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Causes and Treatments of Neck and Arm Pain

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

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  1. Causes and Treatmentsof Neck and Arm Pain Brian T. Ragel, MD Department of Neurosurgery

  2. Introduction • Anatomy • Definitions • Cervical spondylosis • Herniated disc • Dx / Tx • Axial neck pain • Radiculopathy • Myelopathy

  3. Cervical Spondylosis • degenerative aging process from wear and tear • “bone spurs” • loss of disc height • Osteophytes • Mineral deposition in ligaments and discs

  4. Degenerative changes that contribute to spinal cord/nerve root compression

  5. Axial Neck Pain • Sx • Neck pain (poorly understood) • Nerve endings in discs and facets • musculoskeletal • Dx • ? • Tx • NSAID and physical therapy

  6. Natural History of Axial Neck Pain • 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

  7. Cervical Radiculopathy • 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

  8. Cervical Myelopathy • 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

  9. Natural History of Cervical Myelopathy • 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

  10. Summary • Cervical spondylosis (degeneration) • Dx / Tx • Axial neck pain • Radiculopathy • Myelopathy

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