Diffuse severe pain in neck and back when you wake up in the morning

Introduction Patients with chronic strained neck and back fascial fibrosis often complain of diffuse pain in the neck and back (sometimes including the chest and back), which is evident at the junction of the medial side of the shoulder and the neck and chest. It is characterized by severe pain in the morning, activity for a few minutes or It relieved after half an hour, but it seems that the pain has reappeared due to too much activity in the evening, and it improved after rest, which is similar to hypertrophic spondylitis. The pathogenesis of this disease is more complicated and related to many factors. The most common are cold and humid. Chronic injury, adverse body position and infection of certain viruses, allergic reactions to rheumatism, etc. can also cause diffuse severe pain in the neck and back in the morning.

Cause

The pathogenesis of this disease is more complicated, and it is related to many factors. The common ones are listed below.

1. Cold: The most common of the reasons. The patient has been sleeping in cold ground, vents, etc., or staying in a cold area for a long time, but not enough cold-proof clothing, especially in late autumn, winter and early spring. Because of the cold, especially during sleep, if the neck and shoulders are exposed for a long time, or are hit by the cold wind, it will first cause changes in the blood circulation of the neck and back, including vasoconstriction, ischemia, congestion and edema, resulting in local fiber exudation. Fibrositis. For this reason, the affected person is very sensitive to climate change, especially during seasonal changes.

2. Moisture: Another common cause of this disease, especially when it coexists with cold, it is more likely to develop in a humid air environment, not only the mental mood is affected, but also due to skin metabolism dysfunction (especially perspiration function) and subcutaneous and The blood circulation in the fascia is easy to cause microvascular congestion, congestion, and exudation due to slowing of blood flow, and another mechanism for the formation of fibrositis. Of course, it is also related to the level of atmospheric pressure.

3. Chronic injury and poor posture: In addition to various serious injuries, the fibrosis of the neck and back fascia, muscle and other causes the peripheral nerve to be affected by the symptoms of compression, clinically more common due to various chronic strain factors, especially When the neck is flexed (including the high pillow), not only the internal pressure of the intervertebral space is increased, but also the high tension state of the soft tissue of the neck and back is caused, and a slight tear-like damage is gradually formed. This "endogenous injury" will eventually increase due to fibroid tissue, and with its late contraction, local capillaries and peripheral nerves will be squeezed and symptoms will appear. This kind of injury has a great relationship with occupation. It is more common in front-neck workers in the neck and back, such as office workers, cartographers, designer accounting, assembly line operators and textile workers.

4. Other factors: including the infection of certain viruses, the effects of allergic reactions to rheumatism on the cervical fascia. It is indicated that the cervical fascia can be affected by many factors and the aseptic inflammatory state appears. Further etiological studies have yet to be explored in the future.

an examination

Clinical manifestations:

1. Diffuse pain: The patient complained of diffuse pain in the back of the neck (sometimes including the chest and back), which is obvious at the junction of the medial side of the shoulder and the neck and chest. It is characterized by severe pain in the morning, and the activity is relieved after a few minutes or half an hour. However, it seems that in the evening, the pain has recurred due to too much activity, and it has improved after rest, which is similar to hypertrophic spondylitis.

2. There are many predisposing factors: there are many obvious predisposing factors in patients' onset. Among them, cold, damp and overworked are common, and there are many similar situations in their past medical history.

3. Point tenderness and subcutaneous nodules: patients can use their fingers to clearly indicate their pain points (one or a few points); in addition to local pain, the pressure can be transmitted along the nerve fiber terminals distributed at the pain point, and reflexively appear There is a pain in the vicinity. If the skin is thin, the nodular lumps can be touched deep in the pain point, and the size is more than 5mm × 5mm. Sometimes, the "lipoma"-like nodules with a diameter of about 1cm can be touched (more accompanied by radiation pain).

4. The activity of the upper limbs is affected: due to the fascia fibrositis, the deep muscle contraction activity is limited. When the upper limb is lifted up or forward, the patient has a feeling of stiffness. Especially in the cold season.

diagnosis:

1. History: There are many history of cold and wet or chronic strain.

2. Symptoms and signs: There are generally typical symptoms and signs described in clinical manifestations.

3. X-ray film: It can show that the physiological curve of the cervical spine disappears, especially in the attack period, but no other specificity can be seen.

4. Laboratory examination: clinically, the main detection of erythrocyte sedimentation rate, anti-streptolysin O and rheumatoid factor, positive results indicate that the cause is rheumatoid or rheumatoid lesions, negative results are used for other types of diagnosis or Differential diagnosis.

5. Others: Generally do not need complicated inspections such as MR.

Differential diagnosis

Cervical muscle spasm: one of the clinical manifestations of cervical spondylosis, cervical spondylosis, also known as cervical vertebra syndrome, is the general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, cervical disc herniation, is a A disease based on degenerative pathology.

Maternal neck pain: "Some mothers often feel aching on the back of the neck after feeding the child. As the feeding time is extended, the symptoms become more obvious. This is called lactating neck pain. Some nursing mothers suffer from unstable nipples due to nipple retraction. This forces the mother to look down and adjust the baby's head at any time. In addition, the breastfeeding time is longer and it is easy to cause strain on the neck and back muscles. Discomfort. In addition, suffering from certain diseases such as cervical spondylosis, it will also increase the degree of nerve compression, causing sore neck, numbness of shoulders, arms, fingers, and even dizziness, palpitations, nausea, vomiting, limbs Powerless.

Neck pain: neck pain, upper limb weakness, finger numbness, etc. are clinical symptoms of hyperosteogeny. Osteoproliferation, also known as proliferative osteoarthritis, osteoarthritis (OA), degenerative joint disease, senile arthritis, hypertrophic arthritis, is due to the soft tissue degeneration of cartilage, intervertebral disc, ligament, etc. Degeneration, formation of bone spurs at the edge of the joint, changes in synovial hypertrophy, and bone destruction, causing secondary bone hyperplasia, resulting in joint deformation, a disease that causes joint pain, limited mobility, etc. when subjected to abnormal load . Both primary and secondary.

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