Causes and treatments of neck and arm pain
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Causes and Treatments of Neck and Arm Pain. Brian T. Ragel, MD Department of Neurosurgery. Introduction. Anatomy Definitions Cervical spondylosis Herniated disc Dx / Tx Axial neck pain Radiculopathy Myelopathy. Cervical Spondylosis. degenerative aging process from wear and tear

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Causes and treatments of neck and arm pain

Causes and Treatmentsof Neck and Arm Pain

Brian T. Ragel, MD

Department of Neurosurgery


Introduction
Introduction

  • Anatomy

  • Definitions

    • Cervical spondylosis

    • Herniated disc

  • Dx / Tx

    • Axial neck pain

    • Radiculopathy

    • Myelopathy


Cervical spondylosis
Cervical Spondylosis

  • degenerative aging process from wear and tear

    • “bone spurs”

    • loss of disc height

    • Osteophytes

    • Mineral deposition in ligaments and discs



Axial neck pain
Axial Neck Pain root compression

  • Sx

    • Neck pain (poorly understood)

    • Nerve endings in discs and facets

    • musculoskeletal

  • Dx

    • ?

  • Tx

    • NSAID and physical therapy


Natural history of axial neck pain
Natural History of Axial Neck Pain root compression

  • Notes:

    • 66% of all adults will have neck pain

    • Rothman, no difference b/w op and non-op

    • Gore, no correlation b/w neck pain and x-ray


Cervical radiculopathy
Cervical root compressionRadiculopathy

  • Sx

    • Sx’s in dermatomal distribution from compressed nerve root

      • Example: C6 radiculopathy will produce pain/numbness in lateral biceps -> lateral forearm -> thumb

  • Dx – sx / exam / MRI

  • Tx

    • ACDF / disc arthroplasty

    • Posteriorforaminotomy


Cervical myelopathy
Cervical root compressionMyelopathy

  • Sx

    • Sx’s N/T, clumsy hands, spastic gait, leg weakness due to spinal cord compression

  • Dx – sx / exam / MRI

  • Tx

    • ACDF (usually > 1 level)

    • Posterior decompression


Natural history of cervical myelopathy
Natural History of Cervical root compressionMyelopathy

  • Lees and Turners

    • usually stable nonprogressive disability

    • progressive deterioration exception

  • Symon et al, 67% steady decline

  • Nonrandomized MCT in 2000

    • 20 surgery with improved function

    • 23 non-op with decline in ADL


Summary
Summary root compression

  • Cervical spondylosis (degeneration)

  • Dx / Tx

    • Axial neck pain

    • Radiculopathy

    • Myelopathy