Differentiating Shoulder Pathology from Cervical Spine Pathology: An Algorithmic Approach.

Etiology of neck and shoulder pain may be multifactorial. When surgical intervention is indicated, the choice of whether to start with spine or shoulder surgery is an important clinical decision to make based on severity of pathologies, comorbidities, and patient preference. The literature includes with very few studies exploring the incidence or results of the surgical treatment paths followed in this clinical situation. This study compares patient-reported outcomes of patients with both cervical spine and shoulder pathology who underwent intervention for cervical, shoulder, or both pathologies. The authors retrospectively reviewed 154 charts at a single institution between 2009-2017 who had both cervical spine and shoulder pathology while undergoing operative intervention of one or both pathologies. For each patient, demographics, patient-perceived success, NRS pain scores, functional outcomes (Focus on Therapeutic Outcome scores and neck disability index scores), and post-operative opioid use were reported. Patient-reported success (P=0.85), NRS pain score decreases (P=0.45), all functional outcomes except for final external rotation range of motion (P=0.02), and post-operative opioid use (P=0.30) were similar when comparing only cervical spine to shoulder intervention. Success (P=1.00), NRS pain score decreases (P=0.37), both functional outcomes, and post-operative opioid use (P=0.08) were all similar when comparing patients who underwent cervical then shoulder intervention to shoulder then cervical intervention. Finally, statistical significance was found when comparing reported success (P=0.0004) but not NRS decreases (P=0.18), functional outcomes, or post-operative opioid use (P=0.43) in patients who underwent both operation types versus only one. Similar outcomes are seen when comparing isolated surgical intervention types and order of surgeries when undergoing both interventions. Multiple surgical intervention types, regardless of order, tends to result in higher rates of patient-reported success but similar post-operative outcomes compared to one.

Partial Epiglottoplasty for Pharyngeal Dysphagia due to Cervical Spine Pathology.

Shoulder pain in young athletes generally is a result of poor sports technique and overuse. A number intrinsic causes of shoulder pain have been identified. Pain may also be referred to shoulder area from cervical spine, neck and chest pathology. Overuse stress injury of the proximal humeral physis is important to recognize early in order to prevent later complications. Shoulder impingement syndrome is a general term used to describe multiple underlying lesions and relatively uncommon in young athletes. In adolescent athletes, glenohumeral instability is an important underlying pathomechanical basis for shoulder pain. Other less frequent causes reviewed here include atraumatic osteolysis of the distal clavicle, long thoracic and suprascapular neuropathies.

Introduction Spinal disease is prevalent, yet education regarding these disorders in undergraduate medical education is limited. Objective This study assesses medical students' exposure, confidence, competence, and attitudes regarding their spine anatomy and pathology curricula. Methods US allopathic and osteopathic medical students completed an anonymous, uncompensated survey, including 17 questions on attitudes towards spine education and 15 on spine anatomy and pathology. Surveys completed in <180 seconds or <80% complete were excluded. Students estimated their hours of spine education and rated their comfort in diagnosing spine pathology. Data was analyzed using Stata (StataCorp, College Station, TX, USA) and RStudio (Posit PBC, Boston, MA, USA). Results Of 491 survey respondents, 252 (51.2% allopathic, 48.8% osteopathic) met the inclusion criteria. Surgery and medicine were the most common specialty interests. Students scored significantly higher in lumbar competence (2.20 vs. 1.96; p<0.001, F = 7.40) and confidence (1.72 vs. 0.82; p<0.001, F = 38.66) questions than in cervical spine. Students who reported over 20 hours of spine anatomy teaching answered more lumbar spine questions correctly and reported more confidence answering both cervical and lumbar spine questions. Students with reported interest in either neurosurgery or orthopedics had a non-significant trend to answer more questions correctly overall but were significantly more confident with cervical spine questions (p=0.02, x2 = 19.58, df = 4). A majority (59.1%) of participants wished for more didactic time on spine pathology, and 39.5% of participants expressed dissatisfaction with clinical rotation didactics. Conclusions US medical students demonstrated disparity in recognizing cervical versus lumbar spine pathologies. Most respondents desired more spine-focused didactics, suggesting an area of improvement in medical education by balancing spine education to reflect disease prevalence.

Relation between the painful shoulder and the cervical spine with narrow canal in patients without obvious radiculopathy

The LMA CTrach (CTrach) enables ventilation, glottis visualisation and tracheal intubation via a laryngeal mask conduit. The CTrach has been successfully used in patients with cervical spine pathology, but it is unclear if cervical spine immobilisation affects its ease of use. In this randomised crossover trial, the CTrach was used once with and once without manual in-line stabilisation of the cervical spine in every patient. With manual in-line stabilisation, the median [IQR] time to achieve ventilation was 22 [16-32] s, compared with 19 [13-30] s without stabilisation (p = 0.065). With manual in-line stabilisation, the time to achieving a glottic views was 42 [30-63] s compared with 39 [25-53] s without stabilisation (p = 0.019). There was no difference in the success rates of achieving ventilation and glottic views. These results suggest that manual in-line stabilisation does not affect use of the CTrach.

Copyright: © 2014 Mintken P. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Shoulder pain is common, with a reported prevalence between 2033% [1]. Additionally, the incidence of shoulder pain in the general population appears to be increasing [2]. The prognosis for patients with a new onset of shoulder pain is generally poor, with recovery rates of only 49-59% at an 18-month follow-up [3,4]. Recurrence rates are also high, as Rekola et al. [5] reported that 1 in 4 individuals with shoulder or neck pain will experience at least one episode of recurrence within 12 months of onset. In the year 2000, the direct costs for the treatment of shoulder pain in the United States topped $7 billion, [6] and Kuijpers et al. [7] reported that 74% of the total costs for managing shoulder pain are attributable to individuals with persistent or recurrent symptoms. Shoulder pain can be challenging for both patients and health care providers. A study by Ostor et al. [8] on non-specific shoulder pain reported that 77% were diagnosed with more than one shoulder problem. Many shoulder pathologies present with similar examination findings, but vary widely in their outcomes and require different intervention approaches [9]. Specific diagnosis and classification can be difficult, as de Winter et al. [10] reported only moderate agreement on the classification of shoulder disorders. Given that shoulder pain is difficult to accurately diagnose, Dinant et al. [11] argue that we need a shift from diagnostic to prognostic research.

Lateral gliding cervical spine mobilisation is shown to improve shoulder pain, disability and function. However, despite common clinical-use, no study reports the effect of unilateral anterior-posterior (A-P) cervical mobilisation on shoulder pain and function, and particularly in patients after arthroscopic shoulder surgery. Examine the immediate effect of single-level Grade III cervical unilateral A-P mobilisation on shoulder pain, flexion and abduction range of motion (ROM) and external rotator strength compared to placebo cervical unilateral A-P light touch pressure. Single session intervention with a crossover design in 32 (15 women) postoperative arthroscopic shoulder patients. Immediate and superior treatment effects were shown for A-P cervical mobilisation in improving flexion ROM, isometric strength of external rotation, and pain intensity during flexion (all p< 0.05) when compared to the placebo. However, effects may not be considered clinically meaningful. Unilateral A-P mobilisation applied to the cervical spine shows a tendency toward positively influencing post-arthroscopy shoulder pain and function. Further study examining cervical mobilisations directed in different planes to influence shoulder motion appear warranted.

It is crucial to differentiate more common cervical spine disorders from thoracic outlet syndrome (TOS), which causes neck and shoulder pain and paresthesia in the upper extremities. However, distinguishing between these conditions can be challenging if cervical spine imaging identifies lesions that may explain the symptoms. Herein, we describe the case of a patient who presented with chronic neck and shoulder pain, along with paresthesia in the right arm and hand, which had persisted for two years. Cervical spine imaging revealed ossified posterior longitudinal ligaments and disc protrusion at the C4-5 and C5-6 levels, potentially causing cervical radiculopathy. Nonetheless, the patient's symptoms worsened after strenuous physical activity of the upper extremities, raising suspicions of neurogenic TOS. A thorough history and physical examination confirmed neurogenic TOS and carpal tunnel syndrome, with symptom improvement following decompression surgery of the right brachial plexus and median nerve. Differential diagnosis of asymptomatic cervical lesions in neurogenic TOS can prevent unnecessary cervical spine surgery.

Shoulder pain is usually related to local osteoarticular or periarticular diseases of mechanical or inflammatory origin. Occasionally, it can be secondary to a discoradicular compression in the cervical spine. We report the case of a 67-year-old woman who was hospitalized for degradation of her general state, inflammation and painful shoulders. General and ear-nose-throat examinations were normal. Pain was elicited by palpation of the shoulders and the cervical spine. The mobility of shoulders and the neck was complete and painless. Laboratory tests showed inflammation with marked eosinophilia. Plain radiographs of the shoulders were normal. A 99mTc total bone scintigraphy showed an increased uptake ranging from D3 to D12. The thoraco-abdominal CT scan was normal. The evolution after seven months was marked by a occurrence of a sudden tetraparesy. The neck CT scan and magnetic resonance imagery showed a C6-C7 spondylodiscitis. The patient was operated and the symptoms disappeared. The Löwensten's culture of the removed discal tissue was positive and confirmed the presence of a Pott's disease. The evolution was favorable with a specific quadri-therapy for nine months. A negative scintigraphy and the presence of an eosinophilia were misleading in the present case. For shoulder pain without a clear etiology, cervical exploration should be adviced. Cervical tuberculosis can begin with isolated shoulder pain.

<h3>Background and Aims</h3> For awake fibreoptic intubation, it is essential to ameliorate the cough, swallowing and gag reflexes which can be done by various airway nerve blocks. The superior laryngeal nerve (supplying sensations above vocal cords) and recurrent laryngeal nerve (supplying sensations below the cords) are conventionally blocked in unison. We compared the conditions for awake fibreoptic intubation when a single transtracheal block alone was administered as compared to when bilateral superior laryngeal blocks in combination with transtracheal blocks were administered under ultrasound guidance in patients with preexisting unstable cervical spine <h3>Methods</h3> One hundred and forty patients with cervical spine pathology were randomly allocated to receive either a single transtracheal block or a combination of transtracheal and bilateral superior laryngeal nerve blocks under ultrasound guidance before being taken up for awake fibreoptic intubation. Comfort of awake fibreoptic intubation, represented by patients’ cough and gag scores (Malcharek et al,2015), intubation times, haemodynamic parameters, operator and patients’ experiences and complications were noted <h3>Results</h3> Demographic parameters, intubation times, vital parameters were similar. (p &gt; 0.05 each). Levels of coughing and gagging during the procedure and the time required were comparable. (p &gt; 0.05 each).Intra procedural vital parameters or post procedure sequelae were similar (p&gt;0.05) <h3>Conclusions</h3> Single transtracheal block provides comparable intubating conditions under fibreoptic guidance as compared to combination of transtracheal and bilateral superior laryngeal nerve blocks. Therefore, for airway anaesthesia during awake fibreoptic intubation, in view of its less invasiveness, a single transtracheal block can be preferred over the combination of transtracheal and bilateral superior laryngeal nerve blocks.

Aim: To investigate the hemodynamic indexes during the postisometric relaxation in patients with cervicocranial pain and vestibular dysfunction in patients with the cervical spine pathology. Materials and Methods: The clinical examination included 85 patients of the young age with cervical spine instability. We use randomization into 41 patient with cervicogenic cranialgia and 44 patients with vestibular dysfunctions. Postizometric relaxation (PIR) sessions were included into patients treatment. Results: Our results revealed increased time-averaged indexes of maximal blood flow velocity through vertebral and basilar arteries in patients with cervicogenic cranialgia. The same indexes were registered to be decreased in patients on the 2nd group. We found that hperreactivity to flexion-extension was determined in patients of both groups, and in patients of the 1st group to left-right rotation. After post-izometric relaxation sessions we registered a decrease in the headache intensity, frequency and duration in patients with cervicogenic cranialgia, and a decrease in dizziness intensity and ringing and tinnitus regression in patients with vestibular dysfunctions. Conclusions: We found that hemodynamic changes in patients with cervicogenic cranialgia were manifested in the form of hyperperfusion through vertebral artery and basilar artery and a half-increase in reactivity indexes on rotatory tests. The hemodynamic effect of PIR was determined in the form of vertebral blood flow indexes through vertebral artery and basilar artery stabilization, as well as indexes of reactivity to rotatory tests normalization.

More general practitioners are offering physiotherapy services within primary healthcare; however, this provision may result in increased demand. Resource allocation, based on previous patterns of consultation for musculoskeletal conditions, may be inadequate since the need for treatment in the community may not have been met in the past. Therefore the aim of this study was to determine the prevalence of back, neck and shoulder problems that had restricted normal activity for more than one week during the last year and which health professionals (if any) patients had consulted about their symptoms. A postal survey of 2400 adult patients selected at random from four general practices in Newcastle upon Tyne (600 from each practice). A total of 1546 questionnaires were returned, a 64% response rate. Overall, 40% of respondants reported having at least one back, neck and/or shoulder problem. Back problems were most common (30%), followed by those with neck (21%) and shoulder (20%) problems. Approximately one-third of those with problems consulted no one, a further third consulted a general practitioner and only one in six consulted a physiotherapist. There is a high prevalence of substantial back, neck and shoulder problems in the community and thus a wider provision of physiotherapy services within primary healthcare may be required to manage the considerable levels of potentially unmet need.

Scoliosis-Associated Cervical Spine Pathologies

Horner’s syndrome is caused by impairment of the sympathetic trunk, resulting in associated ptosis, miosis, and anhidrosis. The cervical sympathetic trunk is sometimes damaged during an anterior approach to the lower cervical spine. We report two cases of Horner’s syndrome after anterior decompression and fusion for lower cervical spine pathologies. Case 1 was in a 58-year-old woman with a herniated C5-6 intervertebral disc presenting myelopathy who underwent anterior cervical discectomy and fusion of C5-6. After the operation, miosis and anhidrosis of the right face occurred, and the symptoms continued for more than 15 years. Case 2 was in a 40-year-old woman whose diagnosis was flexion myelopathy with kyphosis at C5-6 and canal stenosis, so she underwent anterior cervical C5-6 discectomy and fusion of C5-6. Immediately after surgery, ptosis and miosis occurred, which lasted for four months. Horner’s syndrome tends to occur during anterior cervical spine procedures, especially at the lower level, and the syndrome may be transient or irreversible. During an anterior approach to the lower cervical spine, taking care not to damage the sympathetic trunk is important to avoid this complication.