1. NECK PAIN Prepared by : Nik Nabilah Nek Rakami 141 Nawwar Afifah Zakaria 151 Nurul Iman Noor Zaidi 152 Nor Aznieda Mohd Rosli 159

2. Introduction Neck pain (or cervicalgia) is a common problem, with two-thirds of the population having neck pain at some point in their lives. Neck pain may come from any of the structures in the neck including: vascular, nerve, airway, digestive, and musculature / skeletal or be referred from other areas of the body

3. CAUSES OF NECK PAIN Nor Aznieda binti Mohd Rosli 159

4. Major and severe causes of neck pain include: Carotid artery dissection Referred pain from acute coronary syndromeacute coronary syndrome Infections: retropharyngeal abscess, epiglottitis, etc.retropharyngeal abscessepiglottitis Spondylosis - degenerative arthritis and osteophytes Spondylosis Spinal stenosis – a narrowing of the spinal canal Spinal stenosis Spinal disc herniation – protruding or bulging discs, or if severe prolapse. Spinal disc herniation

5. Carotid artery dissection We must differentiate between pseudoangina and true angina.

6. spondylosis

7. Cervical stenosis

8. Disc herniation

9. The more common and lesser neck pain causes include: Stress – physical and emotional stresses Stress Prolonged postures – many people fall asleep on sofas and chairs and wake with sore neckspostures Minor injuries and falls – car accidents, sporting events and day to day minor injuries Referred pain – mostly from upper back problems Referred pain Over-use – muscular strain is one of the most common causes Whiplash

10. Prolong posture

11. whiplash

12. stress

13. More causes include poor sleeping posture, torticollis, head injury, rheumatoid arthritis, congenital cervical rib, mononucleosis, rubella, certain cancers(metastasis) ankylosing spondylitis, cervical spine fracture, FMS

14. Nik Nabilah Nek Rakami 06-04-141

16. 1 History and Examination 2 Laboratory test 3 Imaging test 4 Other test

17. History and examination The most important way to diagnose myofascial pain Lab test Traditionally does not produce abnormalities in the results of the patient's lab work Imaging studies Often reveal nonspecific change only and typically are not helpful in making the diagnosis of cervical myofascial pain

18. The patient may present with a history of acute trauma associated with persistent muscular pain manifests insidiously, without a clear antecedent accident or injury Cervical spine ROM is often limited and painful The patient may describe pain radiating into the upper extremities, accompanied by numbness and tingling and making discrimination from radiculopathy or peripheral nerve impingement difficult Patients often present with poor posture. They exhibit rounded shoulders and protracted scapulae While the patient may complain of weakness, normal strength in the upper extremities is noted on physical examination Sensation typically is normal when tested formally. No long tract signs are observed on examination

19. History and examination Stiffness of joint especially at the morning Pain and swollen joints Lab test Rheumatoid factor (RF) (IgM) antibody directed against the Fc fragment (IgG) Imaging test Diagnostic changes also occur in the cervical spine with C1-2 subluxation Persistent cervical flexion in AS

20. Intermittent neck and shoulder pain with parasthesia Chronic suboccipital headache History Cyanocobalamin levels and a serum rapid plasma reagin may help distinguish metabolic and infectious causes of myelopathy from cervical spondylotic myelopathy Lab test Cervical spine films can demonstrate disk-space narrowing, osteophytosis, loss of cervical lordosis, uncovertebral joint hypertrophy, apophyseal joint osteoarthritis, and vertebral canal diameter Imaging study EMG can identify cervical spondylotic myelopathy Other test

21. Imaging studies Lab test History & Examination Asymmetry of the neck and associated neck masses or lymphadeno- pathy Torticollis and decreased range of motion of the neck caused by inflammation of the paraspinal muscles Regularly spiking fevers Blood cultures Abscess cultures with Gram stains High WBC Clotting profile Lateral neck radiography may reveal soft tissue swelling in the prevertebral region CT scans indicate the location, boundaries, and relation of infection to surrounding neurovascular structures

22. History and Examination Patient with symptomatic cervical disc injuries commonly present with segmental neck pain, muscle spasm, loss of ROM, and referred pain in both radicular and nonradicular distribution Nerve root involvement leads to radicular upper extremity pain, weakness, and sensory changes Imaging studies Radiographs of the cervical spine may show straightening or reversal of the normal lordotic curve. This finding is thought to represent spasm, guarding, or splinting of the muscles that stabilize the neck. MRI if detailed analysis of spinal structures and in patients with persistent arm pain, neurologic deficits, or clinical signs of nerve root compression

23. TREATMENT OF NECK PAIN Nurul Iman Noor Zaidi 06-4-152

24. treatment Physical therapy exercise Alternative treatment medicationsurgery

25. Physical therapy ice or heat electrical stimulation therapy

26. Neck traction Massage therapy.

27. Exercise therapy strengthening and improving the muscles, tendons, and ligaments that support the vertebrae Physical therapists can instruct you on proper posture, lifting, and walking techniques

29. Alternative Therapy chiropractic manipulation acupuncture

30. Herbal Remedies  Capsaicin Cream  Devil's Claw  White Willow Bark Yoga

31. Medication 1.nonsteroidal anti-inflammatory drugs -ibuprofen -naproxen  to reduce inflammation and relieve pain analgesic -taken with the NSAID or muscle relaxant 2.Steroids -reduce the swelling -reduce inflammation of the nerves -immediate pain relief within 24-hours. severe

32. Surgery rarely recommended….unless you have; a proven disc herniation, cervical cord compression, problems with balance and coordination, the pain is severe

34. The surgical procedures to treat neck pain includes : Anterior cervical discectomy Laminectomy Laminoplasty Cervical spinal fusion. - for instability; -rheumatoid arthritis subluxation -car accident

35. Neck Pain Prevention and Relief Nawwar Afifah Binti Zakaria 151

36. Examine your home for potential hazards Proper exercise of the shoulders and neck When performing hazardous tasks, have someone present to reduce the likelihood of injury

37. Know your limitations Wear seat belts Stay as active as possible

38. Wear neck- collar Reduce your stress and tension Stop smoking

39. Eat healthy and get enough calcium Check how your computer is set up at home or at the office