Dolor tóraco-abdominal: "Si miras el corazón, encontrarás la razón". Serie de casos

La isquemia miocárdica es un fenómeno secundario a la perfusión insuficiente del músculo cardíaco que en algunos casos puede ocurrir de forma aguda llevando a la necrosis celular y constituyendo el infarto agudo al miocardio (IAM). A pesar de que el diagnóstico de IAM es principalmente clínico, en ciertos casos en que no se sospeche de forma activa por presentar síntomas no típicos de isquemia miocárdica, el diagnóstico puede sugerirse por la Tomografía Computarizada (TC), que puede mostrar hallazgos sugerentes de IAM. A continuación, se comunica una serie de 4 casos clínicos con diagnóstico imagenológico incidental de IAM.

Myocardial ischemia is secondary to myocardial under perfusion. It can develop acutely leading to cell necrosis and myocardial infarction (AMI), or have a chronic course. Though the diagnosis of AMI is mainly clinical, in certain cases the symptoms may be atypical and the diagnosis can be suggested by images such as Computed Tomography (CT). Herein we report a series of 4 clinical cases with diagnosis of AMI following incidental CT imaging. There was an abdominal pain in 3 patients and a cervical pain in the remaining one. CT scan showed a hypodense myocardial image. The final diagnosis was confirmed by the appropriate laboratory and angiographic methods.

Prevalencia de las alteraciones de la movilidad cervical en los estudiantes de una universidad

Resumen La movilidad articular se conoce como la capacidad de movimiento de una articulación en conjunto con los diferentes grupos musculares. En el dolor cervical o cervicalgia, esta se puede ver alterada por varios factores como: el dolor, la debilidad muscular y la limitación. Objetivos : Determinar las alteraciones de la movilidad cervical en los estudiantes de 1er a 3er ciclo de la Carrera de Fisioterapia de la Universidad Católica de Santiago de Guayaquil. Metodología : Estudio de enfoque cuantitativo y alcance descriptivo de diseño no experimental de tipo transversal en 106 estudiantes, considerando los criterios de inclusión se utilizó el IDC y el Test de Flexión Cráneo-Cervical. Resultados : De la muestra conformada por 100%(106) estudiantes; utilizando el Índice de Discapacidad Cervical se pudo evidenciar que el 55% de la población entra en el rango de sin discapacidad, en comparación con el porcentaje sobrante que equivale a un 38% y 7% entran en el rango de discapacidad leve y discapacidad moderada respectivamente, en relación a la evaluación de la movilidad articular mediante el Test de Flexión Cráneo-Cervical el 79% presentó alteración y un 21% el valor normal, en la evaluación con el instrumento Stabilizer Pressure Biofeedback el 75% presentó alteración de la fuerza muscular y el 25 % el valor normal. Conclusiones : Entre los estudiantes de 1ro y 3er ciclo de la carrera de Fisioterapia de la Universidad Católica de Santiago de Guayaquil se determinó que existe un alto porcentaje en relación a las alteraciones de la movilidad cervical.

Abstract Joint mobility is known as the ability to move a joint in conjunction with the different muscle groups. In cervical pain or neck pain, this can be altered by several factors such as: pain, muscle weakness and limitation. Objective : To determine the alterations of cervical mobility in students from 1st to 3rd cycle of the Physiotherapy Career of the Catholic University of Santiago de Guayaquil. Methodology : Study with a quantitative approach and descriptive scope of a non-experimental cross-sectional design in 106 students, considering the inclusion criteria, the IDC and the Cranio-Cervical Flexion Test were used. Results : From the sample made up of 100% (106) students; Using the Cervical Disability Index, it was possible to show that 55% of the population falls into the range of without disability, compared to the excess percentage that is equivalent to 38% and 7%, they fall into the range of mild disability and moderate disability respectively. In relation to the evaluation of joint mobility using the Cranio-Cervical Flexion Test, 79% presented alteration and 21% the normal value, in the evaluation with the Stabilizer Pressure Biofeedback instrument, 75% presented alteration of muscle strength and 25% the normal value. Conclusions : Among the students of the 1st and 3rd cycle of the Physiotherapy career at the Catholic University of Santiago de Guayaquil, it was determined that there is a high percentage in relation to cervical mobility alterations.

Resumo A mobilidade articular é conhecida como a capacidade de mover uma articulação em conjunto com os diferentes grupos musculares. Na cervicalgia ou cervicalgia, isso pode ser alterado por vários fatores, tais como: dor, fraqueza muscular e limitação. Objetivo : Determinar as alterações da mobilidade cervical em alunos do 1º ao 3º ciclo da Carreira de Fisioterapia da Universidade Católica de Santiago de Guayaquil. Metodologia : Estudo com abordagem quantitativa e escopo descritivo de delineamento transversal não experimental em 106 alunos, considerando os critérios de inclusão, foram utilizados o IDC e o Teste de Flexão Crânio-Cervical. Resultados : Da amostra composta por 100% (106) alunos; Utilizando o Índice de Incapacidade Cervical, foi possível evidenciar que 55% da população se enquadra na faixa de sem incapacidade, em comparação ao percentual excedente que equivale a 38% e 7%, se enquadra na faixa de incapacidade leve e moderada Em relação à avaliação da mobilidade articular através do Teste de Flexão Crânio-Cervical, 79% apresentaram alteração e 21% o valor normal; na avaliação com o instrumento Estabilizador de Pressão Biofeedback, 75% apresentaram alteração da força muscular e 25% o valor normal. Conclusão : Entre os alunos do 1º e 3º ciclo da carreira de Fisioterapia da Universidade Católica de Santiago de Guayaquil, constatou-se que há um alto percentual em relação às alterações da mobilidade cervical.

Ventosaterapia no alívio da dor cervical em costureiras do sul catarinense / Cupping therapy in the relief of cervical pain in seamstresses from southern Santa Catarina / Terapia con ventosa para aliviar el dolor cervical en costureras del sur de Santa Catarina

Objetivo:identificar os efeitos do método de ventosaterapia no alívio da dor cervical em costureiras de uma confecção do segmento vestuário jeans, na região carbonífera do sul catarinense. Método: trata-se de um estudo quantitativo e longitudinal, realizado no segundo semestre de 2019, com a utilização da ventosaterapia durante oito semanas consecutivas em costureiras de uma empresa da linha têxtil no ramo do jeans, entre 40 e 50 anos, que apresentam cervicalgia. Foi utilizado a escala visual analógica para avaliação da dor.Resultados: aamostra foi composta por mulheres com média de 44,75 ± 3,58 anos, que 100% relataram dores antes da ventosaterapia, sendo 75% na cervical e 37,5% sentia essas dores diariamente. Após ventosaterapia, 50% não apresentou dores, 87,5% relatou não atrapalhar nas atividades diárias. Conclusão: foi observado a redução significativa na dor das costureiras, após utilização de terapia com ventosas.

Objective: to identify the effects of the cupping therapy method in the relief of cervical pain in seamstresses of a clothing industry in the jeans industry, in the carboniferous region of southern Santa Catarina. Method: a quantitative and longitudinal study, carried out in the second semester of 2019, with the use of cupping therapy for eight consecutive weeks in seamstresses of a textile company in the jeans industry, between 40 and 50 years old, who have neck pain. The visual analogue scale was used to assess pain. Results: the sample consisted of women with an average of 44.75 ± 3.58 years, of which 100% reported pain before cupping therapy, 75% in the cervical and 37.5% experienced these pains daily. After cupping therapy, 50% had no pain, 87.5% reported no disturbance on their daily activities. Conclusion: a significant reduction in the pain of the seamstresses was observed, after the use of cupping therapy.

Objetivo: Identificar los efectos dela terapia comventosaen el alivio del dolor de cuello en costureras de una confección en el segmento de ropa de mezclilla, en la región carbonífera del sur de Santa Catarina.Método: se trata de un estudio cuantitativo y longitudinal, realizado en el segundo semestre de 2019, con el uso de la eólica durante ocho semanas consecutivas en costureras de una empresa de línea textil de la industria del jeans, de entre 40 y 50 años, que presentan dolor de cuello. La escala analógica visual se utilizó para evaluar el dolor. Resultados: la muestra estuvo conformada por mujeres con un promedio de 44,75 ± 3,58 años, que el 100% refirió dolor antes de la eólica, el 75% en la cervical y el 37,5% sintió estos dolores diariamente. Después de la terapia de viento, el50% no tuvo dolor, el 87,5% informó que no le molestaban las actividades diarias. Conclusión: se observó una reducción significativa del dolor de las costureras, luego del uso de la terapia con ventosa.

Uso de teléfonos móviles, postura cervical anormal y su repercusión en el sistema estomatognático / Use of mobile phones, abnormal cervical posture and its impact on the stomatognathic system

Desde la introducción de los teléfonos móviles en los años 80, el crecimiento de su uso ha sido continuo y con una tasa de crecimiento cada vez mayor. Este crecimiento ha generado preocupación a nivel mundial respecto de los efectos que sobre la salud provocan. Uno de ellos tiene que ver con los cambios adaptativos que surgen a nivel de la columna cervical, por la acción de inclinar la cabeza hacia adelante repetidas veces, con el objeto de visualizar la pantalla. Se ha descrito una estrecha relación entre la columna cervical y el completo cráneomandibular, por lo que se espera que los componentes de ambos sistemas tengan la capacidad potencial de influirse de manera recíproca. Se ha demostrado que distintas actitudes posturales derivan en características diversas de oclusión, por lo que una modificación de la posición craneocervical afectaría tanto a la oclusión dentaria de manera particular, como de forma general a la biomecánica mandibular. El propósito de este trabajo es informar sobre los efectos que las posturas inadecuadas que adopta la columna cervical al utilizar teléfonos móviles, pueden provocar a nivel del sistema estomatognático (AU)

Efectos de las Técnicas Manuales Orofaciales en la Disminución del Dolor Cervical. Una Revisión Bibliográfica / Effects of Orofacial Manual Techniques in the Reduction of Cervical Pain. A Bibliographic Review

Introducción: La prevalencia anual de dolor cervical oscila entre un 16,7% y un 75,1%, durando alrededor de 6 meses o más en el 14% de los casos, desencadenando en restricción del movimiento y dolor principalmente. Esto podría deberse a la relación entre la cabeza, columna cervical y estructuras relacionadas a la articulación temporomandibular (ATM). El objetivo de esta investigación es describir a través de la evidencia científica el efecto de las técnicas manuales orales en la disminución del dolor cervical. Métodos: Se incluyeron ensayos clínicos aleatorizados y revisiones sistemáticas encontrados en las bases de datos PubMed, Cochrane y PEDro. Realizando la extracción de datos a través de una tabla estructurada para cada tipo de estudio. Resultados: De 10 estudios seleccionados, 3 corresponden a revisiones sistemáticas y 7 a ensayos clínicos, donde la disminución del dolor cervical fue significativa al aplicar la terapia manual con ejercicios por sobre la terapia manual por sí sola. Por otro lado, las técnicas orofaciales fueron beneficiosas al combinarlas con terapia manual en comparación con un tratamiento habitual. No se encontraron diferencias significativas al aplicar ejercicios de Maitland y movilizaciones en comparación con ejercicios de flexibilidad, fortalecimiento, ejercicios de Mulligan y movilizaciones. Conclusión: Los resultados son debatibles, ya que la terapia manual por sí sola o combinada con ejercicios es la técnica más efectiva no solo en la disminución del dolor cervical, también en la mejoría de la calidad de vida.

Introduction: The annual prevalence of cervical pain ranges from 16.7% to 75.1%, lasting about 6 months or more in 14% of cases, triggering mainly movement restriction and pain. This could be due to the relationship between the head, cervical spine and structures related to the temporomandibular joint (TMJ). The objective of this research is to describe through scientific evidence the effect of oral techniques in reducing cervical pain. Methods: Randomized clinical trials and systematic reviews found in the PubMed, Cochrane and PEDro databases were included. Data extraction was done through a structured table for each type of study. Results: Out of 10 selected studies, 3 correspond to systematic reviews and 7 to clinical trials, where the decrease in neck pain was significant when applying manual therapy with exercises over manual therapy alone. On the other hand, orofacial techniques were beneficial when combined with manual therapy compared to an usual treatment. No significant differences were found when applying Maitland exercises and mobilizations compared to flexibility, strengthening, Mulligan exercises, and mobilizations (p<0.05). Conclusion: The results are debatable, as manual therapy alone or combined with exercises is the most effective technique not only in reducing neck pain, but also in improving quality of life.

Resultados de una cohorte de pacientes tratados con osteopatía en un hospital polivalente / Results of a cohort of patients treated with osteopathy in a polivalent hospital

Introducción: la osteopatía aborda al paciente de manera global y aplica técnicas de tratamiento manual. Se realizó una evaluación retrospectiva sobre 447 pacientes para conocer los resultados del tratamiento del dolor lumbar y cervical. Material y métodos: fueron incluidos en este estudio 447 pacientes con diagnóstico de lumbalgia y cervicalgia (77,4% de sexo femenino). Los pacientes atendidos ya habían realizado tratamientos convencionales sin haber conseguido resultados satisfactorios. Se evaluó a los pacientes con la escala de valor numérico de dolor (EVN), y los puntajes (scores) de Oswestry (ODI) y el índice de discapacidad de la región cervical (NDI). Los 4 osteópatas intervinientes son profesionales certificados en esta disciplina. Resultados: el 42,8% de los pacientes fueron derivados por el Servicio de Traumatología y el 41,3% por el Servicio de Medicina Familiar. El 34,2% tuvieron diagnóstico de dolor lumbar y al 20,81% se le diagnosticó dolor cervical. Tanto en la valoración del dolor como en los scores utilizados se encontraron diferencias estadísticamente significativas entre la primera y la última sesión. Discusión: en pacientes con diagnóstico de lumbalgia y cervicalgia que no habían obtenido resultados satisfactorios con tratamientos convencionales previos, el tratamiento osteopático derivó en mejoras significativas en todos los parámetros estudiados. (AU)

Introduction: osteopathy addresses the patient globally and applies manual treatment techniques. A retrospective evaluation was carried out on 447 patients to know the results of the treatment of lumbar and cervical pain. Material and methods: 447 patients with a diagnosis of low back pain and cervical pain (77.4% female) were included in this study. The patients already had undergone conventional treatments without having achieved satisfactory results. The patients were evaluated with the numerical value of pain scale (VNS), and Oswestry scores (ODI) and the index of disability of the cervical region (NDI). The 4 intervening osteopaths are certified professionals in this discipline. Results: 42.8% of the patients were referred by the Traumatology Service and 41.3% by the Family Medicine Service. 34.2% had a diagnosis of lumbar pain and 20.8% were diagnosed with neck pain. Statistically significant differences were found between the first and last sessions in both the pain assessment and the scores used. Discussion: in patients with low back pain and neck pain who had not obtained satisfactory results with previous conventional treatments, osteopathic treatment resulted in significant improvements in all the parameters evaluated. (AU)

Perfil clínico, epidemiológico y descripción de los resultados de la Tomografía ósea computarizada con emisión simple de fotones (SPECT) en pacientes con dolor de cuello y espalda. Estudio de cohorte transversal / Clinical and epidemiological profile and description of the results of bone single photon emission computed tomography (SPECT) in patients with neck and back pain: Cross-sectional study

Introducción La tomografía ósea computarizada (TAC) con emisión simple de fotones (SPECT: single photon emission computed tomography) es una herramienta diagnóstica importante en los pacientes con dolor de cuello y espalda. Es una prueba funcional que se adelanta a los cambios estructurales en algunas patologías de columna. El objetivo del estudio es definir el perfil epidemiológico de pacientes con dolor axial crónico y/o subagudo en la columna vertebral. Materiales y Métodos Serie de casos cuyo objetivo general es presentar las características clínicas y sociodemográficas, así como los resultados de TAC con SPECT de los pacientes que consultaron al Hospital en un periodo de tiempo con diagnóstico de dolor de cuello o espalda y se les solicitó dicho examen. Resultados 77 pacientes cumplieron los criterios de inclusión, La mediana para la edad fue de 48 años, 57.1% eran hombres y 42.9% mujeres. 57 pacientes tenían localización única del dolor (74%) y 20 pacientes tenían localización múltiple (26%), los segmentos afectados fueron 57 lumbar (74%), cervical 15 (19.5%) y sacro 1 (1.3%). La impresión diagnóstica preexamen más común fue enfermedad facetaría en 25 casos para un 32.5%. En cuanto a los resultados del SPECT el radiofármaco captó en 48 ocasiones (62.3%) y los sitios en que captó el radiofármaco se distribuyeron así: facetas 13 (16.9%), cuerpo vertebral 28 (36.4%), Pars Interarticularis 3 (3.8%), disco intervertebral 1 (1.3%), 3 (3.8%) captaron en sitios diferentes al raquis, El índice de concordancia diagnóstica luego del SPECT se dio en 33 casos (42.85%). Discusión La mayoría de las gammagrafías con captación fueron en los cuerpos vertebrales, en el contexto de nuestro hospital como centro de trauma y que muchos de los pacientes tenían dolor secundario a accidentes de tránsito o accidentes laborales, se correlacionan con microfracturas o contusiones óseas. La gammagrafía con SPECT sigue siendo una prueba funcional que nos puede ayudar en el diagnóstico, pronóstico y enfoque terapéutico de los pacientes con dolor raquídeo axial en sus diferentes estadios.

Background SPECT bone scan with is an important diagnostic tool in patients with neck and back pain. It is a functional test that anticipates structural changes in some spinal pathologies. Aim of study is to define the epidemiological profile of patients with chronic and/or subacute axial spine pain. Methods A retrospective descriptive study whose general objective is to present the clinical and sociodemographic characteristics, as well as the results of the SPECT scans of the patients who visited the Hospital in a period of time with a diagnosis of neck or back pain and were requested such an examination. Results Seventy-seven patients met the inclusion criteria. The median age was 48 years, 57.1% were men and 42.9% were women. Fifty-seven patients had a single location of pain (74%) and 20 patients had multiple location (26%), the affected segments were 57 lumbar (74%), cervical 15 (19.5%) and sacrum 1 (1.3%). The most common pre-examination diagnostic impression was facet disease in 25 cases for 32.5%. Regarding the SPECT results, the radiopharmaceutical captured on 48 occasions (62.3%) and the sites where it captured the radiopharmaceutical were distributed as follows: facets 13 (16.9%), vertebral body 28 (36.4%), pars interarticularis 3 (3.8%).), intervertebral disc 1 (1.3%), 3 (3.8%) captured in sites other than the spine. The diagnostic concordance index after SPECT occurred in 33 cases (42.85%). Discussion Most of the uptake scans were in the vertebral bodies, beneath the context of our hospital, as a trauma center, and that many of the patients had pain secondary to traffic accidents or work behavior accidents, they are correlated with micro-fractures or bone contusions. SPECT scintigraphy continues to be a functional test that can help us in the diagnosis, prognosis and therapeutic approach of patients with axial spinal pain in its different stages.

Síndrome de la apófisis odontoides coronada, una manifestación inusual de dolor cervical. Presentación de un caso / Crowned Dens Syndrome, an Unusual Manifestation of Cervical Pain. A Case Report

Resumen Las enfermedades por depósito de cristales de pirofostato dehidratado de calcio o hidroxiapatita se pueden manifestar en cualquier articulación, y cuando se acumulan en la columna cervical pueden ser causa de dolor. El síndrome de la apófisis odontoides coronada es una rara condición clínica que se presenta por calcificación, en forma de corona, de los ligamentos que rodean a la apófisis odontoides. Se presenta el caso de un hombre de 70 años, con una semana de cervicalgia, cefalea y fiebre, que ingresó por sospecha de patología neurológica. Se realizó tomografía computarizada (TC) de cráneo que documentó calificaciones lentiformes del ligamento transverso del atlas. Se instauró manejo con corticoides y antiinflamatorios no esteroideos con mejoría. Una adecuada anamnesis junto con estudio por imagen evita procedimientos innecesarios y permite incluir esta entidad en el diagnóstico diferencial del dolor cervical agudo.

Abstract The calcium pyrophosphate dehydrate (CPPD) or hydroxyapatite (HA) crystal deposition disease can appear in any joint and the accumulation fo crystals in the cervical spine may be painful. Crowned dens syndrome is a rare clinical condition that involves crown-like calcification of the ligaments around the odontoid process. A 70-year-old man presented cervical pain, fever and a headache for over a week, therefore, a neurological condition was suspected. A CT scan revealed lentiform calcifications of the transverse ligament of the atlas. Steroid treatment and a non-steroidal anti-inflammatory diminished the symptoms. A proper clinical history and imaging studies avoid unnecessary procedures and makes it possible to include this entity as a differential diagnosis in acute cervical pain.

Osteomielitis cervical asociada a otitis crónica. Presentación de un caso / Cervical osteomyelitis associated with chronic otitis. A case report

Introducción : La osteomielitis es la infección de estructuras óseas ya sea por inoculación directa a través de heridas, por vía hematógena a través de focos distantes o por contigüidad con estructuras vecinas como los oídos. Objetivo: Reportar un caso que demuestra la necesidad de seguimiento de las otitis medias con vistas a evitar recurrencias y complicaciones. Presentación del Caso: Paciente femenina, de 62 años de edad, tez blanca y ama de casa de la localidad de Baracoa, provincia Guantánamo, Cuba. Con antecedentes de otitis de un año de evolución que desarrolló osteomielitis crónica cervical y un cuadro neurológico caracterizado por cuadriparesia y dificultad para la acción asociado a la osteomielitis cervical. Se trató con vancomicina y levofloxacino durante 6 semanas y oxigenación hiperbárica con lo cual egresó totalmente rehabilitada. Conclusiones: El manejo inadecuado de la otitis puede desencadenar complicaciones graves y poco frecuentes como la osteomielitis cervical tal y como se presenta en este caso(AU)

Introduction: Osteomyelitis is the infection of the osseous structures associated with the direct inoculation of microorganisms through wounds, hematogenous route from distant focus of infection or the contiguity with neighboring structures like the ears. Objective: The aim of this paper is to demonstrate the need for medical follow-up of otitis media in order to avoid recurrence and complications of this disease. Case presentation: Sixty-two-year-old white woman, housewife, from Baracoa, Guantanamo Province, Cuba. The patient had antecedents of one-year history of otitis media. She developed cervical chronic osteomyelitis and a neurological picture that was characterized by quadriparesis and difficulty to carry out actions, which was associated with cervical osteomyelitis. She was treated with Vancomycin and Levofloxacin during 6 months and hyperbaric oxygenation that helped her to be totally recovered after discharge from hospital. Conclusions: Inadequate treatment of otitis can cause very serious and less frequent complications such as cervical osteomyelitis, as it is presented in this case(AU)

Dolor cervical entre agricultores que producen tabaco en el sur de Brasil / Neck pain among tobacco farm workers in Southern Brazil

RESUMEN Este estudio tiene como objetivo evaluar la prevalencia del dolor cervical y los factores asociados entre agricultores que producen tabaco. Se realizó un estudio transversal en el que participaron 2.469 agricultores que producen tabaco en el sur de Brasil. Para la caracterización del dolor cervical se utilizó una adaptación del cuestionario nórdico para síntomas musculoesqueléticos. El análisis multivariante se realizó mediante la regresión de Poisson, siguiendo un modelo teórico jerárquico. La prevalencia del dolor cervical en el año previo entre la población estudiada fue del 7,4%. Las variables que se asociaron con el dolor cervical entre las mujeres trabajadoras fueron la edad, el consumo de tabaco, el enfardado del tabaco, el uso de motosierras pesadas, trabajar en un ritmo intenso o acelerado y la enfermedad del tabaco verde, mientras que, entre los varones, fueron la edad, el uso de motosierras pesadas, el trabajo sentado en el suelo, la intoxicación por plaguicidas y la enfermedad del tabaco verde. El estudio refuerza la importancia de las cargas de trabajo ergonómicas y fisiológicas en la determinación del dolor cervical. Se necesitan estudios futuros para comprender el papel de la exposición a los plaguicidas y a la nicotina en los problemas musculoesqueléticos. La mecanización de la cosecha del tabaco podría reducir la exposición ergonómica y química, mejorando así la salud de los agricultores.

ABSTRACT This study aims to assess neck pain prevalence and associated factors among tobacco farm workers. This is a cross-sectional study of 2,469 tobacco farm workers in southern Brazil. An adapted version of the Nordic Questionnaire of Musculoskeletal Symptoms was used to characterize neck pain. Multivariate analysis was performed using Poisson regression, following a hierarchical theoretical model. Neck pain prevalence in the last year among the population studied was 7.4%. Worker age, tobacco smoking, tobacco bundling, use of heavy chainsaws, working at an intense or accelerated pace and green tobacco sickness were variables associated with neck pain in females. Among males, age, use of heavy chainsaws, working in a sitting position on the ground, pesticide poisoning, and green tobacco sickness were associated with the outcome. The study reinforces the importance of ergonomic and physiological workloads in the determination of neck pain. Future studies are needed to understand the role of pesticides and nicotine exposures on musculoskeletal problems. The mechanization of tobacco harvesting could reduce ergonomic and chemical exposure, thereby improving farmers' health.

Association between severity of the temporomandibular disorder, neck pain, and mandibular function impairment / Associação entre severidade da disfunção temporomandibular, cervicalgia e limitação funcional da mandíbula

ABSTRACT Purpose: to investigate the possible association between the severity of the temporomandibular disorder, cervical pain, and mandibular function impairment. Methods: is a cross-sectional, descriptive study, conducted with 32 individuals with temporomandibular disorder, categorized by degree of severity, according to the Fonseca Index. Using the diagnosis criteria for temporomandibular disorder, the likely etiological factors for the disorder were established, as well as the intensity of the functional disability, resulting from cervical pain and of the mandibular impairment. The data obtained were statistically treated, adopting the significance level of 5%. Results: the mean age was 33.8 years, 90.6% being females. As for the degree of disorder, 56.3% presented severe TMD, followed by 28.1% showing a moderate one. The myogenic etiology was present in 93.7% of the patients. Cervical pain was present in 90.6% of them, of which, 59.4% presented a mild disability, and 25%, a moderate one. Considering the mandibular function, 46.9% of the patients presented a low, 40.6%, a moderate, and 12.5%, a severe impairment. There was a statistically significant association between cervical pain and mandibular function (p = 0.011). However, although there was an increase in cervical disability and in mandibular impairment as the severity of the TMD also increased, these associations were not statistically significant (p = 0.178 and p = 0.102, respectively). Conclusion: it can be stated that there is a higher prevalence of severe TMD and of myogenic origin, and that cervical pain influences, directly, the mandibular function, which is not necessarily related to the severity of the temporomandibular alteration. Likewise, such severity does not present a relationship to mandibular function impairment either.

RESUMO Objetivo: investigar possível associação entre severidade da disfunção temporomandibular, cervicalgia e limitação funcional mandibular. Métodos: estudo seccional descritivo, em 32 indivíduos com disfunção temporomandibular, categorizados de acordo com o grau de severidade segundo o Índice de Fonseca. Utilizando-se o Critérios Diagnósticos de Pesquisa em Disfunção Temporomandibular, estabeleceram-se prováveis fatores etiológicos da disfunção e a intensidade de incapacidade funcional cervical e mandibular, avaliados pelo Índice de Incapacidade Relacionada à Dor no Pescoço e Questionário de Limitação Funcional Mandibular respectivamente. Os dados obtidos foram tratados estatisticamente, adotando-se nível de significância de 5%. Resultados: a média de idade foi de 33,8 anos, sendo 90,6% pertencentes ao gênero feminino. Quanto à severidade da disfunção, 56,3% possuíam o tipo severo, sendo moderada em 28,1%. Em 93,7%, verificou-se etiologia miogênica. A cervicalgia esteve presente em 90,6% dos pacientes, dos quais 59,4% apresentaram incapacidade leve e 25% moderada. Quanto à função mandibular, houve baixa limitação em 46,9%, moderada em 40,6%, tendo sido severa em 12,5%. Houve associação estatisticamente significante entre a cervicalgia e a função mandibular (p=0,011). Contudo, embora tenha havido aumento na incapacidade cervical e na limitação mandibular com o aumento da severidade da disfunção temporomandibular, estas associações não foram estatisticamente significantes (p=0,178 e p=0,102, respectivamente). Conclusão: é possível afirmar que há maior prevalência de disfunção temporomandibular de intensidade severa e de origem miogênica, e que a cervicalgia influencia diretamente a função mandibular, não estando necessariamente relacionada à severidade da disfunção temporomandibular. Da mesma forma, esta última também não apresenta relação direta com a limitação da função mandibular.

Ictus isquémico y disección bilateral de la arteria carótida interna: una manifestación rara del síndrome de eagle: reporte de un caso / Ischemic stroke and bilateral dissection of the internal carotid artery: a rare manifestation of the eagle syndrome: a case report

RESUMEN Un síndrome caracterizado por dolor cervical y un apófisis estiloides alargado fue descrito por primera vez por Watt Eagle en 1937. Aunque el síndrome de Eagle en su variante vascular es raro y no es reconocido como causa clara de disección carotídea, en los últimos años ha sido reportado un incremento del número de casos de disección carotídea causada por una apófisis estiloides alargada. Paciente de 56 años que acudió al servicio de urgencias por paresia facial izquierda aguda y habla confusa. Presentaba dolor cervical de dos días de evolución, relacionado con un ataque de tos. Se activó el código ictus y la tomografía computarizada (TC) mostró isquemia del lóbulo temporal derecho y disección bilateral de la arteria carótida interna. La angio-TC de los troncos supraaórticos con reconstrucción tridimensional, identificó una apófisis estiloides alargado en ambos lados. El paciente fue sometido a una angioplastía con colocación de dos stents. Debido al alto riesgo de padecer nuevo ictus, se decidió realizar tratamiento quirúrgico. Para el lado derecho se realizó un abordaje transoral y en el izquierdo un abordaje abierto. La apófisis estiloides alargado es una causa importante de disección carotídea y de las complicaciones cerebrovasculares relacionadas.

ABSTRACT A syndrome characterized by cervical pain and an abnormally elongated styloid process was first described by Watt Eagle in 1937. Even though vascular Eagle syndrome is uncommon and is not well recognized as a cause for carotid artery dissection, in the last few years there have been an increasing number of case reports of carotid artery dissection caused by an elongated styloid process. A 56 years old man presented to the emergency department with acute left facial weakness and slurred speech. He complained of two days neck pain, related to a coughing fit. The code stroke protocol was activated and imaging showed a right temporal bone stroke and a bilateral internal carotid artery dissection. A scan angiography of the supra-aortic vessels with 3D reconstruction was performed showing a bilateral abnormally elongated styloid process. The patient underwent angioplasty with two stent placements. Due to the high risk of recurrent strokes, the patient was evaluated in the otolaryngology department for styloid process resection. Finally a transoral approach for the right side and an open approach for the left side were performed. We have to consider an elongated styloid process as an important cause of carotid artery dissection and subsequent cerebrovascular complications

Thoracic Posture and Mobility in Mechanical Neck Pain Population: A Review of the Literature

Neck pain is a common condition with several proposed biomechanical contributing factors. Thoracic spine dysfunction is hypothesized as one of the predisposing factors, which necessitates the need to explore the contribution of thoracic posture and mobility toward neck pain. Accordingly, the present work aimed to review the existing literature investigating the presence of thoracic spine dysfunction in individuals with neck pain. A literature search was conducted in the three electronic databases of PubMed, CINAHL, and Web of Science. Studies published between 1990 and 2017 were considered. After reviewing the abstracts, two authors independently scrutinized the full-text documents for their relevance. The initial search yielded 2,167 articles, of which nine studies involving comparisons of neck pain patients and healthy controls were identified for the review. Increased thoracic kyphosis was positively correlated with the presence of forward head posture but not uniformly associated with neck pain intensity and disability. Thoracic mobility was reduced in the neck pain population, and the role of thoracic kyphosis as a risk factor for pain development could not be confirmed. Thus, an association exists between thoracic kyphosis and postural alteration in the cervical spine. The review favors the inclusion of thoracic spine assessment and treatment in mechanical neck pain patients. Further studies are needed to investigate the cause-effect relationship between thoracic posture and cervical dysfunction.

Audiología y Mareo de Origen Cervical / Audiology and dizziness of cervical origin

En la presente revisión sistemática se discute la relación entre la etiología del mareo de origen cervical, el uso de pruebas vestibulares y el rol del especialista en audiología en el abordaje de esta patología. La búsqueda de artículos se realizó a través de bases de datos electrónicas. Se usaron términos libres como mareo de origen cervical, vértigo cervicogénico, cervicogenic dizziness, dolor cervical, latigazo cervical y espondilosis cervical. La valoración de la calidad de los estudios incluidos se realizó con la guía de análisis crítico de calidad metodológica propuesta por (Carvajal C, 2004). Los resultados de la revisión muestran las evidencias etiológicas del mareo de origen cervical reportadas en la literatura y si el especialista en audiología, por su formación, puede abordar esta condición de acuerdo con los procedimientos hallados para su manejo actualmente. Las evidencias sugieren que la afectación de las estructuras musculo esqueléticas del cuello puede derivar en sensaciones de mareo. Adicionalmente, a partir de la revisión se concluye que, aunque la literatura no reporte el rol específico del especialista en audiología en el abordaje del mareo de origen cervical, es pertinente que este lo aborde desde su fase diagnóstica y de inter vención

This systematic review discusses the relationship between the etiology of cervical dizziness, the use of ear canal testing, and the role of the audiology specialist in approaching this pathology. An electronic database was used in researching articles that utilized open terminologies such as cervical dizziness, cervicogenic vertigo, cervicogenic dizziness, sharp cervical pain, and cervical spondylosis. The studies included were evaluated for quality by using the critical analysis guide of methodological quality. The results of the review show reported etiological evidence of cervicogenic dizziness in literature and whether an audiology specialist, through their training, is able to address and handle this condition in accordance with the most up-to-date procedures. The evidence suggests that the affectation of the musculoskeletal framework in the neck can be derived from dizziness symptoms. Additionally, it could be concluded from the review that although the literature does not report the specific role of the audiology specialist in approaching cervical dizziness, it is pertinent to address this role as early as the diagnostic and intervention phases

Estudio para reducir el dolor posoperatorio en pacientes sometidos a tiroidectomía total o disección cervical por patología tiroidea mediante crioterapia / Study to reduce postoperative pain in patients undergoing total thyroidectomy or cervical dissection for thyroid pathology by cryotherapy

Contexto: en la actualidad, la creciente incidencia de patología tiroidea amerita una mayor resolución quirúrgica que demanda manejo del dolor posquirúrgico, lo que amerita buscar métodos o terapias complementarias para atenuar el dolor. Objetivo: comparar el nivel de dolor posquirúrgico en pacientes sometidos a tiroidectomía total o disección cervical por patología tiroidea benigna o maligna mediante el uso de crioterapia comparado con métodos tradicionales, en los servicios de Cirugía General y Cirugía Oncológica del Hospital Eugenio Espejo de Quito. Sujetos y métodos: estudio epidemiológico, observacional, transversal, en 204 pacientes sometidos a tiroidectomía total o disección cervical, divididos en un grupo manejado con terapia analgésica estándar (paracetamol y tramadol) y un grupo control que recibió similar terapia farmacológica más crioterapia; en ambos grupos se valoró la escala de dolor (EVA) por 24 horas. Las variables cuantitativas se reportaron como promedios (desviación estándar) y las cualitativas con sus valores absolutos y relativos (porcentajes). La comparación de las variables cuantitativas se realizó previa prueba de normalidad, mientras que las variables cuantitativas que cumplieron criterios de normalidad se usó la t de Student para grupos independientes o sus equivalentes no paramétricos. Resultados: ambas terapias (cold pack y terapia estándar) disminuyen significativamente la percepción de dolor desde su primera evaluación (6 horas) hasta la valoración final (24 horas) (p <0,0001). La analgesia complementada con crioterapia (cold pack) supera al tratamiento estándar con analgésicos (p <0,0001). Para el grupo tratado con cold pack, el descenso de dolor fue 2 puntos de EVA (RIQ: 1,3 puntos; p < 0,001). Conclusión: el uso de la terapia combinada (analgesia estándar más crioterapia) redujo el dolor en dos puntos según la escala de dolor EVA, mostrando que la terapia combinada es superior en el manejo del dolor de acuerdo al grupo control.

Context: currently, the increasing incidence of thyroid pathology deserves a greater surgical resolution that demands the management of postoperative pain, which also deserve complementary methods or therapies to attenuate pain. Objective: to compare the level of postsurgical pain in patients under total thyroidectomy or cervical dissection, due to benign or malignant thyroid pathology, through the use of cryotherapy compared to traditional methods, in the General Surgery and Oncology Surgery services of the Eugenio Espejo Hospital in Quito. Subjects and methods: epidemiological, observational, crosssectional, performed in 204 patients under total thyroidectomy or cervical dissection, divided into a group managed with standard analgesic therapy (paracetamol and tramadol) and a control group that received similar pharmacological therapy plus cryotherapy. In both groups the pain scale (VAS) was assessed for 24 hours. Quantitative variables were reported as averages (standard deviation) and qualitative variables with their absolute and relative values (percentages). The comparison of the quantitative variables was carried out after a normality test, while the quantitative variables that met the normality criteria, "t" test was used for independent groups or their non-parametric equivalents. Results: both therapies (cold pack and standard therapy) significantly decrease the perception of pain from its first evaluation (6 hours) until the final evaluation (24 hours) (p <0.0001). Analgesia supplemented with cryotherapy (cold pack) exceeds the standard treatment with analgesics (p <0.0001). For the group treated with cold pack, the decrease in pain was 2 points of VAS (IQR: 1.3 points; p <0.001). Conclusion: the use of combined therapy (standard analgesia plus cryotherapy) reduced pain by two points according to the VAS pain scale, showing that the combined therapy is superior in pain management according to the control group

Efficacy of Carbon Microcoils in Relieving Cervicogenic Dizziness

Abstract Introduction Cervical pain contributes to postural deviations and imbalance. Nanotechnology may be used for the treatment of neck pain by fixing to the skin small rounds silicone patches containing double spiral carbon nanotubes arranged in the form of a coil (Helical), which would then relieve dizziness caused by muscular contraction. Objective The objective of this study is to Evaluate pain and dizziness scores before and after Helical patches effect on cervicogenic dizziness treatment. Methods The selected patients should have neck pain arising from muscle contraction with loss of balance or instability lasting more than 90 days and normal electrooculography. Treatment consisted of placing 10 Helical patches distributed as follows: two in the upper cervical area, two in the lower cervical area (near the 5th and 6th vertebrae), two in the upper trapezius muscle area (between neck and shoulder), and four in the tender point area (as reported by the patient). Using a Visual Analogue Scale (VAS), we matched pain and dizziness scores from Day 1 to those from Day 15 and Day 30 using Mann-Whitney test. Results There was a significant difference between pain score reported on Day 1 and Day 15 (Z = 2.43, U = 5, p = 0.01). We also found significant differences between dizziness scores reportedondays1 and15 (Z = 2.62, U = 3.5, p = 0.01) and days 1 and 30 (Z = 2.36, U = 5.5, p = 0.01). Conclusion The Helical patches seem to be an effective treatment for cervicogenic dizziness.

Effectiveness of Selective Nerve Root Block on the Need for Surgical Treatment of Patients with Cervical Radicular Pain: A Minimum 5 Years Follow-Up / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to assess the 5-year outcome of patients considering surgery for complaint of cervical and radiating pain treated by selective nerve root block (SNRB). MATERIALS AND METHODS: Between January 2001 and December 2007, 39 cases were selected from patients who underwent SNRB before the operation and were followed-up for more than five years. The mean follow-up period was 64.3 months and the mean age was 57.7 years. The patients were divided into the operation group and the only cervical SNRB group. The groups were compared for gender, age, duration, disease, single or multi-level, and root compression rate on magnetic resonance imaging. The clinical results were analyzed using the neck disability index (NDI) and the visual analogue scale (VAS) score. RESULTS: Among the 39 cases scheduled for the operation, 20 cases (51.3%) did not proceed to the operation and 13 cases among them were treated with additional conservative treatment. The average VAS score for the operation group and the cervical SNRB group was 8.1 points and 7.5 points at the preoperative state and the pre-injection state. After surgical treatment and cervical nerve root block, the scores were 3.0 points for all. The NDI for the operation group was 11.3 points at the last follow-up. The NDI for the cervical nerve root block group was 13.6 at the last follow-up. There was no significant difference between the two groups. Shorter duration and younger age tended to show a higher operation rate. At the last follow-up, 7 cases (17.9%) after cervical SNRB had persistent symptom relief without other treatment. CONCLUSION: Cervical SNRB is considered an effective treatment for patients with cervical disease with radiating pain and who are scheduled for an operation.

Evaluation of body painful areas in patients with muscular temporomandibular disorder: a retrospective study / Avaliação das áreas de dor no corpo em pacientes com disfunção temporomandibular muscular: estudo retrospectivo

ABSTRACT BACKGROUND AND OBJECTIVES: Among temporomandibular disorder classifications, masticatory muscles myofascial pain is the most frequent. Its multifactorial etiology makes its treatment difficult. Identifying other painful sites related to temporomandibular disorders may help controlling comorbidities and, as a consequence, improving their symptoms. This study aimed at evaluating the presence of body pain in temporomandibular location. METHODS: We have evaluated 328 medical charts of the Dental Research Center São Leopoldo Mandic, with diagnosis of muscular temporomandibular disorder. Patients were evaluated by means of a body map to locate pain complaints. RESULTS: From 328 analyzed medical charts, 180 (55%) had body pain (160 females, 20 males), and 148 (45%) had facial pain only (116 females, 32 males). Areas with most frequent pain reports were cervical, lumbar and shoulders.Females had more body pain (with pain n=160, without pain n=116, p≤0.001) as compared to males (with pain n=20, without pain n=32) with statistical difference.In most cases pain has affected both body sides (bilateral face 67%, bilateral body 92%). CONCLUSION: Most patients with temporomandibular disorder had pain in body parts different from the face. Regions marked in human body drawings with more pain were cervical followed by lumbar and shoulders.

RESUMO JUSTIFICATIVA E OBJETIVOS: Dentre as classificações das disfunções temporomandibulares, as dores miofasciais nos músculos da mastigação são as mais frequentes. Sua etiologia multifatorial dificulta o tratamento. Reconhecer outros locais de dor relacionados à disfunção temporomandibular pode ajudar no controle das comorbidades e consequentemente melhorar o seu quadro. O objetivo deste estudo foi avaliar a presença de dor no corpo em pacientes com disfunção temporomandibular, a frequência desses relatos e sua localização. MÉTODOS: Foram avaliados 328 prontuários do Centro de Pesquisa Odontológica São Leopoldo Mandic, com diagnóstico de disfunção temporomandibular muscular. Os pacientes foram avaliados por meio de desenhos de mapa corporal para determinar a localização de queixas de dor. RESULTADOS: Dos 328 prontuários analisados, 180 (55%) apresentaram registro de dor pelo corpo (160 mulheres, 20 homens), e 148 (45%) apresentavam dor apenas na região da face (116 mulheres, 32 homens). As áreas com maior relato de dor foram: cervical, lombar e ombros. O gênero feminino apresentou maior frequência de dores no corpo (com dor n=160, sem dor n=116, p<0,001) que o gênero masculino (com dor n=20 e sem dor n=32) com diferença estatística. Na maior parte dos casos a dor acometeu os dois lados do corpo (face 67% bilateral e corpo 92% bilateral) CONCLUSÃO: A maioria dos pacientes com diagnóstico de disfunção temporomandibular apresentou dor em outras partes do corpo além da face. A região anotada nos desenhos do corpo humano com maior acometimento da dor foi a cervical seguida da lombar e ombros.

Estudio controlado, doble ciego, randomizado, multicéntrico, para evaluar la eficacia de la combinación fija tiocolchicósido más diclofenaco potásico en contracturas / Multicentered, randomized, double-blind and controlled study for the evaluation of efficacy of a set combination of thiocolchicoside plus potasium diclofenac in spams

Objetivo: determinar la eficacia y la tolerabilidad de la combinación a dosis fija, en una sola tableta, de tiocolchicósido 4 mg más diclofenaco potásico 50 mg en la reducción de la contractura muscular aguda estriada dolorosa comparado contra placebo y el uso de paracetamol tabletas de 500 mg como medicación de rescate. Métodos: fueron reclutados 97 pacientes de 2 ciudades ecuatorianas, Quito y Guayaquil, en tres centros de investigación, públicos y privados, con cervicalgia, dorsalgia y lumbalgia, principalmente de causa funcional. Los pacientes fueron asignados al azar en dos grupos: 1) grupo medicación activa, tiocolchicósido más diclofenaco potásico, 50 pacientes, 2) grupo placebo 47 pacientes. La eficacia en ambos grupos se evaluó por la reducción de la contractura muscular apreciada por inspección, palpación y reducción del dolor medido por una escala visual análoga, después de 5 días de tratamiento. Resultados: la evolución del grado de contractura muscular en el grupo medicación activa por evaluación visual pasó de un 100 por ciento con contractura visible con o sin actividad antiálgica fija a 96 por ciento sin signos visibles de contractura; de un 82 por ciento de contractura moderada a severa con o sin dolor evocado por palpación a un 74 por ciento de contractura leve sin dolor y 26 por ciento de ausencia de contractura. El promedio de dolor según la escala visual análoga disminuyó de 6,66 cm antes del tratamiento a 0,86 cm al finalizar el quinto día de tratamiento. Los efectos adversos fueron leves en el grupo tratado. Conclusiones: la combinación fija de tiocolchicósido 4 mg más diclofenaco potásico 50 mg en una sola tableta, administrado dos veces al día, es eficaz en el manejo de la contractura muscular aguda dolorosa de diversa etiología de manera estadísticamente significativa, bien tolerada y no altera el rendimiento psicomotor(AU)

Objective: to determine the efficacy and tolerability of a combination at a set dose in a single tablet of thiocolchicoside 4 mg plus potassium diclofenac 50 mg in the reduction of painful acute muscle spasm compared with the placebo and the use of 500 mg paracetamol as rescue medication. Methods: ninety seven patients from two Ecuador cities, named Quito and Guayaquil, were recruited in three research centers, both public and private. They suffered cervical pain, low back pain and dorsal pain, mainly of functional cause. The patients were randomly assigned in two groups 1) active medication group with 50 patients treated with thiocolchicoside plus potassium diclofenac and 2) placebo group with 47 patients. The efficacy of both groups was evaluated by the reduction of muscle spams observed in checking, palpation and pain reduction measured in an analogue visual scale after 5 days of treatment. Results: the progress of the muscle spasm degree in the active medication group according to visual evaluation went from 100 percent with visible spasm with or without fixed antialgic activity to 96 percent with no visible signs of spasm; from 82 percent of moderate spasm to severe with or without evoked pain by palpation to 74 percent of mild spasm without pain and 26 percent of spasm-free muscle. The pain average according to the visual scale decreased from 6.66 cm before treatment to 0,86 cm after the 5th day. The adverse effects were mild in t he treated group. Conclusions: the fixed combination of thiocolchicoside 4mg plus potassium diclofenac 50 mg in a single tablet, administered two times a day is efficacious in the painful acute muscle spasm of diverse etiology in a statistically significant way, well-tolerated and with no alteration of the psychomotor performance(AU)

The Relationship between Neck Pain and Cervical Alignment in Young Female Nursing Staff

OBJECTIVE: Degenerative changes in the cervical spine are commonly accompanied by cervical kyphosis which can cause neck pain. This study examined the relationship between neck pain and cervical alignment. METHODS: A total of 323 female nursing staff from our hospital were enrolled. Sagittal radiographs of the cervical spine, Body Mass Index (BMI), Visual Analogue Scale (VAS) measures of neck and arm pain, Neck Disability Index (NDI) and the Short Form (36) Health Survey (SF-36 scores) were obtained and reviewed retrospectively. Global lordosis (GL) of the cervical spine was measured on radiograph images. Correlations between GL and questionnaire scores were investigated using the following three methods : 1) correlation between GL and questionnaire scores among the entire sample; 2) subgroup analysis of patients with "kyphosis (KYP) : GL scores0" on questionnaire measures; and 3) subgroup analysis of patients with pain vs. those without pain, on GL and questionnaire measures. RESULTS: There was no significant correlation between GL and any questionnaire measure. There was a significant difference between the mean GLs of the KYP and LOR groups, but there were no group differences in BMI, age or any questionnaire measures. There was no difference between the pain (n=92) and pain-free (n=231) groups in age, BMI or GL, but there were differences in neck, and arm pain, and physical function and NDI scores. CONCLUSIONS: Our data suggest that kyphotic deformity was not associated with neck pain.