Neck and back muscle spasms

Introduction Cervical spondylosis is one of the clinical manifestations of cervical spondylosis. Cervical spondylosis, also known as cervical vertebra syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, and cervical disc herniation. Sexual pathological changes are based on the disease.

Cause

Mainly due to long-term cervical vertebrae strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical syndromes of dysfunction. The manifestation of cervical disc degeneration itself and its secondary series of pathological changes, such as vertebral instability, loosening, nucleus protruding or prolapse, ligament formation of ligament hypertrophy and secondary spinal stenosis, stimulate or oppress the adjacent The nerve root, spinal cord, vertebral artery and cervical sympathetic nerves and other tissues, and cause a variety of symptoms and signs of the syndrome.

an examination

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Phosphocreatine kinase necking test EMG

Mainly neck pain, upper limb weakness, finger numbness, lower limb weakness, difficulty walking, dizziness, nausea, vomiting, and even blurred vision, neck and back muscle spasm, tachycardia and difficulty swallowing. The clinical symptoms of cervical spondylosis are related to the location of lesions, the degree of tissue involvement and individual differences.

(1) tenderness point paravertebral or spinous process tenderness, tenderness position is generally consistent with the affected segment.

(2) The range of cervical vertebra activity is the examination of flexion, extension, lateral flexion and rotational activity. Nerve root cervical spondylosis patients with limited neck activity, and vertebral artery type cervical spondylosis patients can appear dizziness when moving in a certain direction.

(3) Intervertebral foramen crush test: The patient's head is tilted to the affected side. The examiner's left palm is placed flat on the top of the patient's head. The right hand grips the palm and gently slams the back of the left arm. If there is root pain or numbness, it is positive. In patients with severe radicular symptoms, pain, numbness, or exacerbation can occur with gentle pressure on the head.

(4) Intervertebral foramen separation test: For patients with suspected root symptoms, the patient is seated, hands are placed on the head and pulled upwards, and if the upper limb pain is numb, it is positive.

(5) nerve root pull test. Also known as brachial plexus pull test, the patient sits, the head turns to the healthy side, the examiner holds the hand against the back of the ear, and holds the wrist in one hand and pulls in the opposite direction. If there is limb numbness or radiation Pain is positive

(6) Hoffman's expedition to check the right arm of the patient's forearm, the index finger of one hand grips the middle finger, and the thumb is used to slam the middle finger nail. If there is a positive four-finger buckling reflex, it indicates that the spinal cord and nerve are damaged.

(7) The cervical spine test is also called the vertebral artery twist test: the patient sits in the position and actively rotates the neck activity, repeated several times. If vomiting or sudden fall occurs, it is a positive test, suggesting vertebral artery type cervical spondylosis.

(8) Sensory Disorder Examination A skin sensory examination of a cervical vertebra patient can help to understand the extent of the lesion. Sensory disturbances in different parts can determine the segment of the cervical vertebrae; pain usually occurs early, and when it appears numb, it has entered the middle stage, and the feeling disappears completely in the late stage of the lesion.

(9) Muscle strength examination Cervical spondylosis injury nerve root or spinal cord, muscle strength decreased, if the nerves are lost, the muscle strength can be zero. The location and segment of the nerve injury can be determined according to the different nerves of each muscle.

Differential diagnosis

Differential diagnosis of cervical and back muscle spasms:

1. Cervical rib and anterior scalene muscle syndrome: The patient is younger, mainly characterized by dry compression under the brachial plexus, numbness of the medial extremities, atrophy of the intermuscular muscles and interosseous muscles. Because the subclavian artery is often compressed at the same time, the affected limb is pale and cool, and the radial artery beats weakened or disappeared. The Adson test (head turned to the affected side, temporary aspiration after deep inhalation, brachial artery beat weakened or disappeared) was positive. The neck film can confirm the neck ribs.

2. Intraspinal extramedullary subdural tumors, intervertebral foramen and peripheral neurofibromatosis, and tumors near the lung tip (Pancoast tumor) can cause upper limb pain. Cervical radiographs may reveal signs of lesions in the spinal canal and enlargement of the intervertebral foramen without cervical degenerative changes. CT or MRI can directly display tumor images, and Pancoast tlamor patients are also accompanied by Horner's syndrome.

3. Neuropathic muscle atrophy: often involving the C5 distribution area, causing severe pain, shoulder muscle weakness and atrophy. However, the sensory disorder is mild, the symptoms often relieved quickly, and generally do not involve the neck.

4. angina pectoris: pain can be radiated to the upper limbs and shoulders and neck, but mostly episodes, oral nitroglycerin tablets can be relieved, patients have a history of coronary heart disease, generally not difficult to identify.

5. Tendon sleeve syndrome: mainly manifested as shoulder abduction weakness and abduction more than 30. In the later pain, there is tenderness in the tendon, which is different from nerve root pain.

6. Rheumatic polymyalgia: similar to brachial plexus neuralgia, but without dyskinesia. Mainly neck pain, upper limb weakness, finger numbness, lower limb weakness, difficulty walking, dizziness, nausea, vomiting, and even blurred vision, neck and back muscle spasm, tachycardia and difficulty swallowing. The clinical symptoms of cervical spondylosis are related to the location of lesions, the degree of tissue involvement and individual differences.

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