Clarification Of Neck And Back Pain

Neck pain and back pain are among the most common causes of doctor visits. This section deals with neck pain that the rear neck (not limited to the anterior neck pain) relate to, and does not extend to the major traumatic injuries (eg. As fractures, dislocations, subluxations). Pathophysiology Depending on the cause neck or back pain may be accompanied by neurological symptoms. If a nerve root is concerned, the pain can distally along the supply area of ??the root broadcast (as radicular pain or lower back pain, sciatica al hereinafter). Strength, sensitivity and reflexes of the innervated by the root area may be affected. Symptoms often radiculopathy on the level of the spinal segment height symptoms C6 pain Trapeziusloge and shoulder top, often radiating to the thumb, with paresthesia and sensory impairments in the same areas biceps weakness Decreased reflexes Mm. biceps brachii and brachioradialis C7 pain in the shoulder blade and armpit, radiating to the middle finger Trizepsschwäche Reduced reflection of the triceps brachii T (each) band-shaped dysesthesia around the thorax L5 pain in the buttocks, in the rear lateral thigh, in calf and foot drop foot with weakness the front and rear tibia and fibula muscle sensory loss over the shin and the foot dorsal S1 pain along de r rear side of the leg and buttocks weakness of the medial gastrocnemius muscle with reduced plantar loss of the Achilles tendon reflex sensory disturbance to the lateral lower leg and foot If the spinal cord affected, strength, sensitivity and reflexes can in the affected spinal segment, and (all lower segments called. segmental neurologic deficits) be affected. If the cauda equina is concerned, segmental deficits in the lumbosacral region, usually with loss of bowel and bladder function, loss of perianal sensitivity, erectile dysfunction, urinary retention, and loss of rectal tone and Sphinkterreflexe (for development. B. bulbokavernöser reflex, anal wink). Each painful disease of the spine can also cause a reflex-induced tension (spasms) lead the paraspinal muscles, which can be unbearable. Etiology neck and back pain are usually caused by disorders of the spine. Fibromyalgia (fibromyalgia) is also a common cause, and can be superimposed on a chronic primary spine disease. Occasionally, the pain from diseases is extraspinalen (v. A. Vascular, gastrointestinal or such of the urinary tract) forwarded. Some rare causes – spinal and extraspinal – are serious. Most spinal problems are mechanical reasons. Few include infection, inflammation or cancer (as a non-mechanically considered). Common causes cause Most mechanical spinal disorders, the neck or back pain, include a non-specific mechanical fault: muscle strain, ligament strain, spasm or a combination Only about 15% include specific structural lesions that cause significant symptoms: Herniated disc compression fracture Lumbar spinal stenosis osteoarthritis spondylolisthesis The other mechanical disturbances there are no specific lesions, or if the findings (eg. B. incident or degeneration of the intervertebral disc, osteophytes, spondylolysis, congenital anomalies facet) are common among people with no neck or back pain as well as pain and are therefore questionable cause. Frequently, however, the etiology of back pain (v. A. Mechanical) is multifactorial, with an underlying disorder exacerbated by fatigue, lack of physical exercise and sometimes by psychosocial stress or a psychiatric disorder. Therefore, identification of a single cause is often difficult or impossible. Neck and back pain are sometimes a myofascial pain syndrome attributed (myofascial pain syndrome), but some experts see this syndrome rather as part of another disease (such as fibromyalgia) than as a primary disease an.Ernste rare causes serious causes can make timely treatment necessary to prevent disability or death. Extraspinalen to serious disturbances include aortic abdominal aortic aneurysm carotid or vertebral artery acute meningitis angina or myocardial infarction certain disorders of the gastrointestinal tract (for example, cholecystitis, diverticulitis, diverticular abscess, pancreatitis, penetrating peptic ulcer, appendicitis retrozökale.) Certain disorders of the basin (z. .. as ectopic pregnancy, ovarian, salpingitis) certain lung diseases (eg, pleurisy, pneumonia) certain urinary tract (such as prostatitis, pyelonephritis, nephrolithiasis) Among the serious diseases of the spine. infections (eg discitis, epidural abscess, osteomyelitis) primary tumors (metastatic spinal cord or vertebral bodies) tumors Wirbelkör by (mostly from breast, lung or prostate) Mechanical spinal disorders can be serious when they compress the nerve roots or the spinal cord in particular. A spinal cord compression, by tumors, a spinal epidural abscess or hematoma entstehen.Andere rare causes neck or back pain may be due to many other diseases such as Paget’s disease, torticollis, thoracic outlet syndrome, temporomandibular joint syndrome, herpes zoster, retroperitoneal fibrosis and Spondylarthropathies (often ankylosing spondylitis, but also enteropathic arthritis, psoriatic arthritis, reactive arthritis and undifferentiated spondyloarthropathy). Clarification General Since the cause is often multifactorial, a definitive diagnosis in many patients can not be found. However, the doctor should when a try to determine possible: whether the pain a spinal or extraspinal cause has whether the cause of a serious medical condition is history ZurAnamnese the current disease include quality, onset, duration, size, location, presence and time course of pain and modifying factors such as conservation, activity, changes in position, stress and time of day (eg. as in the night, waking up). Accompanying symptoms to look for, are stiffness, numbness, paresthesias, weakness, urinary retention and incontinence. In reviewing the organ systems must be alert to symptoms, can shed light on the cause of the disease: fever, sweats and chills (infection); Weight loss and loss of appetite (infection or cancer); Fatigue, signs of depression and headache (multifactorial mechanical back pain); Deterioration of neck pain when swallowing (esophageal disease); Anorexia, nausea, vomiting and changes in bowel function or stool consistency (gastrointestinal disorders); Urinary symptoms and flank pain (urinary disorders) as they occur intermittently, colicky and relapsing especially (nephrolithiasis); Cough, dyspnea, and deterioration by inhalation (pulmonary disease); vaginal bleeding or discharge, and pain associated with the menstrual cycle (Beck disease). The history includes known neck or back diseases (incl. Osteoporosis, arthritis, disc disease and recently previous history or longer past injuries) and operations, risk factors for back disorders (eg., Cancer, osteoporosis), risk factors for aneurysms (eg. As smoking, hypertension) and risk factors for infection (e.g., immune suppression, intravenous drug use;. recent previous history of surgery, penetrating trauma or bacterial infection) .Körperliche test temperature and general condition are held. If possible, patients should be observed to inconspicuously as they enter the examination room to undress and put on the examination table. If the symptoms are exacerbated by psychological problems, the true functional state can be better estimated when the patients are not aware that they are judged. The investigation focuses on the spine and neurological status. If no mechanical spinal pain source is identifiable, patients are tested for sources of referred pain. How to research the back The investigation was shown by Paul Liebert, MD, Tomah Memorial Hospital. var model = {videoId: ‘5510371512001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘’, title: ‘How to research your back’, description: ”, credits: ‘the investigation was shown by Paul Liebert, MD, Tomah Memorial Hospital’, hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true};. var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); In examining the spine back and neck for visible deformation, erythematous areas or vesicular rash be inspected. Spine and paravertebral are sampled on tenderness, muscle spasms and characteristics of myofascial pain syndrome (stretched ligaments, trigger points and pressure sensitivity). The entire range of motion is tested. How to research the neck The investigation was shown by Paul Liebert, MD, Tomah Memorial Hospital. var model = {videoId: ‘4616468564001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘’ title: ‘How to research the neck’, description: ”, credits: ‘the investigation was shown by Paul Liebert, MD, Tomah Memorial Hospital’, hideCredits. true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true} ; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); The neurological examination should assess at least the function of the entire spinal cord. Strength and muscle reflexes are investigated. In patients with neurological symptoms sensation and function of sacral nerves (such. As rectal tone, anal reflex, reflex bulbokavernöser) tested. Reflex tests are among the most reliable physical tests to determine a normal spinal cord function. A dysfunction of the corticospinal tract is indicated by positive Babinski and Hoffman character. To test for Hoffman character, the doctor taps the nail or the volar surface of the third finger. If you encounter any involuntary flexion of the distal phalanx of the thumb, the test is positive, indicating usually a dysfunction of the corticospinal tract due to a cervical Rückenmarkstenose. Sensory findings are subjective and can be unreliable. The straight leg raise test is useful to confirm a sciatic syndrome. The patient lies on his back stretched with both knees and ankles dorsiflexion. The doctor slowly raises the affected leg and holds the stretched knee. When a sciatica is present, raising to 10-60 ° typically causes symptoms. For the crossed straight leg raise test the affected leg is lifted; the test is positive if sciatica occur in the affected leg. A positive straight leg test is sensitive but not specific to a herniated disc; the crossed straight leg raise test is less sensitive, but specifically to 90%. The straight leg raise test is performed in a sitting position while the patient is sitting with a bent 90 ° hip joint, the lower leg is raised slowly until the knee is fully stretched. When a sciatica is present, the pain occurs in the spine (and often the radicular symptoms) when the leg is stretched. As part of the general examination, the lung is abgehorcht. The abdomen is examined for tenderness, masses and, especially in patients> 55 years, a pulsatile mass (suggestive of an abdominal Aaortenaneurysma). With a fist, the doctor taps the costovertebral angle onto tenderness, suggesting a pyelonephritis. A rectal examination, including stool occult blood test and prostate exam for men is carried out. For women with signs giving rise to suspicion of a gynecological disease, or unexplained fever with not a gynecological examination is performed. The pulses in the lower extremities are überprüft.Warnzeichen The following findings are particularly important: abdominal aorta with a circumference> 5 cm (especially if painful) or pulse deficits acute in the lower limbs, tearing pain in the center back cancer diagnosed or suspected duration of pain > 6 weeks neurological deficits fever gastrointestinal findings such as localized abdominal tenderness, peritonitis, melena or hematochezia risk factors for infection (eg, immunosuppression, intravenous drug use;. recent previous history of surgery, penetrating trauma or bacterial infection) meningism severe nocturnal or marked pain unexplained, emerging pain after the age of 55 year unexplained weight sverlust interpretation of the findings Although serious vast extraspinal diseases (eg. As cancer, aortic aneurysms, epidural abscesses, osteomyelitis) are unusual causes of back pain, they are still not uncommon, especially in high-risk groups. Spinal cause is likely (but not definitely) is present as a pain radiating extraspinalen cause when the pain worsened by movement or impact and improved by rest or bed rest, vertebral or paravertebral tenderness. Serious findings should reinforce the suspicion of a serious cause (s. Interpretation of serious findings in patients with back pain). Interpretation of serious findings in patients with back pain finding Eligible causes diameter of the abdominal aorta> 5 cm (especially with pressure sensitivity) or pulse deficits in the lower extremities abdominal aortic aneurysm Acute, tearing pain in the center back Thoracic aortic dissection cancer, diagnosed or suspected metastasis Duration of pain> 6 weeks Cancer Subacute infection fever infection Gastrointestinal cancer findings such as localized abdominal tenderness, peritonitis (abdominal rebound tenderness or stiffness), melena or hematochezia Possible gastrointestinal emergency (eg. As peritonitis, abscess, gastrointestinal bleeding) Risk factors for infection infection meningism Meningitis Neurological deficits spinal cord or nerve root compression severity night or debilitating pain cancer infection Unexplained pain after the age of 55 year cancer abdominal aortic aneurysm Unexplained weight loss Cancer Subacute infection Other findings are also helpful. Erythema and tenderness over the spine is suggestive of infection, particularly in patients with risk factors. Exacerbation of pain in flexion indicates a disc disease; Worsening of the pain with extension due to suspicion of a spinal stenosis, arthritis of the facet joints or retroperitoneal inflammation or infiltration (z. B. pancreatic or renal inflammation or tumor). Tenderness over specific trigger points can think of fibromyalgia. Deformities of the proximal and distal interphalangeal joint, as well as stiffness within 30 min subsides after waking up, suggests suspicion of osteoarthritis. Neck pain, unrelated to swallow and which occur during physical exertion, suggest an angina out. Tests If the pain only exist for a short time (<4-6 weeks), usually no test is required unless there are serious findings present, the patients had a serious injury (eg. As car accident, fall from height, penetrating trauma), or the evaluation points to a specific non-mechanical cause down (z. B. pyelonephritis). Based on survey radiographs an osteoporotic fracture and osteoarthritis can be identified. However, this does not outline abnormalities in soft tissue (the most common cause of back and neck pain) or nerve tissue (as found in many serious diseases). Therefore, X-rays are usually unnecessary and do not affect the treatment. Occasionally x-rays are taken to identify obvious bone abnormalities (eg. As a result of infections or tumors) and to avoid an MRI or CT to perform the more difficult, but much more accurate and usually are also required. The tests are based on the findings and the suspected cause: Neurological deficits, especially those with spinal cord compression: MRI or CT myelography as soon as possible infection: WBC count, ESR, imaging (usually MRI or CT) and culture of the infected tissue cancer: CT or MRI and possibly biopsy aneurysm: CT, angiography or occasionally sonography aortic dissection: angiography, CT or MRI symptoms that impair or stop the> 6 weeks imaging (usually MRI or CT) and, if an infection is suspected of leukocytes and ESR (some doctors start with anteroposterior and lateral radiographs of the spine to locate and sometimes to diagnose abnormalities) More extraspinal diseases. if necessary examinations (eg chest X-ray for lung Erkrankunge n, urinalysis urinary tract or for back pain with no clear cause mechanical) treatment The underlying disorders are treated causal. Acute musculoskeletal pain (with or without radiculopathy) are treated with analgesics heat and cold early mobilization, followed by exercises to stabilize acetaminophen or NSAIDs are the first choice for pain medication, but also opioids may be needed for severe pain. Adequate analgesia immediately after acute injury is important to inhibit the cycle of pain and tension. Acute muscle tension can be alleviated by cold or heat. During the first 2 days after injury cold to heat is usually preferred. Ice and cold packs should not be placed directly on the skin. You should z. B. be surrounded by plastic and be placed on a towel or cloth. The ice must be removed after 20 minutes and later for 20 minutes to reapply for a period of 60-90 min. This process occurs during the first 24 h are repeated several times. Heat using a heating pad can be used for the same periods. Since the skin on the back may be sensitive to heat, the heating pad must be used with care to avoid burns. Patients are advised not to use a heating pad at bedtime to avoid prolonged exposure in the event of falling asleep with the pillow on his back. The diathermy can help you with the muscle myogelosis or pain following the acute stage. Oral muscle relaxants (eg. As cyclobenzaprine, methocarbamol, metaxalone) are controversial. The benefits of these drugs should be weighed against their CNS effects and other side effects, especially in older patients who show more severe side effects. Although a short period (eg., 1-2 days) decreased activity at the beginning seems to be necessary on occasion for convenience, for a prolonged bed rest, of the spine sprain and corsets, this is not an advantage. Patients with torticollis and cervical sprain can benefit from a neck brace and a contour pillow, until the pain subsides and they can participate in a program to stabilize. Manipulation of the spine can be helpful in pain from a muscle myogelosis or after an acute back or neck injury. However, some forms of manual therapy involve risks, v. a. in patients with disc disease or osteoporosis. When the acute pain has decreased so much that movement is possible, starting with a lumbar stabilization program. This program includes exercises that strengthen the abdominal and lower back muscles, combined with recommendations on proper sitting position while working. The aim is to strengthen the skeletal system of the back and to minimize the probability that it comes to chronicity or recurrence of complaints. Physicians should assure patients with acute non-specific musculoskeletal back pain, the prognosis is good and that activity and exercise are safe, even if they cause discomfort. Physicians should therefore be friendly, empowering and not rashly judging. If the depression or a secondary gain last for several months, a psychological evaluation should be considered. Geriatric basics Deep-seated back pain affecting 50% of adults older than 60 years old. An abdominal aortic aneurysm (and a CT or ultrasonography for detection) should be considered in elderly patients with non-traumatic lower back pain into consideration, particularly those who smoke or have hypertension, even if no physical findings suggestive of this diagnosis. Imaging of the spine may be appropriate in elderly patients (eg. As to rule out cancer), even if the cause uncomplicated musculoskeletal back pain seem to be. Oral muscle relaxants (eg. As cyclobenzaprine, methocarbamol, metaxalone, tetrazepam) are controversial. Anticholinergic, CNS and other side effects outweigh the possible benefits of these drugs in elderly patients. Summary Most neck and back pain caused by mechanical spinal diseases, usually non-specific, self-limiting musculoskeletal disorders. Most mechanical disorders are treated by analgesics, early mobilization and exercises; prolonged bed rest and immobilization should be avoided. Back pain is often multifactorial, making diagnosis difficult. Serious spinal or extraspinal disorders are unusual causes. Serious findings often indicate a serious illness and require clarification. Patients with segmental neurologic deficits need as quickly as possible an MRI or CT. A normal spinal cord function during the physical examination is confirmed best by testing the sacral nerve function (z. B. rectal tone, anal reflex, reflex bulbokavernöser), the patellar and Achilles tendon reflexes and the force. Pain that is not getting worse by movement, is often extraspinaler cause, especially if no vertebral or paravertebral tenderness is detected. An abdominal aortic aneurysm should at every elderly patients with lower back pain that are not clearly mechanical cause, are to be considered, even if no physical findings suggestive of this diagnosis.

Health Life Media Team

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