements in physical function and pain reduction compared to hyaluronic acid plus saline.
3. A randomized controlled trial that demonstrated alendronate effectively prevented bone loss in the hip in men during the first year after a traumatic spinal cord injury.
4. A study that found patients with acquired brain injuries who had contractures required more intensive rehabilitation therapy, longer
This document summarizes 4 research articles on topics related to physical medicine and rehabilitation (PMR). The first article finds that certain hematological parameters can predict abnormal CT scan findings and injury severity in pediatric patients with traumatic brain injury. The second article identifies sociodemographic and clinical factors associated with readmission within 30 days of hospitalization for traumatic brain injury. The third article estimates the minimal clinically important difference in Berg Balance Scale scores for patients with early subacute stroke who require walking assistance versus those who do not. The fourth article finds that early, intensive lower extremity rehabilitation shows preliminary efficacy in improving gross motor function in young children with perinatal stroke.
presentation about relation between posture and pain. there is lot of talk and research regarding bad posture and chronic pain. but posture, disease along with physical activity intervention should be done to manage.
community inclusion of people with disabilities mrinal joshi
Community inclusion aims to provide equal access and opportunities for people with disabilities through participation in employment, housing, education, recreation, and civic roles. Factors influencing participation include medical care, self-efficacy, physical abilities, accessible equipment and environments, social support, and disability policies. Promoting inclusion requires addressing barriers like low education, poverty, prejudice, and inaccessible settings through rehabilitation, community support, empowerment, and addressing social justice. Life care planning can support community reintegration by outlining medical, housing, equipment, preventative, and cost needs over a person's lifetime.
This document summarizes a systematic review that compared the effectiveness of task-specific training using assistive devices to task-specific usual care for improving upper limb performance after stroke. Seventeen studies were included in the review. A meta-analysis found that in the subacute phase post-stroke, task-specific training using assistive devices was more effective at reducing upper limb impairment than task-specific usual care alone, based on Fugl-Meyer Assessment scores. However, in the chronic phase post-stroke, both interventions led to similar improvements in upper limb performance, with no significant differences found between the groups. The review concluded that both interventions can improve upper limb function after stroke but task-specific training using assistive devices may
This study compared the incidence of neurobehavioral side effects of levetiracetam versus phenytoin in patients with traumatic brain injury (TBI). In a prospective observational study of 100 TBI patients treated with either levetiracetam or phenytoin, researchers found:
1. Levetiracetam was associated with significantly fewer neurobehavioral side effects than phenytoin, including less irritability, aggression, and confusion.
2. Phenytoin treatment resulted in nearly double the incidence of neurobehavioral side effects compared to levetiracetam.
3. Levetiracetam appears to be a better-tolerated antiepileptic drug for
This document discusses chemo-neurolysis, a technique using chemical agents to block nerves for managing spasticity. It provides a brief history of phenol use in neurolysis since the 1860s. While chemo-neurolysis was commonly used before botulinum toxin, its use has declined due to high botulinum toxin costs and lack of training. The document outlines various nerve blocks and injection techniques used to manage spasticity in specific muscles, such as the pectoralis nerve block. It discusses factors like phenol concentration and dosage. Potential side effects are also noted. The document advocates for chemo-neurolysis as a low-cost alternative for focal spasticity management.
The article discusses the impacts of the COVID-19 pandemic on physiatry and rehabilitation medicine. It highlights how physiatrists played a vital role in the front lines during the pandemic by converting rehabilitation units and innovating care delivery. However, the pandemic has also caused significant disruptions and stress for medical practices through reduced patient volumes, higher costs, and threats of reimbursement cuts from insurers and governments. Moving forward, physicians are questioning the level of support they will receive from their employers and the government given the sacrifices many have made during the pandemic.
This document discusses rehabilitation for spastic paresis. It begins by defining spastic paresis and related conditions like spasticity, dystonia, and contractures. It then describes the underlying upper motor neuron lesion pathology. The document outlines rehabilitation goals and assessments. It provides an overview of common physical rehabilitation protocols including stretching, splinting, constraint-induced movement therapy, gait training, strengthening, biofeedback, electrical stimulation, virtual reality, and robotic therapy. It discusses each technique and provides references to support the use of these approaches.
This document summarizes and discusses several articles on physical medicine and rehabilitation (PMR) topics that were published in recent issues of various journals. The articles cover a range of topics including the treatment of 12th rib syndrome, the use of the tourniquet ischemia test to diagnose complex regional pain syndrome, physiotherapy interventions for treating spasticity, a telehealth intervention to increase fitness for those with spinal cord injuries, spinal cord involvement in COVID-19, the use of local anesthetic injections in athletes, and a comparison of video-based and text-based physical activity interventions. The document also provides an introduction and welcome from the editor as well as information about new contributors.
Shoulder impingement occurs when soft tissues in the shoulder joint become entrapped and causes pain when raising the arm or lying on the affected shoulder. It is usually caused by overuse or repetitive strain without preceding trauma and affects those over 40 years old. Evaluation involves clinical exams, imaging like x-rays and MRI, and injections to diagnose impingement. Conservative treatments include immobilization, anti-inflammatories, physical therapy, cortisone injections, and exercises to strengthen muscles and improve range of motion.
1) The document summarizes several journal articles related to physical medicine and rehabilitation (PMR). It includes abstracts on topics like cognitive communication skills after mild traumatic brain injury, seizure comorbidity and hospital readmissions after traumatic brain injury, effects of traumatic brain injury and spinal cord injury on sexual function, the relationship between white matter hyperintensities and response to language treatment in post-stroke aphasia, using mental imagery therapy to treat neuropathic pain in spinal cord injury patients, and impairments in spatial navigation during walking in younger patients with mild stroke.
2) The editor's preface welcomes readers to the first issue of 2021 and thanks contributors and the recognition from IAPMR. It encourages readers to keep learning with the
The document presents the second edition of the "PMR Buzz" which provides abstract summaries from current rehabilitation medicine journals, and includes contributions from several rehabilitation experts. It contains a systematic review and meta-analysis comparing the effectiveness of autologous blood products and steroid injections for plantar fasciitis, and a randomized controlled trial comparing the effects of balance training and aerobic training for patients with degenerative cerebellar disease. The document aims to disseminate practice-changing research and receive feedback to improve the quality of information presented in future editions.
Cancer Rehabilitation. integrating rehabilitation with oncology. a model of care. cancer survivorship. rehabilitation care in low resource area. Mrinal Joshi. Rehabilitation Research Center. Jaipur.
This document discusses urodynamic testing procedures like uroflowmetry and cystometrogram that are used to evaluate lower urinary tract function and diagnose conditions like overactive bladder. It provides details on parameters measured and what different tests can reveal. Common urodynamic findings are defined, like detrusor overactivity and poor bladder compliance. Neurogenic causes of lower urinary tract dysfunction are outlined for different spinal cord injury levels. A step-wise approach to managing the neurogenic bladder is proposed starting with self-voiding and progressing to clean intermittent catheterization or other options if needed.
The document discusses different types of prosthetics including transfemoral sockets, ischial containment sockets, suction sockets, prosthetic knees, stance control knees, hydraulic knees, and pneumatic knees. It provides details on the design, advantages, and disadvantages of each type. The Dr. P.K. Sethi Rehabilitation Centre in Jaipur, India was the first private hospital in the country to have a prosthetics and orthotics center, established in 1985.
5 Must-Have’s in ePCR Software for a More PROFITABLE and EFFICIENT EMS, NEM...Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS & NEMT organization, not just certain groups of people or certain departments.
It should benefit EMS crews – making it convenient to enter data and have the tools to increase document accuracy.
It should benefit the back-office by streamlining documentation and billing processes internally and with health facilities.
It should benefit the entire organization by improving workflow efficiency, comply with regulations, reduce costs, and contribute to generating data-driven reports.
To achieve those benefits, ePCR software must have these 5 functions.
Attitude and Readiness towards Artificial Intelligence and its Utilisation: A...ShravBanerjee
AI is a hot topic in recent days... We students of IPGME&R, Kolkata, India have done a study on Attitude, Readiness and Utilization of AI by medical students.
Artificial Intelligence (AI): The theory and development of computer systems able to perform tasks normally requiring human intelligence, such as visual perception, speech recognition, decision-making, and translation between languages.
Our study showed that:
1. Nearly half of the study participants showed a favorable attitude towards role of AI in healthcare
2. Around three-fifth of the participants could define basic concepts of data sciences and AI and were ready to choose AI based applications for healthcare; they were willing to accept AI usage despite feeling a lack of cognitive skills
3. Most of them used AI-based applications for studying (ChatGPT), however, some of them faced difficulties in using them
Thank you!
Yoga for Hypertension and Heart Diseases
Yoga Hypertension and Heart Diseases Certificate Course
Prevention and healing have been always the main purpose of yoga therapy practice. Yoga therapy is the process of empowering every individual to progress toward better health and optimal well-being through the application of the teachings and practices of Yoga therapy class. With the support of the Yoga trainer, implements a personalized and evolving Yoga therapy techniques that not only addresses the illness in a multi-dimensional manner, Pancha Kosa (Five Sheaths): Annamaya Kosha (Physical Body), Pranamaya Kosha (Energy Field), Manomaya Kosha (Mental Dimension), Vignanamaya Kosha (Psychic level of experience), Anandamaya Kosha (Bliss and Beatitude). It helps to reduce patient suffering in a progressive, non-invasive and complementary manner.
Why to study yoga Hypertension and Heart Diseases course?
Consequently, the demand for yoga therapist with specialized knowledge in yoga as a therapeutic tool, in different fields such as: health management organizations, hospitals and alcohol rehabilitation centers have grown rapidly. Studying yoga therapy as a tool to overcome and ease the symptoms of common illnesses has become extremely popular recently, due to the great therapeutic effects yoga practitioners experience in their body, mind and soul.
What you will learn from this course?
You may offer special seminars for people with similar diseases/conditions.
You will learn how to use yoga to assist in healing ailments and managing conditions?
You aim to be part of a positive change regarding health and lifestyle habits.
You want to teach people how to prevent diseases.
In group classes, you can teach your students how to become healthy.
You will feel more self-confident when approached by students that come to yoga seeking for support in their healing process.
Therapeutic applications of posture, movement and breathing.
Pre-Requisites:
This course is open to all students who wish to deepen their knowledge and application of some of the highest teachings of
Participants do not need to be yoga
Mastery of any yoga practice is not
Only yours sincere desire for knowledge and your commitment to personal
Love for Yoga is the most important eligibility factor for learning this course.
Students who want to know Yoga in totality and move beyond Asana and Pranayama, Mudra & Bandha.
Assessment and Certification
The students are continuously assessed throughout the course at all levels. There will be a written exam at the end of the course to evaluate the understanding of the philosophy of Yoga and skills of the students. Participants should pass all different aspects of the course to be eligible for the course diploma.
What do I need for the online course?
Yoga mat
Computer / Smartphone with camera
Internet connection
Yoga Blocks
Pillow or Bolster or Cushion
Strap
Notebook and Pen
Zoom
Recommended Texts
Asana Pranayama Mudra Bandha by Swami
21. Alignment for Advanced Yoga Asana
The advance asanas that are taught during various asana classes throughout the duration of the teacher training are brought up for analytical discussions and practical sessions of methods to adjust advance postures with both verbal cues and hands-on adjustments. Learning revolves around demonstrations, observation and practicums by assisting the lead instructors during some advanced yoga classes. Students will demonstrate observe and assist lead instructors in adjusting in a basic yoga class.
Learning Objective
Be able to identify misalignments of advance postures. Be able to observe student’s capacity during adjustments. Be able to safely and gently adjust advance postures with verbal cues and with hands-on adjustments. To provide adjusting and assisting techniques of yoga asana class.
Revolutionize Pain Management with Almagia’s PEMF Devices Shop Now.pptxALMAGIA INTERNATIONAL
In this blog, we will dig into some scientific studies that highlight the effectiveness of Almagia’s PEMF devices for sale and how they have transformed the landscape of pain management.
"NeuroActiv6: Revitalize Your Mind with Youthful Energy and Clarity"Ajay Agnihotri
In today's fast-paced world, maintaining mental clarity and energy can be challenging. The constant demands of work, family, and social commitments often leave us feeling drained and foggy. Enter NeuroActiv6, a revolutionary supplement designed to rejuvenate your mind and restore youthful energy and clarity.
NeuroActiv6 is a brain-boosting supplement that combines a unique blend of natural ingredients known for their cognitive-enhancing properties. This powerful formula is designed to support brain health, improve mental performance, and boost energy levels. Whether you're a busy professional, a student, or someone looking to enhance your cognitive function, NeuroActiv6 offers a range of benefits to help you achieve your goals.
NeuroActiv6 works by providing your brain with the essential nutrients it needs to function at its best. The combination of these powerful ingredients helps reduce brain fog, improve focus and concentration, and increase energy levels. By supporting brain health and enhancing cognitive function, NeuroActiv6 allows you to tackle your day with renewed vigor and mental clarity.
This presentation tells about health education for hand wash to children. Every child should know that how to keep hand clean. And maintain the good hand washing practices. Nowadays disease are easily spread through uncleaned hands.germs are habitat in their hands and then it causes different types of diseases.so, we must give the health education for hand washing to every children. And make them practice.
Etiologies of Bipolar disorders. Power Point Presentation ptxseri bangash
www.seribangash.com
Bipolar disorder, formerly known as manic-depressive illness, is a complex psychiatric condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). The etiology of bipolar disorder involves a combination of genetic, biological, and environmental factors. Here's a breakdown of these etiologies:
Genetic Factors:
Family History: Bipolar disorder tends to run in families, suggesting a genetic component. Studies indicate that having a close relative with bipolar disorder increases the risk.
Genetic Studies: Research has identified specific genetic variations associated with bipolar disorder. These include genes involved in neurotransmitter signaling, ion channel function, and circadian rhythms.
Neurobiological Factors:
Neurotransmitter Imbalance: Imbalances in neurotransmitters such as dopamine, serotonin, and norepinephrine are implicated in bipolar disorder. For example, elevated dopamine levels during manic episodes and decreased levels during depressive episodes.
Neuroendocrine Factors: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and abnormal cortisol levels have been observed in individuals with bipolar disorder.
Neuroanatomical Factors:
Brain Structure and Function: Structural and functional abnormalities in certain brain regions are linked to bipolar disorder. These include the prefrontal cortex, amygdala, and hippocampus, which are involved in emotional regulation and cognition.
Environmental Factors:
Stress: Stressful life events, such as trauma, loss, or significant life changes, can trigger or exacerbate episodes of bipolar disorder.
Substance Abuse: Substance use, particularly stimulants or drugs that affect neurotransmitter systems, can precipitate manic episodes or worsen the course of the disorder.
Developmental Factors:
Early Life Experiences: Adverse childhood experiences, including abuse, neglect, or chronic stress, may increase susceptibility to developing bipolar disorder later in life.
Trajectories: Some individuals may have a prodromal phase marked by subthreshold symptoms or other behavioral indicators before full-blown episodes manifest.
Reimbursement Bootcamp- Coding, Coverage & Payment lecture by David Farber, K...Levi Shapiro
Presentation by David Farber, King & Spalding LLP, "Reimbursement Bootcamp- Coding, Coverage & Payment". Includes a comparison of FDA and CMS – The Important Differences. Setting Expectations and Understanding Timing. FDA Approval/Clearance vs. CMS (Medicare) Coverage. “Reasonable and Necessary”
CMS coverage determination
(formal or informal);
Focus on health benefits;
Economic data is important;
Superiority endpoint often needed; Focus on Medicare beneficiaries; Public processes; Publishes proposed decisions. Information Considered by CMS. Center for Medicare & Medicaid Services. Clinical evidence (including FDA submissions)
External technology assessments;
Advisory committee recommendations;
Position statements by relevant groups; Expert opinions;
Public comments;
Economic and other cost-effectiveness data;
Other informal opinions. The Basics of Reimbursement
• Coverage
Is the item or service eligible for payment?
• Coding
How is the item or service identified?
• Payment
What are the payment methodologies and amounts?
Medicare Coverage:
Defined Benefit Category
Not Excluded
“Reasonable and necessary for
the diagnosis or treatment
of illness or injury or to improve
the functioning of a malformed
body member.”
— Social Security Act § 1862(a)(1)(A). CMS and Its Contractors Make
Medicare Coverage Decisions
• National Coverage
Determinations (NCDs)
• Local Coverage
Determinations (LCDs)
• Individual Consideration
National Coverage
Determinations (NCD):
National and binding decision by CMS
Coverage and Analysis Group (CAG).
May be requested by anyone
(CMS or external party.)
Public process that generally takes
9-12 months once initiated.
May include certain conditions for coverage (including Coverage with Evidence
Development (CED)). Coverage with Evidence Development (CED). Evidence-based coverage paradigm
that permits CMS to develop
coverage policies for treatments
that are likely to show health benefits
for Medicare beneficiaries but for
which the evidence base is not
sufficiently developed. Two kinds of CED: (1) clinical study
and (2) registry. Local Coverage
Determinations (LCD):
Issued by local Medicare
Administrative Contractors (MACs).
May be requested by anyone
(MAC or external party.)
New formal process in 2019 to
request LCDs.
Limited to particular MAC jurisdiction. Medicare Administrative Contractors. Coding is the “language of
reimbursement.”
Coding operationally links
coverage and payment.
Having a code does not
guarantee reimbursement! TYPE OF CODE, CODING SYSTEM, WHO SETS CODE? WHO USES CODE? Diagnosis, Procedure or Service, Products and Certain Services, Drugs. Current Procedural Terminology (CPT) Codes. Maintained by the AMA CPT Editorial Panel.
Identify medical services furnished by physicians.
5-digit numeric codes with generic descriptors.
Three types of CPT codes. Application process takes at least 15 months for Category I codes, with specific clinical data requirements.
Yoga Nidra Retreat in Bangalore
Yoga Nidra Retreat in Bangalore
A restful night is key to a healthy lifestyle. The reason behind many health issues that most people have from the modern way of living is nothing but lack of proper sleep. Well, it’s not like they don’t want to sleep, lack of time, an after-effect of day-long stress, and long-term anxiety trigger sleeplessness and thus respective disorders as well.
As per the recent survey, the insomnia percentage in India is above 33%, and the people who are most likely to be impacted with sleep deprivation hover around 52%. These numbers are higher compared to other countries.
Are you one of those populations suffering from sleeplessness and health issues due to lack of proper sleep? If Yes, then you must know that Yoga is the only way to get out of your situation to ensure restful nights after daylong stress and busy working schedules throughout the week.
Besides, even scientific studies prove that frequent consumption of stress-relieving, depression, or sleeping pills is not at all good for health and the brain. In such a scenario, Yoga is the only effective and probably most reliable way to get your sleep on track. Karuna Yoga Vidya Peetham will be on your side as a reliable Weekend Yoga Nidra Retreat in Bangalore.
Yoga Nidra aims at activating the relaxation response and improving the nervous and endocrine system functioning to ensure peaceful nights and active working hours.
Benefits:
An emphasis on some of the more Eastern practices (like yoga nidra, including pranayama, kriyas, mantras).
A peaceful location – the perfect setting for a Yoga Nidra Retreat.
Deepen your yoga practice and take it to the next level.
Retreat Curriculum Details
Practice Relaxation & Preparation for Yogic Sleep
Introduction to the concept and practices of relaxation
Relaxation in daily life
Sequence of relaxation practices
Tension & relaxation exercises
Systematic relaxation exercises
Preparations for Yoga Nidra
Mantra chanting
Introduction to mantra science
Morning prayers & Evening prayers
Surya-namaskar 12 mantras along with bija mantras
Pranayama Practices
Establishment of diaphragmatic breath
Different practices of pranayama
Yoga Nidra philosophy, Lifestyle, & Yoga Ethics
What is Yoga Nidra?
Philosophy of Yoga Nidra
Yoga Ethics
What Makes This Retreat Special
The practice of Yoga Nidra has been secret and imparted to those few yogis who have mastered their sleep. In Indian Mythology, there occurs a unique concept of sleep. We often find even the trinity of the universe Lord Brahma, Vishnu, and Shiva under the domination of sleep.
The course will explore the concept of Yoga Nidra details at theoretical and practical levels. This is designed to assist students of yoga to understand and experience the deeper layers of their personalities.
Type: Yoga Nidra Retreat
Date: 11th Sep 2021
Duration: 2 days
Location: Bangalore outskirt, India.
Food: Vegetarian
Accommodation
Shared Dormitory
Room
2. RADICULOPATHY
RADICULAR PAIN
Pain perceived as arising in a limb or
the trunk wall caused by ectopic
activation of nociceptive afferent fibers
in a spinal nerve or its roots or other
neuropathic mechanisms. (IASP
taxonomy)
RADICULOPATHY
Neurological state in which
conduction is blocked along a spinal
nerve or its roots => muscle weakness
& sensory changes
(Vervest, 1988; Bogduk, 2009)
• Radiculopathy and radicular pain commonly occur together
• Radicular pain may or may not occur with radiculopathy
5. Facet Joints (Zygapophyseal Joints)
Vx C3 - C7
Pillars at Pedicle –
Lamina
Posterior to exiting
nerve root
Synovial with capsule
Medial branch of dorsal
primary ramus
Directional stability and
prevent translation of
vx
6. Intervertebral disc
six
Each named after vx
above it
annulus fibrosus +
nucleus pulposus + 2
cartilaginous endplates
Thicker anteriorly than
posteriorly – lordosis
7. Uncovertebral articulations (joints of Luschka)
Lateral aspect of lower Vx
body has superior
projection (uncinate
process) &
lateral part of inferior
surface of upper vx body
facing it is slightly concave
On posterolateral border
of disc & anteromedial
portion of IVF
Not true synovial joints
Can hypertrophy
associated with disc
degeneration, and result
in narrowing of IVF
9. Note
• There is no C1 dermatome marked on the skin
The sensory fibers entering are from the meninges around the
cerebellum and medulla, not from the skin
• The C1 spinal nerve sends motor axons to a few muscles in 3
locations, the mouth, the front of the neck and the back of the skull.
10. Unique - 2 joints form boundary
Allows to dynamically change
configuration according to
movements
roof – inferior
aspect of notch
of pedicle
floor - superior
notch of pedicle
Posterior aspect of vx bodies, disc,
lateral expansion of PLL, venous
sinus
superior and
inferior
articular
process of ZP
joint ,lateral
prolongation
of LF
11. Spinal nerve root
DRG
Spinal artery of segmental artery
Communicating veins
Recurrent meningeal (sinu-vertebral) nerve
Transforaminal ligament
Fat
skin & muscles of backremaining ventral parts of the
trunk and the upper and lower
limbs
(cervical and brachial plexus)
ligaments, dura, blood vessels,
discs, facet joints, periosteum
VENTRAL RAMUS
DORSAL
RAMUS
Recurrent m. N
14. Degeneration,
spondylosis,
hypertrophy of ZP
joint or
uncovertebral joint
Disc herniation
Spinal instability
Trauma
Tumors
Disc herniation
Degeneration,
spondylosis,
hypertrophy of ZP
joint or
uncovertebral joint
15. Herniation of an intervertebral disk may be caused by degenerative processes or trauma.3 Disk
herniations may occur centrally or laterally. Central disk herniations may compress the cervical
cord directly; lateral disk herniations result in compression of a cervical nerve root. - See more
at: http://www.rheumatologynetwork.com/articles/identifying-musculoskeletal-causes-neck-
pain#sthash.r7bQLpXS.dpuf
16. Irritation of the spinal dorsal ramus system
- a potential source of pain
Each spinal dorsal ramus arises from the spinal
nerve and then divides into a medial and lateral
branch
Medial branch supplies the tissues from the
midline to the ZP joint line and innervates two
to three adjacent ZP joints and their related
soft tissues.
Lateral branch innervates the tissues lateral to
the ZP joint line
Clinical pain presentations follow these
anatomic distributions, which can be used for
localizing involved ramus
Diagnosis can be confirmed by performing a
single dorsal ramus block that results in relief of
pain
Treatment - spinal dorsal ramus injection
therapy
18. Classic Patterns
ABNORMALITIES
NERVE ROOT MOTOR SENSORY REFLEX
C5 Deltoid, elbow flexion Lateral arm Biceps
C6 Biceps, wrist extension Lateral forearm, thumb Brachioradialis
C7 Triceps, wrist flexion Dorsal forearm, long
finger
Triceps
C8 Finger flexors Medial forearm, ulnar
digits
NA
19. C5 Neck, shoulder, lateral
arm
C6 Neck, dorsal lateral
(radial) arm, thumb
C7 Neck, dorsal lateral
forearm, middle finger
C8 Neck, medial forearm,
ulnar digits
Distribution of Pain
20. Spurling test/ Foraminal compression test/ Neck
compression test/ Quadrant test
◦ Neck extension + Rotation +
Downward pressure on head
◦ Positive finding eliciting
reproduction of radicular pain into
ipsilateral arm of head rotation
◦ 92% sensitive, 95% specific
Low sensitivity but high specificity-
not useful as a screening tool, but it
does help confirm the diagnosis
21. Shoulder abduction test/ Shoulder abduction relief
sign/Bakody’s sign
◦ Active/passive abduction of
ipsilateral shoulder
◦ Relief of radicular symptoms
◦ takes stretch off of the affected
nerve root and may decrease or
relieve radicular symptoms
23. Lhermitte sign/ Barber chair phenomenon
◦ Flexion of neck producing electric
shock like sensations that extend
down the spine and shoot into the
limbs
◦ Usefulness is limited
◦ Indicates spinal canal stenosis, disc
impingement, multiple sclerosis, or
tumor
24. Anterior doorbell sign
•Indicates nerve root
tension/radiculopathy
•Deep palpation over C5
segment produces pain in
superior scapulovertebral
border that radiates to upper
limb
25. Others
NAFFZIGER'S TEST
(for nerve root compression)
Manual compression of the jugular
veins bilaterally
An increase or aggravation of pain or
sensory disturbance over the
distribution of the involved nerve root
confirms the presence of an extruded
intervertebral disk or other mass
VALSALVA MANEUVER
Deep breath and hold it while
attempting to exhale for 2-3
seconds
Positive response - reproduction of
symptoms
The pushing increases intrathecal or
intraspinal pressure revealing
presence of a space occupying mass
such as and extruded intervertebral
disc, or narrowing due to
osteophytes
28. Plain radiography
Role somewhat limited in evaluation
of nerve roots
Initial study to rule out instability or
pathologic changes in bone
Oblique views can show narrowing
of the neuroforamina secondary to
degenerative changes
29. MRI
MRI has become the method of choice for imaging the neck to detect
significant soft-tissue pathology, such as disc herniation.
The American College of Radiology recommends routine MRI as the most
appropriate imaging study in patients with chronic neck pain who have
neurologic signs or symptoms but normal radiographs
Sagittal T1 - Hypointense signal is common for herniated degenerative disks,
calcified ligaments, and bone spurs, making differentiation of these structures
more difficult
Axial T1 - Insight into both intraspinal and extraspinal disorders, as well as the
intrathecal nerve root anatomy
T2-weighted sequence or variants - “myelo-graphic” view
30. Cervical myelogram
Outlines SC and exiting nerve roots
with radiopaque dye
Water-soluble agent may be injected
via the C1-2 interval, allowing the dye
pool to gravitate caudally
Accuracy has been estimated 67% to
92%. For this reason, cervical
myelography is often accompanied by
CT
Excellent visualization of nerves in
relation to surrounding osseous
structures
31. Electrodiagnosis plays a critical role
Referred to as an extension of neurologic examination, as it is able to
provide physiologic evidence of nerve dysfunction
1. EMG
2. Motor and sensory nerve conduction studies
3. Late responses
32. ELECTROMYOGRAPHY
EMG is the most useful test
Localize lesions to a particular root level
The goal -- find a pattern of spontaneous and/or chronic motor unit changes in a
clear myotomal pattern
Limitations –
◦ can only detect change in the motor nervous system
33. Diagnostic Criteria for Needle EMG
To diagnose radiculopathy electrodiagnostically, needle study of 2
muscles that receive innervation from the same nerve root,
preferably via different peripheral nerves, should be abnormal.
Adjacent nerve roots should be unaffected unless a multilevel
radiculopathy is present
34. NERVE CONDUCTION STUDIES
The primary role -- determine if other neurologic processes exist as
an explanation for a patient’s clinical picture, or if another process
coexists with a root level problem
In pure radiculopathy, the sensory nerve studies should be normal.
Pathologic lesion in radiculopathy typically occurs proximal to the
DRG. Since the DRG houses the cell bodies for the sensory nerves,
the sensory nerve studies should be normal.
common nerve entrapments such as median neuropathy at the
wrist or ulnar neuropathy at the elbow
35. LATE RESPONSES
The utility of late responses such as F-waves and H-reflexes in
diagnoses of cervical radiculopathy is debated.
While H-reflexes can be useful in diagnosing S1 radiculopathies,
there is less evidence to support use of late responses in the upper
extremity.
F-waves are not sensitive
tend to be abnormal in severe disease
only tests motor fibers
not well tolerated by patients(supramaximal stimulation)
37. Myofacial pain
syndrome
No dermatomal distribution
Has tender points
Cervical spondylotic
myelopathy
Changes in gait
Falls
Bowel, bladder, sexual dysfunction
Difficulty using the hands
UMN findings like spasticity
Facet joint
arthropathy
Axial pain
Tenderness over facet joints or
paraspinal muscles
Pain with cervical extension or
rotation
No neurologic abnormalities
CRPS
Pain and tenderness of the
extremity, out of proportion with
examination findings
Skin changes, vasomotor
fluctuations, or dysthermia
Limited ROM, stiffness
Entrapment
syndromes
For example, carpal tunnel
syndrome (median nerve) and
cubital tunnel syndrome (ulnar
nerve)
Parsonage-Turner
syndrome (neuralgic
amyotrophy)
Acute onset of proximal upper extremity
pain
Usually followed by weakness typically in
the C5–C6 region and sensory disturbances
Typically involves upper brachial plexus
(unlike in cervical radiculopathy, in which
pain and neurologic findings occur
simultaneously)
Herpes zoster
(shingles)
Acute inflammation of DRG
Painful, dermatomal radiculopathy
Followed by appearance of typical
vesicular rash
Rotator cuff
pathology
Shoulder and lateral arm pain only
rarely radiates below the elbow
Aggravated by active and resisted
shoulder movements, rather than
by neck movements
Normal sensory examination,
reflexes
Thoracic outlet
syndrome
Median and ulnar nerve (lower
brachial plexus nerve roots, C8 and
T1) dysfunction
Compression by vascular or
neurogenic causes, often a tight band
of tissue extending from first thoracic
rib to C7 transverse process
Cardiac pain
Radiating upper extremity pain,
particularly in the left shoulder and
arm, that has possible cardiac origin
39. Immobilization
Some advocate short course (one week) of
neck immobilization may reduce symptoms
in the inflammatory phase
Cervical collar has not been proven to
alter the course or intensity of the disease
process
Adverse effects - especially when used for
longer periods of time. It is feared that a
long period of immobilization, can result in
atrophy-related secondary damage
40. Traction
Distracts neural foramen and
decompresses nerve root
Typically, 8 to 12 lb of traction at
approximately 24 degrees of
flexion for 15- to 20-minute
intervals
Most beneficial when acute
muscular pain has subsided
Not be used in patients who have
signs of myelopathy!
42. Physical therapy
A graduated physical therapy
program -- restoring range of
motion and overall conditioning
of the neck musculature
As the pain improves, a
gradual, isometric strengthening
program may be initiated
active range-of-motion and
resistive exercises as tolerated.
43. Pharmacological management
NSAIDs - effects on pain and inflammation
In general, 10-14 days of regular dosing is all that is needed to
control pain and inflammation
Oral steroids - reduce the associated inflammation from
compression
No controlled study exists
Longer-term use is not recommended
Tricyclic antidepressants - adjunct in controlling radicular pain
Opioid medications - generally not necessary for pain relief, but can
be used when other medications fail to provide adequate relief
44. SPINAL MANIPULATIVE THERAPY &
MOBILIZATION
Descrbed as external force applied to the patient by the hand, an instrumental
device or furniture resulting in movement and/or separation of the joint
articular surfaces with high or low velocity of joint movement
Evidence low in quality
45. Epidural Steroid injection
Principle- steroid decreases pain and
inflammation at the site, decreases PG
Indication –
◦ Radicular pain unresponsive to non-
interventional care for 1-2 months
◦ Patients without progressive neurological
deficit or cervical myelopathy can be
considered before sx
Complications
◦ Dural puncture, vasovagal reaction, facial
flushing, fever, nerve root injury,
pneumocephalus, epidural hematoma,
subdural hematoma, stiff neck, transient
paresthesias, hypotension, respiratory
insufficiency, transient blindness and
46. Surgery
RED FLAGS!!!
Persistent or recurrent unresponsive to nonoperative
management for at least 6 weeks
Disabling of 6 weeks’ duration or less (i.e., deltoid palsy, wrist
drop)
Progressive
Static or referred pain
or deformity of functional spinal unit +
Surgical Management of Cervical Radiculopathy, Todd J. Albert, MD, and Samuel E. Murrell, MD, J Am Acad Orthop Surg 1999;7:368-376
47. Posterior lamino-foraminotomy (with or
without diskectomy)
◦ Burr thins lamina over nerve root
◦ Nerve root exposed
◦ Angled curette can remove
additional bone & expand
foraminotomy
◦ Disk material can be exposed &
removed
48. Anterior cervical diskectomy and fusion
(ACDF)
◦ Most widely used
◦ Removes ventral compressive lesion
WITHOUT need for retraction of SC
◦ Disc removed and iliac crest bone
autograft placed to ENCOURAGE
FUSION
◦ Nowadays, allografts (no donor site
morbidity)
◦ In 1990s, cervical plates were added
to INCREASE stability and decrease
post op bracing
49. Anterior cervical diskectomy without
fusion
◦ Because of high incidence of
pseudarthrosis after ACDF
◦ Reported outcomes comparable
◦ Disk-space collapse and osseous fusion
◦ There is stress on removal of PLL (buckling
of ligament as disk space collapses
produces compression of the neural
elements) but removes another stabilizing
structure
Post anterior cervical diskectomy without fusion Lateral cervical radiograph shows
increase in kyphosis. T2-weighted MRI - stenosis, ligamentum and disk bulging,
spondylosis, and cord compression