limited head and neck movement
Introduction
Introduction One of the symptoms of cervical spondylosis, head, neck, shoulders, back, arms are sore, neck and neck are stiff, and activities are limited. 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 disease based on degenerative pathological changes.
Cause
Cause
Long-term cervical spine, bone hyperplasia or intervertebral disc prolapse, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression. Conditions that must be differentiated from cervical spondylotic myelopathy: There are many conditions that need to be identified, and some can be identified from X-ray films, such as congenital malformations of the cervical or occipital bone, cervical fracture and dislocation, spontaneous atlantoaxial subluxation, cervical tuberculosis Or tumor; some can be identified from the smooth passage of the subarachnoid space in the lumbar puncture, such as primary lateral sclerosis, atrophic lateral sclerosis, etc. have no subarachnoid obstruction.
Examine
an examination
Related inspection
Brain CT examination EEG examination
(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, such as limb numbness or radiation 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.
Diagnosis
Differential diagnosis
Differential diagnosis of head and neck activity limitation:
1. A condition that must be differentiated from the upper cervical disc syndrome: a sprain or subluxation of the occipital ankle joint and the atlantoaxial joint can often cause the same clinical manifestations as the upper cervical disc syndrome. The patient is younger, with or without a history of injury, often complaining of severe neck pain, radiating to one side of the scalp, to the forehead. The neck is stiff, the paravertebral muscles are paralyzed, and the neck cannot be turned. It is often deformed by the torticollis. There is tenderness at the paravertebral muscles and "wind pool", but no upper limb pain and signs. X-ray film is normal, or the subluxation of the atlantoaxial joint is seen from the mouth of the mouth. These signs are common in "pillows" and in children are spontaneous subluxations of the cervical spine. The so-called "slipping pillow" is a paraspinal tendon caused by a subluxation or a joint sprain in the upper neck due to poor sleep posture. However, after middle age, especially for the accumulative "slowing pillow", the upper cervical disc degeneration should be suspected.
2. Conditions that must be differentiated from root cervical spondylosis: Because root cervical spondylosis is more common in the lower cervical segment, it is manifested as brachial plexus neuralgia, so it must be differentiated from the thoracic outlet, shoulder, elbow, and radiculitis. .
(1) Anterior scalene syndrome or "thoracic outlet syndrome": The distal nerve roots of the brachial plexus, especially the T1 nerve root, can be squeezed at the thoracic outlet at the anterior scalene and middle scalene muscles. Between the first rib. If a neck rib or fiber band is emitted from the cervical vertebra, the chest; the nerve root and subclavian artery will be lifted and oppressed. The patient has pain and loss of the inner side of the forearm (neck 8 or chest 1 skin area), the hand is cold, white or purple, and the brachial artery beats weakened or disappeared. The neck can be seen from the X-ray positive slice, the transverse process is longer, or there is a neck rib.
(2) supraclavicular mass or Pancoast tumor: rare, mostly originated from the supraclavicular fossa lung tip lung cancer. The upper limb of the patient has a root disease, and the sensory abnormality or disappearance of the cervical 5 and 6 nerve distribution areas. Neck 8, chest 1 is sometimes involved, causing atrophy of the internal muscles of the hand and Horner syndrome. An opaque area is visible from the X-ray film to the tip of the lung. And the destruction of the thoracic vertebra 2.
(3) shoulder pain and shoulder disease: the lower cervical disc syndrome often has shoulder pain, shoulder muscle spasm, shoulder abduction activity and other signs, so it must be differentiated from shoulder disease, such as acromioclavicular arthritis, Acromion sac bursitis, frozen shoulder, and supinary muscle tear. However, there are no neck pain and positive X-ray signs in the shoulder disease. If it is still difficult to identify, it can be used as a cervical sympathetic ganglion block. If the "coagulation shoulder" is caused by cervical spondylosis, the nerve block is lagging behind and the shoulder can move freely.
(4) radiculitis: In viral radiculitis, the distribution of pain along the nerve roots, the muscles rapidly shrink after the onset, and there is severe tenderness along the muscles and nerves. The other case is neuropathic muscular atrophy (Spillian disease), which is severely painful and weak, but gradually recovers within a few months. Careful examination is often a specific nerve involvement, especially the nerves that innervate the anterior serratus.
(5) angina pectoris: cervical spondylosis has left upper limb ulnar pain and pain in the pectoralis major muscle area, often can be set as angina pectoris, but after injection of procaine in the pressure zone, the pain disappears. There is no tender point in the thoracic angina, and the electrocardiogram changes. Taking nitroglycerin can relieve pain.
(6) rheumatism: often have neck and shoulder pain, limited neck activity and other symptoms, but multiple, no radiation pain, the application of adrenocortical hormone has obvious curative effect.
3. Conditions that must be differentiated from cervical spondylotic myelopathy: There are many conditions that need to be identified, and some can be identified from X-ray films, such as congenital malformations of the cervical or occipital bone, cervical fracture and dislocation, spontaneous atlantoaxial subluxation, Cervical tuberculosis or tumor; some can be identified from the smooth passage of the subarachnoid space in the lumbar puncture, such as primary lateral sclerosis, atrophic lateral sclerosis, etc. have no subarachnoid obstruction. Need to be identified;
(1) Spinal cord tumor: may have neck, shoulder, occipital, arm, hand pain or sensory disturbance, the ipsilateral upper limb is the lower motor neuron damage, and the lower limb is the upper motor neuron damage. Identification point:
1 From the X-ray film, the intervertebral foramen can be seen to increase, and the vertebral body or vertebral arch is damaged. 2 myelography showed that the obstruction was inverted cup.
(2) Tumor in the large occipital region: identification point:
1 The obstruction of myelography is high, and the contrast agent cannot enter the cranial cavity.
2 late stage may have elevated brain pressure, symptoms such as fundus edema.
(3) Adhesive spinal arachnoiditis: may have spinal nerve anterior root, posterior root or spinal cord conduction bundle symptoms. Identification point:
1 There may be complete or incomplete obstruction in the lumbar puncture examination.
2 In myelography, the contrast agent is difficult to pass through the subarachnoid space and is waxy and tear-like.
(4) syringomyelia: identification points: 1 occurs in young people, 20 to 30 years old. The neck and thoracic segments are more common.
2 There are obvious, typical pain sensations and other deep and light sensation separations, and the temperature sensation diminishes or disappears, especially prominent.
Spinal cord lesions can be clearly seen with 3CT and MRI.
4. Conditions to be differentiated from vertebral artery type cervical spondylosis: In all types of cervical spondylosis, vertebral artery type is quite common, and its incidence rate is second only to root type. The first, second and third segments of one or both vertebral arteries can be distorted, compressed, and affected by the cervical sympathetic nerves, causing paralysis, causing different degrees of vertebral artery insufficiency, and the tissue supplied by the vertebral artery is removed. The whole brain outside the second lobes of the forehead, as well as the central nervous system such as the cerebellum, diencephalon, brainstem, and spinal cord, are supplied to the inner ear and the eye. Therefore, its symptoms and signs are ever-changing and cannot be generalized. There are many diseases that need to be identified. This section is just a few simple symptoms.
(1) Inner ear disease: It can be internal arterial embolism, sudden tinnitus, deafness, dizziness, severe symptoms without reduction. It can also be Meniere's syndrome, with headache, dizziness, nausea, vomiting, tinnitus, deafness, nystagmus, slow pulse rate, and decreased blood pressure. Identification points: often related to factors such as excessive fatigue, rather than induced by neck activity.
(2) Eye-induced vertigo: caused by refractive errors. Identification points: vertigo disappeared when closing eyes, ametropia, eye-induced nystagmus and so on.
(3) Atherosclerosis: Identification points:
1 history of hypertension.
2 vertebral artery angiography.
(4) Retrosternal goiter: The first segment of the vertebral artery is compressed. Identification point: vertebral artery angiography.
(5) Others: such as anaemia or neurosis caused by anemia or prolonged bed rest.
