ࡱ> @ bjbjFF +8,,A?Z-Z-Z-8-,-Th.."@.@.@.@.@.@."$$$$$$$ R]PH@.@.@.@.@.H@.@.]...@.@.@.".@."..@.. ygZ-V.2\"s0l.R@.@..@.@.@.@.@.HHdV.VNeck Pain Causes and Treatments David J. Rolnick, M.D. ~ MedEx, LLC Key Driving Factors Adversarial Scheme Framework Wrong Incentives Lack of Knowledge Wrong Incentives Encourage: Claimants to stay sick Medical over-servicing Legal intervention Process driven (not outcome focused) performance by insurers Why doesnt whiplash exist in countries without access to compensation? Why dont demolition derby drivers sustain whiplash injuries? Vertebrae 33 spinal bones (vertebrae), most with a disc separating them 3 important, noticeable curves Cervical Vertebra and Facet Joints Purposes of the Spine Provide mobility Provide stability Protect the nerves and spinal cord Act as a shock absorber Intervertebral Disc Permits free motion Transmits shock Annulus Fibrosis Confines the nucleus pulposus Nucleus Pulposus Distributes forces Acts as a ball bearing Nerves Spinal Cord Nerve Roots to the arms and hands Ligaments Muscles of the Neck Muscular Pain Overuse and Postural Problems: Long hours and poor posture fatigue muscles which eventually become strained. Acute Trauma Whiplash-type injuries Whiplash Annual cost of $29 billion Herniation of a degenerated disc occurs frequently without injury Two thousand volunteer collisions have never produced chronic neck pain Psychological and social factors create the setting for chronic pain Disc Problems Degenerative Changes Discs lose water content causing tears in the outer annulus and narrowing of the intervertebral space. Annular tears occur frequently without injury or symptoms Acute Trauma Disc Herniation Arthritis Joint deterioration and inflammation related to age, overuse, and injury Cervical Radiculopathy Diagnosis Patient History Physical Examination X-rays MRI CAT Scan Myelography Patient History Does the pain go down your arms or legs? What increases/decreases your pain? Bowel/bladder problems? Physical Examination How well do you move your neck? Tenderness/muscle spasm? Numbness/Reflexes/Strength Major Peripheral Nerves C-5 Level C-6 Level C-7 Level C-8 Level T-1 Level X-rays Magnetic Resonance Imaging (MRI) Computer Assisted Tomography (CAT Scan) Myelography (Myelogram) Electromyogram (EMG) Testing the speed at which nerve roots send signals. Treatment Relieve Pain Improve Function Reduce the likelihood of re-injury and chronic pain and conditions Non-surgical Treatment Medications Cervical Collar Cervical Pillow Physical Therapy Cervical Traction Conservative Treatment In one study, patients who received active treatment in the form of neck exercises within 96 hrs of injury onset fared better in terms of pain and cervical motion than did control patients who were told to rest the neck for 2 weeks. Common Surgical Procedures Discectomy Cervical Fusion Laminectomy Epidural Steroid Discectomy Done for disc herniation Usually done along with a single level fusion Often done from an anterior approach Reasonable for a single nerve root compression from a disc herniation Non-operative treatment often successful Cervical Fusion Done for degenerative disc disease Most degenerative disc disease is asymptomatic Often multiple levels are fused The remaining mobile levels are at risk Difficult to tell what level is causing symptoms: MRI and Discography Laminectomy Done for spinal stenosis, a degenerative progressive condition Often associated with fusion Not usually done for traumatic neck pain Epidural Steroids No value for axial pain No value for degenerative discs No value for uncovertebral osteophytes May help radicular pain from a herniated disc Cervical Spine Manipulation An aggressive, non-invasive procedure; Potential for serious complications Radiculopathy Myelopathy Vertebral artery occlusion - Stroke Spinal cord injury Caring for Your Neck Positioning and Posture Proper Lifting Not just for your back! Simple Exercises Questions? Thank you! PAGE  David J. 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