MD wwwctorthocom Outline Anatomy what makes up the spine Common problems Sprainsstrains Disc herniations Arthritis Spinal cord problems Cross section Soft tissues Sprain Strain ID: 1008989
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1. Neck and Arm PainJohn Beiner, MDwww.ct-ortho.com
2. OutlineAnatomy: what makes up the spine?Common problems:Sprains/strainsDisc herniationsArthritis Spinal cord problems
3. Cross section
4. Soft tissues
5. Sprain / StrainHeavy or repetitive liftingOverhead workRaking Whiplash Bad sleeping position
6. Sprain / StrainPhysical ExamStiffnessDiffuse tendernessSpasm No real extremity weaknessNo sensory deficit ‘numbness’ in back/neck
7. Sprain / StrainTreatmentRest for 1-2 daysNSAIDs? Muscle relaxants ?Physical therapyManual therapyAerobic exercisemobilize !
8. Disc herniationRuptured discSlipped discExtruded discProtrusion (possibly abnormal)Bulge (normal)
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11. RadiculopathyDermatomal sensory deficitFocal weaknessGait normalReflexes normal or decreased
12. Disc herniation: Natural HistoryMost (75%) get better!Can take weeks to monthsNumbness is usually the slowest to resolve
13. Approach to disc herniationAnti-inflammatory or medrol dose packMinimize narcoticsPhysical therapyModalitiesExercises/stretchesTraction? Epidural steroid injections
14. What is nerve damage?Can occur when disc rupturesCan occur with ongoing compressionThis is largely an unknown time frameWeakness is the most worrisome findingDominant armSome muscle groups more important than others
15. Disc herniation: when is surgery necessary?Progressive or persistent weaknessWhen disc is pushing on the cord (Myelopathy)Incapacitating pain or persistent weakness that has failed conservative treatment
16. ACDFRemove discTake away the disc fragment from the nerveFill the gap with bone graft or cage with graft/substituteStabilize with small plate and screws
17. Spondylosis/Arthritis: historyPain in AM, better warming upStiffness with any prolonged positionDiffuse neck painScapular or shoulder blade painNormal exam in nervesExacerbation or newBetter with rest or lying down
18. Cervical spondylosisC5-C6 most commonLoss of lordosis Instability
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20. ArthritisTreatmentRest for 1-2 daysNSAIDsPhysical therapyManual therapyAerobic exerciseCortisone shots or RFAmobilize !
21. Canal StenosisDangerous only if Myelopathy present TraumaCentral cord injuryUppers > lowersNeck pain variableUsually associated with radiculopathy
22. MyelopathyNo or nonfocal sensory deficitWeakness patchy or focalStraight line gait abnormalRomberg’s abnormalHyperreflexicHoffman’s Babinski’sClonus
23. Cervical imaging
24. Surgical optionsACDFCorpectomyPosterior foraminotomyLaminectomy and fusion
25. Thank You