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3333750-904875001038225-90487500-1143000-904875004267200-91440000-11423652667000The neck: Symptoms: pain: in the neck &referred to the shoulder or arms.487743522733000Stiffness; deformity; neural deficit: numbness &weakness 410527519050000in upper limbs(root pressure) or lower limbs(cord pressure).-10858506286500Signs:look→ neck deformity; feel→ tenderness; move: flexion, extension, lateral flexion &rotation. 410146515748000Neurological exam.: muscle power, reflexes &sensation.-108775521717000Imaging: X-ray: AP, Lat. &open mouth view(to see upper 2 vert.).Lat. view: see 7 vertebrae with normal cervical lordosis. 465455020701000350520010223500CT→ shows bony structures; MRI→ discs, neural structures, tumor &infection.-116141513589000Deformities of the neck in childrenTorticollis: the chin is twisted up &to one side. It is either congenital or acquired.Infantile(congenital) torticollis: it is common.530034519050000The cause is unknown(may be birth injury or abnormal position in utero).-114236533655000At birth a lump in the sternomastoid is noticed on one side remaining for few months then disappears; after the first year, the muscle starts to become fibrous pulling the head to one shoulder. With time the deformity ↑ leading to asymmetrical development of the face(plagiocephaly). ??→ bony anomaly, fracture, discitis & lymphadenitis. 45313454635600?: during infancy→ daily muscle stretching; if persistbeyond 1year→ surgical division of contracted muscle at -116205010033000lower or upper end or both → rigid collar &stretching exercise.Acquired (secondary) torticollis: may be secondary to: congenital bone anomaly, trauma, infection( tonsillitis, lymphadenitis, discitis, TB), ocular dysfunction.Klippel-Feil syndrome: congenital fusion of 2 or more cervical 2755900228600003654425228600001352550233045003810020002500-119062520002500vertebra → short neck with limitation of movement. 9525-91440000-1143000-914400005172075-914399001238250-914400003086100-91440000 Acute cervical disc prola pse Is less common than lumbar disc prolapse because the load is less.-114300017462500517207584963000 The precipitated cause is strain or injury. Usually it occurs above or below C6. Prolapsed disc pressing on PLL→ neck pain, stiffness &pain referred to scapular region &upper limb or occiput; pressure on nerve root→ paraesthesia & weakness in one or both arms usually C6 or C7.413385015811500C6 innervates: biceps reflex, biceps muscle, wrist extensors &sensation of lateral forearm, thumb &index finger.C7 innervates: radial reflex, triceps muscle, wrist flexors &finger extensors &sensation in the middle finger.49885603556000Imaging: X-ray→ straightening out of normal cervical lordosis due to muscle spasm &narrowing of disc space in chronic cases.-11525251206500371030519304000MRI→ is the best showing the disc &its relation to nerve root. ??→ rotator cuff lesion, psychosomatic illness, cervical spine infection &tumor.?→ heat, analgesia, rest in a collar for 1-2 weeks. Surgery: indication: 1-severe persistent pain, -1143000179070004648835825500 2-progressive neurological deficit or 3-myelopathy.Operation: the aim is cord &root decompression ± fusion either through anterior or posterior approach: Posteriorly→ decompressive laminectomy or laminotomy, laminoplasty, foraminotomy, discectomy, instrumentation & fusion.Anteriorly→ discectomy & artificial disc replacement or-113347520701000discectomy(or corpectomy) + fusion &instrumentation. Cervical spondylosis: chronic disc prolapse will end with spondylosis: the disc become flat, the facet joint &uncovertebral 437197519939000joint become arthritic with bony osteophytes that may cause pressure on nerve root(radiculopathy) or cord(myelopathy).366712519113500??→ nerve entrapment &thoracic outlet syndrome.140017517970500?→ same as disc prolapse.-11525241143000359600544450004876800-90487500161925-91440000-1152525-904875001394460-914400002886075-91440000 Cervical spinal stenosis: AP diameter ?11mm.-115252529972000 Causes: disc prolapse, posterior osteophytes, OA of facet joint, thickening of ligamentum flavum or vertebral displacement. These will cause pressure on the cord &nerve roots(cervical myelopathy).CF: neck pain + paraesthesia, weakness &clumsiness in the arms &legs with unsteady gait. 488632511620500O/E: upper motor neuron signs in the lower limbs(↑tone, brisk reflexes &clonus) & numbness & weakness in the hands.??→ multiple sclerosis, syringomyelia, spinal cord tumor, vertebral disease &amyotrophic lateral sclerosis.-11525256032500?→ conservative (analgesics, collar &physiotherapy).Surgery (decompression): if myelopathy is rapid or progressive.Either anterior cervical discectomy (or corpectomy) & fusion; or if the compression from posterior→ laminotomy, if multiplelevels are involved→ laminotomy (or laminoplasty) + fusion. 4829175825500Rheumatoid arthritis: occurs in 30% of RA patients.Three lesions: 1-erosion of atlanto-axial joint →instability;-114617513462000327660022733000 2-erosion of atlanto-occipital joint→ cranial sinkage. 3-erosion of facet joint in midcervical 39052521463000180022521463000 region→ anterior subluxation.48418759652000 -118110018732500Ankylosing spondylitis: of cervical spine cause stiffness &kyphosis (chin on chest)→ cervical spine osteotomy.Thoracic outlet syndromeIs the result of compression of lower trunk of brachial plexus468058516954500(C8-T1) &subclavian vessels between the clavicle &the first rib. A cervical rib( or a fibrous band) will ↑ the compression.-115252541973500104775043878500281940044767500CF: 30 years female with long neck &sloping shoulders having numbness in the ulnar side of arm, forearm &medial 2 fingers. 600075-904875002447925-904875003648075-87630000-1152525-90487500 O/E: clawing &wasting of intrinsic muscle. -11334756921500 Vascular signs are uncommon →cyanosis, coldness &unilateral Raynaud's phenomenon. Investigation: X-ray → cervical rib or long C7 35801302159000transverse process. Angiography, EMG &NCS.??→ cervical spondylosis, Pancoast's syndrome.-124777518161000?→ posture training to prevent shoulder drop & exercise to strengthen shoulder girdle muscle. Surgical decompression by excision of 1st rib or cervical rib is indicated for severe pain &3952875259207000 neurological or vascular dysfunction. 146621519939000358140017653000-17970515557500-1114425460375000-1133475121285001143001117600031076903968750012280903048000-112395054292500180022519634200014668503082925002752725308292500 ................
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