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xx Cervical degenerative disc disease
« Thread started on: Nov 19th, 2006, 10:57pm »

Cervical degenerative disc disease
Disc degeneration
Cervical disc degeneration is a common cause of neck pain, most frequently felt as a stiff neck. Cervical degenerative disc disease is much less common than disc degeneration in the lumbar spine because the neck generally is subjected to far less torque and force. Nonetheless, a fall or a twisting injury to the disc space can spur degeneration, and accumulated wear and tear on the disc over time can also lead to neck pain caused by disc degeneration.

Cervical degenerative disc disease pain and symptoms
In addition to having the low-grade pain of a stiff or inflexible neck, many patients with cervical disc degeneration have numbness, tingling, or even weakness in the neck, arms, or shoulders as a result of nerves in the cervical area becoming irritated or pinched. For example, a pinched nerve root in the C6-C7 segment could result in weakness in the triceps and forearms, wrist drop and altered sensation in the middle fingers or fingertips.

Cervical disc degeneration can also contribute to spinal stenosis, and other progressive conditions, as well as a more sudden disc herniation.

Cervical degenerative disc disease diagnosis
Successful diagnosis of cervical degenerative disc disease begins with a physician reviewing the patientís history of symptoms and performing a physical examination to measure neck extension and flexibility. During the exam, patients may be asked to perform certain movements and report whether the neck pain increases or decreases.

If a physical exam warrants further investigation, imaging studies such as X-Ray, MRI and possibly a CT scan will be taken. These diagnostic images can confirm whether and where degeneration is occurring, and can identify other conditions (such as calcification or arthritis) that could be causing the symptoms.

Cervical degenerative disc disease treatment
The general treatment is largely the same as for degenerative disc disease in the lumbar spine. That is, conservative care (no-surgical) is recommended as the primary strategy and surgery is only considered if a concerted effort at conservative care fails to provide adequate pain relief or a patientís daily activity has been significantly compromised.

Conservative care
Patients may find relief by applying ice or heat, using medications to control pain and inflammation, and exercising the neck and shoulder areas (alone or with the help of a professional familiar with neck conditions) to relieve stiffness and maintain flexibility. In addition, neck appliances or traction may be prescribed.

Over the counter and prescription medications can provide relief. These include non-steroidal anti-inflammatories (NSAIDs) and pain relievers like acetaminophen (such as Tylenol). Prescription medications such as oral steroids, muscle relaxants or narcotic pain medications may also be used.

Exercise, specifically stretching as many dimensions of the neck as possible, is essential to maintain flexibility in the neck and relieve chronic stiffness. A specific set of exercises should be developed by a physician or physical therapist. Some exercises that could be done several times a day include:

Chin-to-chest stretch, which stretches the back of the neck

Side-to-side swivel, which involves slowly turning the head to the left and right

Eyes-to-the-sky, where a patient lifts the chin upward to stretch the front of the neck and upper thoracic area

Ear-to-shoulder stretch to extend the sides of the neck as much as possible (this can be facilitated by gently placing a hand on the head but should not involve pulling or pushing the neck and head to the shoulder)

Physical therapy or chiropractic manipulation may also provide relief by helping patients extend the neck and shoulders to increase, at least temporarily, the disc space in the affected vertebral segment

Use of a cervical collar, cervical pillows or neck traction may also be recommended to stabilize the neck and improve neck alignment so the disc compression is not exacerbated as a patient sleeps or relaxes at home

Surgery
If pain is not relieved adequately with six months of conservative care and daily activities become difficult, surgery may be considered. Specifically fusion may be recommended to stop the motion of the affected cervical vertebral segment. This entails removal of the disc, decompression of the nerve root, and insertion of a bone graft or a metal cage device to help maintain or reestablish the normal height of the disc space as well as neck stability and alignment. A cervical plate may be used to promote fusion between the two vertebrae.

Generally, a one-level fusion is done, and in rare circumstances a two-level fusion would be considered. However, patients should know that surgery for neck pain is much less reliable than surgery to relieve arm pain from cervical degenerative disc disease. Thus if the only or predominant symptom is neck pain, fusion surgery should be recommended only as a last resort and after all other treatment options have been exhausted. If a disc space cannot be identified as the probable pain generator, it is reasonable even in cases where conservative treatment has not worked well to avoid surgery.

By: Peter F. Ullrich, Jr., MD
Last updated November 2, 2006
(Originally published September 8, 1999)

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xx Re: Cervical degenerative disc disease
« Reply #1 on: Nov 19th, 2006, 10:57pm »

Miscellaneous causes of upper extremity pain
Miscellaneous causes:

Rotator cuff tendinitis
Brachial plexus
Carpal tunnel syndrome
Cubital tunnel syndrome
Occipital neuralgia
Reflex sympathetic dystrophy
Rotator cuff tendinitis
The rotator cuff is a set of four muscles (Supraspinatus, Infraspinatus, Subscapularis, and Teres Minor) that lie over the humeral head in the shoulder that help provide shoulder stability. These muscles can become inflamed and produce shoulder pain. The pain tends to be:

Generally worse at night or after activity

Shoulder motion causes pain and is limited

More common in athletes who do a lot of throwing

More common in older individuals (over 50)

If the pain is severe, it can be difficult to distinguish between rotator cuff tendinitis and a cervical radiculopathy. In such cases, an injection of a numbing agent (such as Lidocaine) into the shoulder area can help. If the pain is completely relieved, then the cuff is probably the pain generator (not the nerve).

Tendinitis may be associated with a rotator cuff tear, which can be diagnosed with either an MRI scan or an arthrogram of the shoulder.

NSAID's medications and exercise
Treatment includes NSAIDís and physical therapy exercises to strengthen the rotator cuff. For more severe cases, a steroid injection into the shoulder can help decrease the inflammation. If a tear is present, surgery may be necessary to repair the torn muscle/tendon.

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« Reply #2 on: Nov 19th, 2006, 10:58pm »

Brachial plexitis is an inflammation of the brachial plexus. This is a rare, poorly understood condition.

After the nerve roots leave the cervical spine they combine to form the brachial plexus (a network of nerves). This plexus can become inflamed and cause arm pain. Usually the pain is severe but only lasts for several days, after which the arm becomes weak in multiple different muscles. The weakness may be profound, but will usually get better with time.

Imaging studies of the cervical spine will usually be negative, and if there is any question that the pain is from a pinched nerve root or a brachial plexus inflammation, an EMG study can help differentiate the two conditions

Treatment typically includes oral steroids, rest, and patience.

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