AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were rec...AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were recruited randomly from the Rheumatology and Rehabilitation Outpatient Clinic at the Faculty of Medicine-Suez Canal University. Two groups were compared: 30 patients with chronic neck pain with mean age(36.97 ± 12.45 years) and 10 apparently healthy controls. Trapezius muscle examination including inspection and range of motion both active and passive was performed. A full clinical neurological examination was carried out to exclude peripheral neuropathy and motor neuron disease. According to the subject's type of work, cases were categorized into labor-intensive and non-labor intensive tasks. A nerve conduction study(NCS) was performed on spinal accessory nerves at both sides for all patients and controls. Parameters including latencies and amplitudes of compound motor action potential(CMAP) were compared with the chronicity of neck pain using the neck disability score. This cross sectional study was carried in the Rheumatology and Rehabilitation Department, at Suez Canal University Hospital, Ismailia, Egypt.RESULTS: Physical examination revealed that 80% of cases had spinal trapezius muscle spasm. Restricted neck motion was present in 16.6% of cases. No one suffered from muscle wasting or weakness. Pain was bilateral in 18 patients(60%), localized to the right side in six patients(20%) and localized to the left side in six patients(20%). The causes of neck pain in the patients studied were nonspecific, due to physical stresses, cervical spondylosis and mild cervical disc herniation. Mean disease duration in patients with labor-intensive tasks was(3.9 ± 2.1 years), which was longer than that in patients with non-labor intensive tasks(3.1 ± 1.9 years); however, this difference was statistically insignificant. Spinal accessory NCSs were performed while subjects were in sitting positions and relaxed with naturally suspended arms to minimize muscular movement. The results of electrophysiological studies revealed that mean right and left latencies of the spinal accessory nerve were 2.96 ± 0.69 ms, 2.98 ± 0.61 ms in the patient group and 2.44 ± 0.38 ms, 2.33 ± 0.36 ms in control group respectively. These differences were statistically significant with P = 0.028 and 0.006 respectively. Spinal accessory NCS showed normal CMAP amplitude in both patients and controls. Comparing the results of the neck disability index(NDI) to different characteristics in patients with chronic neck pain, showed that patients with labor-intensive work had a higher NDI score mean(34.7 ± 9.5) compared to those with non-labor-intensive work, with significant statistical difference(P = 0.011). In addition, mean NDI scores were higher in males, and patients aged over 40 years and this difference was statistically significant(P = 0.007 and P = 0.009 respectively). Correlation studies between right and left spinal accessory nerve latencies and disability percent calculated using the NDI revealed a positive correlation. Moreover, there was a positive correlation between age and disability percent.CONCLUSION: This study demonstrates electrophysiological evidence of demyelination in a significant proportion of patients with chronic cervical pain.展开更多
目的观察内热针治疗慢性非特异性颈痛(nonspecific chronic neck pain,NCNP)的临床疗效。方法将2017年1月-2018年12月于解放军总医院海南医院康复理疗科就诊并确诊为NCNP的60例慢性非特异性颈痛的患者,随机分为治疗组和对照组,治疗组(n=...目的观察内热针治疗慢性非特异性颈痛(nonspecific chronic neck pain,NCNP)的临床疗效。方法将2017年1月-2018年12月于解放军总医院海南医院康复理疗科就诊并确诊为NCNP的60例慢性非特异性颈痛的患者,随机分为治疗组和对照组,治疗组(n=30)使用内热针治疗,对照组(n=30)使用热磁治疗。治疗前、治疗后2周及治疗后3个月随访,分别采用疼痛视觉模拟量表(visual analogue scale,VAS)和颈部残损指数量表(neck disability index scale,NDI)进行疗效评定。结果治疗前两组患者性别、年龄、病程、VAS及NDI评分差异无统计学意义(P>0.05)。重复测量方差分析显示VAS评分、NDI评分在组间、时间、交互作用上均有统计学差异(P<0.05)。治疗后2周和3个月,治疗组VAS评分、NDI评分均持续下降,任意两时间点比较差异均有统计学意义(VAS:5.3±1.4 vs 2.0±1.2和1.7±0.8;NDI:14.6±4.6 vs 8.1±3.9和7.7±3.6;P均<0.05),说明患者疼痛程度持续减轻,颈部功能持续恢复;治疗组VAS评分、NDI评分均显著低于对照组(P均<0.05)。治疗后2周,对照组VAS评分、NDI评分下降,与治疗前比较差异有统计学意义(VAS:4.8±1.6 vs 3.3±1.3;NDI:15.9±4.4 vs 11.9±3.7;P均<0.05);治疗后3个月,VAS评分(4.9±1.5)及NDI评分(16.1±4.4)均上升,与治疗前比较差异无统计学意义(P>0.05),说明对照组远期治疗效果不佳。结论内热针治疗可缓解慢性非特异性颈痛患者的疼痛并改善颈椎的功能,且与常规理疗相比具有更好的远期效果。展开更多
文摘AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were recruited randomly from the Rheumatology and Rehabilitation Outpatient Clinic at the Faculty of Medicine-Suez Canal University. Two groups were compared: 30 patients with chronic neck pain with mean age(36.97 ± 12.45 years) and 10 apparently healthy controls. Trapezius muscle examination including inspection and range of motion both active and passive was performed. A full clinical neurological examination was carried out to exclude peripheral neuropathy and motor neuron disease. According to the subject's type of work, cases were categorized into labor-intensive and non-labor intensive tasks. A nerve conduction study(NCS) was performed on spinal accessory nerves at both sides for all patients and controls. Parameters including latencies and amplitudes of compound motor action potential(CMAP) were compared with the chronicity of neck pain using the neck disability score. This cross sectional study was carried in the Rheumatology and Rehabilitation Department, at Suez Canal University Hospital, Ismailia, Egypt.RESULTS: Physical examination revealed that 80% of cases had spinal trapezius muscle spasm. Restricted neck motion was present in 16.6% of cases. No one suffered from muscle wasting or weakness. Pain was bilateral in 18 patients(60%), localized to the right side in six patients(20%) and localized to the left side in six patients(20%). The causes of neck pain in the patients studied were nonspecific, due to physical stresses, cervical spondylosis and mild cervical disc herniation. Mean disease duration in patients with labor-intensive tasks was(3.9 ± 2.1 years), which was longer than that in patients with non-labor intensive tasks(3.1 ± 1.9 years); however, this difference was statistically insignificant. Spinal accessory NCSs were performed while subjects were in sitting positions and relaxed with naturally suspended arms to minimize muscular movement. The results of electrophysiological studies revealed that mean right and left latencies of the spinal accessory nerve were 2.96 ± 0.69 ms, 2.98 ± 0.61 ms in the patient group and 2.44 ± 0.38 ms, 2.33 ± 0.36 ms in control group respectively. These differences were statistically significant with P = 0.028 and 0.006 respectively. Spinal accessory NCS showed normal CMAP amplitude in both patients and controls. Comparing the results of the neck disability index(NDI) to different characteristics in patients with chronic neck pain, showed that patients with labor-intensive work had a higher NDI score mean(34.7 ± 9.5) compared to those with non-labor-intensive work, with significant statistical difference(P = 0.011). In addition, mean NDI scores were higher in males, and patients aged over 40 years and this difference was statistically significant(P = 0.007 and P = 0.009 respectively). Correlation studies between right and left spinal accessory nerve latencies and disability percent calculated using the NDI revealed a positive correlation. Moreover, there was a positive correlation between age and disability percent.CONCLUSION: This study demonstrates electrophysiological evidence of demyelination in a significant proportion of patients with chronic cervical pain.
文摘目的观察内热针治疗慢性非特异性颈痛(nonspecific chronic neck pain,NCNP)的临床疗效。方法将2017年1月-2018年12月于解放军总医院海南医院康复理疗科就诊并确诊为NCNP的60例慢性非特异性颈痛的患者,随机分为治疗组和对照组,治疗组(n=30)使用内热针治疗,对照组(n=30)使用热磁治疗。治疗前、治疗后2周及治疗后3个月随访,分别采用疼痛视觉模拟量表(visual analogue scale,VAS)和颈部残损指数量表(neck disability index scale,NDI)进行疗效评定。结果治疗前两组患者性别、年龄、病程、VAS及NDI评分差异无统计学意义(P>0.05)。重复测量方差分析显示VAS评分、NDI评分在组间、时间、交互作用上均有统计学差异(P<0.05)。治疗后2周和3个月,治疗组VAS评分、NDI评分均持续下降,任意两时间点比较差异均有统计学意义(VAS:5.3±1.4 vs 2.0±1.2和1.7±0.8;NDI:14.6±4.6 vs 8.1±3.9和7.7±3.6;P均<0.05),说明患者疼痛程度持续减轻,颈部功能持续恢复;治疗组VAS评分、NDI评分均显著低于对照组(P均<0.05)。治疗后2周,对照组VAS评分、NDI评分下降,与治疗前比较差异有统计学意义(VAS:4.8±1.6 vs 3.3±1.3;NDI:15.9±4.4 vs 11.9±3.7;P均<0.05);治疗后3个月,VAS评分(4.9±1.5)及NDI评分(16.1±4.4)均上升,与治疗前比较差异无统计学意义(P>0.05),说明对照组远期治疗效果不佳。结论内热针治疗可缓解慢性非特异性颈痛患者的疼痛并改善颈椎的功能,且与常规理疗相比具有更好的远期效果。
