Neck Pain Syndrome

CERVICAL FACET SYNDROME

What is Cervical Facet Syndrome?

Cervical Facet Syndrome is a constellation of symptoms consisting of neck, head, shoulder, and proximal upper extremity pain that radiates in a nondermatomal pattern.

Signs and Symptoms:

  • Tenderness to deep palpation
  • Spasm
  • Decreased range of motion

Diagnosis:

Cervical Facet Syndrome is a diagnosis of exclusion that is supported by a combination of clinical history, physical examination, radiography, and MRI and by intra-articular injection of the suspected facet joints.

Treatments:

  • Medications
  • Physical Therapy
  • Medial Branch Blocks

What is Cervical Radiculopathy?

Cervical radiculopathy is a constellation of symptoms consisting of neurogenic neck and upper extremity pain emanating from the cervical nerve roots.

Causes of Cervical Radiculopathy:

  • Herniated Disc
  • Foraminal Stenosis
  • Tumor
  • Osteophyte Formation
  • Infection (rarely)

Signs and Symptoms:

  • Pain
  • Numbness, Tingling, Paresthesias
  • Weakness
  • Lack of Coordination
  • Muscle Spasms
  • Decreased Sensation
  • Weakness
  • Reflex Changes

Testing:

  • MRI
  • CT
  • Myelography
  • Bone Scan
  • Plain X-Rays
  • Electromyography
  • Nerve Conduction Velocity Testing
  • Laboratory Testing

Diagnosis:

Cervical radiculopathy is diagnosed by an extensive clinical history, physical examination, radiography and MRI.

Treatment:

  • Physical Therapy
  • Drug Therapy
  • Epidural Steroid Injection
  • Spinal Nerve Root Block

Cervicocranial Syndrome is due to vertebral instability and or dysfunction related to trauma of any source including surgery, which affects the function of the nerve cell aggregations and reflexes located in the neck just in front of the vertebrae as well as spinal cord.

Vertebral instability or misalignment as well as dysfunction occurs because the ligaments that support the neck become weakened or injured. This condition may develop in people who spend a good portion of their day hunched over while working, sustained traumatic injury to head and neck or surgery of either head or neck.

Any activity that precipitates the head forward posibtion and puts the cervical vertebral ligaments in a stretched position will cause the ligaments to weaken over time.

Signs and Symptoms:

  • Vertigo
  • Cephalea/Headache
  • Tinnitus
  • Facial pain/facial numbness/swelling on one side of the face
  • Otalgia/ear pain
  • Dysphagia(difficulty swallowing)
  • Dysfunction of equiloibrium
  • Loss of voice/hoarseness
  • Neck pain
  • Severe fatigue/Muscle weakness
  • Sinus congestion
  • A sense of the eyeball being pulled out
  • A sense of pins-and-needles sensation of the hands and forearms
  • Dental pain
  • Lacrimation (tearing of the eyes)
  • Blurred vision
  • Shoulder pain
  • Nausea/Vomiting
  • Localized cyanosis of the face (bluish color)

Testing: 

  • History and Physical examination
  • Cervical X-rays
  • CT or CAT scan
  • MRI
  • Diagnostic Block

Diagnosis: 

A comprehensive medical history and thorough physical exam by clinician, along with appropriate testing to determine there are no pathogenesis lesions of the joints of the skull, which may be responsible for pain and dysfunction in the segmental areas.

Treatments: 

  • Drug therapy
  • Physical therapy
  • Anesthetic/Corticosteroid Injections of involved joints and ligaments
  • Osteopathic manipulation
  • Massage therapy
  • Diagnostic Nerve Blocks
  • Radiofrequency Thermocoagulation/rhizotomy of pathologic reflexes and neural tissue
  • Nero Stimulation

Many factors increase the risk for disc herniation:

  • Lifestyle choices
  • Tobacco use
  • Inadequate nutrition
  • Age
  • Natural biochemical
  • Poor posture
  • Incorrect body mechanics
  • daily wear and tear,
  • Injury

Signs and Symptoms:

  • Dull neck pain
  • Sharp neck pain
  • Dull or sharp pain between the shoulder blades radiating pain down the arm to the hand or fingers, or numbness or tingling in the shoulder or arm
  • Motor deficit
  • Diminished reflexes
  • Weakness
  • Prior neck surgeries

Testing:

  • Physical exam
  • MRI
  • X-Ray
  • CT or CAT scan
  • Discography
  • Myelograms
  • EMG
  • Ultrasound imaging

Treatment:

  • Drug therapy
  • Physical therapy
  • Spinal Nerve Root Block
  • Epidural Steroid Injection
  • Facet Joint Nerve Rhizotomy
  • Spinal Cord Stimulator
  • Neurosurgical procedures

Diagnosis:

A comprehensive medical history along obtaining a vocational history is important because many skilled laborers or assembly line workers perform the same offending motion at work. Proper testing clinician can determine diagnosis as well as what type of herniation is involved.

 Pinched nerve is the term for pain or impaired function of a nerve that is under pressure. It happens to nerves that control muscle movements or relay sensations to the brain.

Radiculopathy is usually due to the nerve root being “Pinched” or compressed. Radiculopathy usually occurs in the neck (cervical spine) or the lower back (lumbar spine). Even though the injury or irritation to the nerve root occurs at the spine, the symptoms of Radiculopathy are experienced at a distant site. This is known as referred pain.

Cervical Radiculopathy symptoms are felt in the shoulders, arms, and/or hands. Lumbar Radiculopathy symptoms are felt in the buttocks, leg, and/or feet.

Signs and Symptoms:

  • Shooting pain down the buttocks and legs or in the neck, shoulders, arms and fingers
  • Burning sensation
  • Numbness
  • Tingling

Testing:

  • Physical exam
  • MRI
  • X-Ray
  • CT or CAT scan
  • Discography
  • Myelograms
  • EMG
  • Ultrasound imaging

Diagnosis:

A comprehensive medical history along obtaining a vocational history is very important because many skilled laborers or assembly line workers perform the same offending motion at work.

Treatment:

  • Drug therapy
  • Physical therapy
  • Spinal Injections
  • Spinal Nerve Root Block
  • Facet Joint Nerve Rhizotomy
  • Spinal Cord Stimulator
  • Neurosurgical procedures

What is failed neck surgery?

Failed neck surgery syndrome refers to patients who have chronic pain following a surgical procedure on the neck.

Commonly patients experience failed neck surgery syndrome when: (1) the original problem recurs following surgery, (2) scarring or other complications exacerbate existing conditions, (3) implanted surgical devices have failed, (4) bone and tissue do not heal properly.

Signs and Symptoms:

  • Sharp or dull pain in the neck
  • Testing
  • Plain X-rays
  • Magnetic Resonance Imaging (MRI)
  • Computerized Tomography (CT)

Diagnosis:

A targeted history and physical examination combined with appropriate testing should help the clinician identify and properly treat this condition.

Treatment:

Since failed neck surgery syndrome is a highly variable condition, treating the syndrome typically requires a multitude of approaches. These approaches may include, non-invasive, minimally invasive and support therapies.

  • Drug Therapy
  • Physical Therapy
  • Spinal Exercises
  • Injections
  • Facet Joint Nerve Rhizotomy
  • Corrective Surgery
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