Cervical pain

Introduction Cervical vertebra pain is one of the clinical symptoms 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. It is a degenerative pathology. Change the underlying condition.

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 manifestations of cervical disc degeneration and its secondary pathological changes, such as vertebral instability, loosening; nucleus protruding or prolapse; spur formation; ligament hypertrophy and secondary spinal stenosis, etc., stimulated or oppressed Adjacent nerve roots, spinal cord, vertebral artery, and cervical sympathetic nerves, and cause a variety of symptoms and signs of the syndrome.

an examination

Related inspection

Crest test neck mobility test neck test intervertebral foramen compression test cervical CT examination

The symptoms of cervical spondylosis are very rich, diverse and complex. Most patients begin to have milder symptoms, which gradually worsen later, and some of them have more severe symptoms. This is related to the type of cervical spondylosis, but often the type is simple, with one type as the main cum and one to several types mixed together, called mixed cervical spondylosis, so the symptoms are very rich and diverse. complicated.

Its main symptoms are sore head, neck, shoulders, back, arms, neck and neck, and limited mobility. Neck and shoulder pain can be radiated to the head and upper parts of the head, some with dizziness, house rotation, severe with nausea and vomiting, bedridden, a few can have dizziness, tripping. Some of the face is hot, and sometimes sweating is abnormal. The shoulders and back are heavy, the upper limbs are weak, the fingers are numb, the skin of the limbs is weakened, the grip is weak, and sometimes the unconscious grip falls. Other patients have weak limbs, unstable walking, numb feet, and feeling like walking cotton when walking. When cervical spondylosis involves sympathetic nerves, dizziness, headache, blurred vision, dilated eyes, dry hair, open eyes, tinnitus, ear block, balance disorder, tachycardia, palpitation, chest tightness, There are even symptoms such as flatulence. A small number of people have large, urinary out of control, sexual dysfunction, and even quadriplegia. Also have difficulty swallowing, dysphonia and other symptoms. These symptoms have a certain relationship with the degree of onset, the length of onset, and the physical condition of the individual. Most of them are light and not taken seriously by people. Most of them can recover on their own, and they are light and heavy. Only when the symptoms continue to increase and cannot be reversed, it will only attract attention when it affects work and life. If the disease is cured for a long time, it will cause psychological damage, resulting in insomnia, irritability, anger, anxiety, depression and other symptoms.

Lumbar spondylosis such as cervical spondylosis and lumbar disc herniation and lumbar spinal stenosis are both degenerative changes of the spine, both of which are prone to neuralgia. However, there are more obvious differences between the two. In general, cervical spondylosis is more complicated and variable than the symptoms and signs of lumbar spondylosis, and it is more likely to be ignored by patients and missed diagnosis and misdiagnosis by doctors. Symptoms and signs caused by cervical spondylosis are more extensive and severe than lumbar spondylosis.

Clinical examination

Including the following aspects.

(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 The 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.

Special case check

The diagnosis of cervical spondylosis mainly relies on clinical manifestations and image examinations. However, when the conditions permit, some auxiliary methods can be used to determine the nature, location and differential diagnosis of the lesions, such as Kuigen's test, myelography, vertebral artery. Contrast, selective spinal angiography, cervical venography and so on. The Kuegan test determines the presence or absence of obstruction by measuring the pressure of cerebrospinal fluid by penetrating the lumbar 4 to 5 into the subarachnoid space of the spinal canal. It is also possible to infer the degree of obstruction from the biochemical examination of cerebrospinal fluid according to the increase in the amount of protein, and to understand the spinal cord compression, thereby contributing to the diagnosis and differential diagnosis of cervical spondylosis.

Myelography is the injection of iodine preparation or air into the spinal canal for myelography. It can help to diagnose and differentially diagnose various diseases in the spinal canal and spinal canal, such as spinal cord disease, spinal cord compression and spinal canal measurement caused by cervical spondylosis, and can also identify the site and extent of spinal cord compression. . However, because the spinal canal itself can cause a series of side effects, the use of contrast agents can occur in a variety of reactions, with certain risks, the clinical must be strictly controlled.

Vertebral angiography is performed by vertebral artery, subclavian artery, puncturing, or incision of the radial or femoral artery for intubation. Mainly used for the diagnosis and differential diagnosis of vertebral artery type cervical spondylosis. It is also a routine examination before decompression, which can determine the location and extent of the operation.

Differential diagnosis

Neck pain: neck pain first considers neck muscle strain, but requires cervical MRI, except for other symptoms caused by other lesions. Cervical hyperplasia can have this symptom. Cervical vertebra hyperplasia refers to the degenerative lesions of the cervical intervertebral disc and the hyperplasia of the cervical spinal cord or cervical nerve roots, also known as cervical syndrome.

Root pain of the cervical joints: cervical synovial joint synovitis, fluid accumulation in the joint capsule, swelling, can cause adjacent nerve roots to stimulate root pain. If the neck 5 to the chest 1 anterior branch is provoked, the patient may have the upper limb brachial plexus neurosis; when the joint is inflamed, the joint capsule is distributed with sensitive nerve endings, which can reflexively cause the related muscles to contract or Hey, there is radiation pain on one side of the upper limb, neck and shoulder pain, and neck function is limited. The root artery is the nutritional artery of the cervical nerve root, and the anterior root artery in front of the nerve root in the intervertebral foramen is compressed, causing the corresponding nerve root ischemic lesion and root symptoms.

Cervical fracture and dislocation: At the same time of cervical vertebral fracture, accompanied by severe dislocation of the vertebral joint, it is called cervical fracture and dislocation. This is a typical complete injury. It is not uncommon in clinical practice, and it is often accompanied by spinal cord injury, which occurs in the three intervertebral spaces of the neck 4 to 5 and the neck 6 to 7.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.