[Cervicalgia and interescapular pain by cervical osteochondroma: About a case] / Cervicalgia y dolor interescapular por osteocondroma cervical: A propósito de un caso

Background and objective: Osteochondroma is the most frequent benign bone tumor, it can present in solitary or multiple form. Only 1 to 4% of osteochondromas are found in the spine and the most frequent of these is located at the cervical level. Of all spinal osteochondromas, only 0.5% develop insidious and progressive symptoms of medullary compression, either in the form of myelopathy or radiculopathy. These tumors do not grow once the bone maturation is complete, so if the clinic appears, it does so mainly in young patients, between 20 and 30 years old. Methodology: young male with asymptomatic one year evolution posterior cervical tumor, that begins with cervicalgia and interscapular pain, without alarm symptoms. Surgical resection of the tumor is decided. Results: the pathological result describes the tumor as an osteochondroma. Six months after the intervention, the patient did not report cervicalgia or interscapular pain with a good state of scarring and cervical mobility. Conclusion: Regarding the management of these tumors, surgical treatment, by means of their resection, is indicated, if the patients present symptoms, with good functional results and a low number of complications. Its management in asymptomatic cases is controversial.

Antecedentes y objetivo: El osteocondroma es el tumor óseo benigno más frecuente, puede presentarse de forma solitaria o múltiple. Solo el 1 al 4% de los osteocondromas se encuentran en la columna vertebral y de ellos el más frecuente es el localizado a nivel cervical. De todos los osteocondromas espinales solamente el 0,5% desarrollan síntomas insidiosos y progresivos de compresión medular, ya sea en forma de mielopatía o radiculopatía. Estos tumores no crecen una vez completada la maduración ósea, por lo que si la clínica aparece, lo hace principalmente en pacientes jóvenes, entre 20 y 30 años. Metodología: varón joven con tumoración cervical posterior asintomática de un año de evolución que comienza con cervicalgia y dolor interescapular, sin síntomas de alarma. Se decide resección quirúrgica del tumor. Resultados: el resultado anatomopatológico describe la tumoración como un osteocondroma. A los 6 meses de la intervención el paciente no refiere cervicalgia ni dolor interescapular con buen estado de cicatriz y movilidad cervical. Conclusión: Respecto al manejo de estos tumores, el tratamiento quirúrgico, mediante su resección, está indicado, si los pacientes presentan sintomatología, con buenos resultados funcionales y bajo número de complicaciones. Siendo controvertido su manejo en casos asintomáticos.

Clinical Evaluation of Neck in Patients with Proprioceptive Cervicogenic Dizziness.

OBJECTIVE: To establish a functional connection between neck physical evaluations, dizziness discomfort and image findings among subjects diagnosed with proprioceptive cervical dizziness. METHODS: After exclusion of peripheral vestibular disorders, 20 subjects with proprioceptive cervical dizziness hypothesis were selected. A Visual Analogue Scale (VAS) was used to quantify pain and vertigo. The active neck Range of Motion (ROM) and the Muscle Strength (MS) of the neck region were examined. The manipulation of vertebral bodies by the Maitland method and imaging scan were performed. RESULTS: A positive correlation between pain and vertigo VAS scores was found. The ROM of the cervical spine was limited and vertebral joint movement was restricted, especially at C3 and C5. No loss of MS was noticed. CONCLUSIONS: Proprioceptive cervical dizziness is usually an exclusion diagnosis among episodic chronic vertigos. Characteristically, it is reported by patients as instability or vertigo in crises. It is directly related to the neck ache severity and worsens with neck movements. The common pattern on clinical examination includes restriction and pain during neck flexion without loss of MS. Reduction of joint mobility and pain are also observed, especially at C3 and C54 kHz.

Relationship Between Intensity of Neck Pain and Disability and Shoulder Pain and Disability in Individuals With Subacromial Impingement Symptoms: A Cross-Sectional Study.

OBJECTIVE: This study aimed to verify a possible relationship between shoulder disability and shoulder pain intensity and the variables related to cervical-spine dysfunction, and determine which of these can differentiate moderate to severe shoulder pain (>4 on a numerical rating scale [NRS]) from mild shoulder pain (≤4 on the NRS) in individuals with subacromial impingement symptoms. METHODS: One hundred and forty volunteers with shoulder pain were evaluated. Demographic information and variables related to the shoulder and neck were collected. Self-reported pain and disability of the shoulder and cervical spine were measured using the Shoulder Pain and Disability Index (SPADI) and Neck Disability Index (NDI) questionnaires, respectively. An NRS was used to measure pain in the shoulder and cervical spine. A purposeful modeling strategy was used to determine the best model to predict shoulder disability and shoulder pain (dependent variables). Multiple logistic regression analysis followed by receiver operating curve analysis was used to determine which variables better differentiated moderate to severe shoulder pain from mild shoulder pain. RESULTS: Variables such as Neck Disability Index (NDI) score (ß = 1.09, P = .00) and age (ß = -0.19, P = .03) were associated with the total SPADI score. Neck pain was significantly associated with shoulder pain (ß = 0.40, P = .00). The combination of variables predicting moderate to severe shoulder pain was total SPADI score (odds ratio [OR] = 1.15, P = .003), neck pain (OR = 3.20, P = .04), and age (OR = 1.01, P = .05). CONCLUSION: Our results demonstrate the important connection between shoulder- and neck-related symptoms in individuals with subacromial impingement symptoms.

Muscleskeletal pain in dysphonic women.

OBJECTIVE: To investigate the location, frequency and intensity of muscle pain in dysphonic functional/organofunctional women in comparison to women with healthy voices. METHODS: Sixty women, ranging in age from 18 to 45 years, divided into two groups: Dysphonic Group (DG) - 30 women with functional or organofunctional dysphonia; Non-Dysphonic Group (NDG) - 30 women without vocal complaints, and with adapted voices. All answered a protocol, marking the localization, frequency and intensity symptoms of pain on the temporal area, masseters, submandibular areas, larynx/pharynx, front and back of the neck, shoulders, upper back, lower back, elbows, fists/hands/fingers, hip/this, knees and ankles/feet. The volunteer should report the frequency in which pain was present in the last 12 months: no, rarely, frequently or always. The intensity of pain was measured by visual-analogue scales. The DG and NDG groups were compared using the Mann-Whitney test (p<0.05). RESULTS: The women of the DG reported significantly greater frequency of submandibular area (p=0.008), laryngeal pain (p<0.001), front of the neck (p=0.015), back of the neck (p=0.001), shoulder pain (p=0.027), upper back (p=0.027) and also reported significant greater intensity of pain in the larynx/pharynx (p=0.022) and back of the neck (p=0.003). CONCLUSION: The frequency and intensity of musculoskeletal pain was more frequent and more intense in dysphonic women than in women without vocal complaints, showing that pain may be related to functional and organofunctional dysphonia in women.

Effectiveness of global postural reeducation compared to segmental exercises on function, pain, and quality of life of patients with scapular dyskinesis associated with neck pain: a preliminary clinical trial.

OBJECTIVE: The purpose of this study was to assess the effectiveness of global postural reeducation (GPR) relative to segmental exercises (SE) in the treatment of scapular dyskinesis (SD) associated with neck pain. METHODS: Participants with SD and neck pain (n = 30) aged 18 to 65 years were randomly assigned to one of two groups: GPR and SE (stretching exercises). The upper extremity was assessed using the Disabilities of the Arm, Shoulder, and Hand questionnaire; function of the neck was estimated using the Neck Disability Index; pain severity was measured using a visual analogical scale; and health-related quality of life was assessed using the Short Form-12. Assessments were conducted at baseline and after 10 weekly sessions (60 minutes each). The significance level adopted was α < .05. RESULTS: For pre-post treatment comparisons, GPR was significantly associated with improvements in function of neck and upper extremities, pain, and physical and mental domains of quality of life (P < .05). Segmental exercises improved function of upper extremities and of the neck and severity of pain (P < .05). When contrasting groups, GPR was significantly superior to SE in improving pain and physical domains of the quality of life. CONCLUSION: This study showed that GPR and SE had similar effects on function of the neck and upper extremity in patients with SD associated with neck pain. When comparing groups, GPR was superior to SE in improving pain and quality of life.

Neck pain disability is related to the frequency of migraine attacks: a cross-sectional study.

BACKGROUND: Migraine and neck pain can be critical causes of disability. The contribution of neck pain for the overall disability of individuals with migraine remains unknown. OBJECTIVE: To contrast the disability experienced by individuals with episodic and chronic migraine with and without neck pain as captured by the Neck Disability Index. METHODS: Disability due to neck pain was assessed using the Neck Disability Index in individuals with episodic or chronic migraine seen at a university-based headache center. Neck disability was defined as mild (score ranging from 5 to 14 points), moderate (15-24 points), severe (25-34 points) or complete (35 points or higher). To compare differences between groups, a chi-square test was applied. Log-binomial logistic regression was used to estimate disability as a function of headache status after adjustments for age, time since migraine onset, and headache intensity. RESULTS: Sample consisted of 169 individuals, 104 with episodic migraine and 65 with chronic migraine. Any disability due to neck pain happened in 69% of those with episodic migraine, relative to 92% in chronic migraine (P < .001). Individuals with chronic migraine were at a significantly increased risk to have mild (RR = 2.5; CI 95% 1.1-6.1), moderate (RR = 3.7; CI 95% 1.5-8.8) and severe (RR = 5.1; CI 95%2.1-11.9) cervical disability relative to those with episodic migraine. Relative risks remained significant after adjustments. Time since episodic or chronic migraine onset significantly influenced the model (P = .035), but age and headache intensity did not (P = .27; P = .46). CONCLUSION: Neck pain significantly adds to the overall disability of individuals with episodic and chronic migraine.

Xerostomia and salivary flow in patients with orofacial pain compared with controls.

OBJECTIVES: Pain in the orofacial region is frequently reported by patients in dental and medical offices. Facial pain, headache, masticatory abnormalities and other complaints often become chronic and may be associated with local disturbances, such as xerostomia and teeth abnormalities. The objective of this study was to investigate salivary flow and xerostomia in patients with orofacial pain. DESIGN: This was a case-control study; we evaluated 82 patients with chronic orofacial pain compared with 56 healthy subjects using a Clinical Pain Questionnaire (pain characteristics, duration, intensity and descriptors), complete dental examination (including static and dynamic evaluation of the jaw) and a Xerostomia Inventory. The salivary flow was quantitatively evaluated. Data was compared through Pearson's chi-square, Fisher's exact, analysis of variance (ANOVA) 1 factor and Mann-Whitney tests. RESULTS: Patients often had temporomandibular disorder (TMD) (P=0.001) and pain during facial (P<0.001) and neck palpation (P=0.002). There were no differences in dental examination or other structural aspects of the jaw between the groups. There were more complaints associated with xerostomia in the study group, including burning sensation in the oral mucosa (P=0.003), in the throat (P=0.035) and in the stomach (P=0.050). Patients had lower salivary flow (P=0.008). CONCLUSIONS: Orofacial pain patients need to be evaluated with regard to their salivary function, which was often found abnormal in this sample and may have contributed to the complaints of these patients. Assessing salivary flow and xerostomia may help in the treatment of chronic orofacial pain.

Síndrome de eagle importancia para el odontológo: revisión de la literatura / Eagle Syndrome importance for practitioner: a literature review

El síndrome de Eagle es una entidad descrita por el Dr. Watt W. Eagle en 1937, en un estudio realizado en un grupo de pacientes cuyo síntoma principal manifestado era dolor cervicofaringeo. Dicha patología, también conocida con el nombre de síndrome de la arteria carótida, síndrome estiloide o síndrome del proceso estiloide alargado y osificado, se caracteriza por una malformación de la apófisis estiloide en donde se evidencia la elongación de dicha estructura o la calcificación de sus ligamentos, presentándose generalmente en personas de sexo femenino entre la tercera y sexta década de la vida. El método de diagnóstico más utilizado es la radiografía panorámica. De acuerdo a la sintomatología manifestada en el paciente, se orienta el tratamiento a seguir

The Eagle's syndrome, is an entity described for the first time by Dr. Watt W. Eagle in 1937, during a research that took place in a group of patients whose main symptom was cervical pain. This pathology, also known as carotid artery syndrome, styloid syndrome or elongated and ossified styloid process syndrome, is characterized by styloid apophysis malformation where elongation is evidenced. It's most likely to be found in females, among the 3rd and 6th decade of life. Diagnosis is carried out by Orthopantomography. An accurate treatment will be decided according to every patient in particular

Signs of temporomandibular disorders in migraine patients: a prospective, controlled study.

OBJECTIVES: To identify signs of temporomandibular disorders and cervical pain in individuals with episodic and chronic (transformed) migraine (CM), relative to controls without headaches. METHODS: In this prospective, controlled, double-blind study, we examined 93 individuals divided in 3 groups: episodic migraine EM, (n=31), CM chronic migraine (n=34), and controls without migraine (n=28). We recorded signs of temporomandibular disorders, and of pain in the neck, after the protocol of Helkimo (1974). We calculated the odds ratio (OR) and confidence intervals (CI) of symptoms as a function of headache status. Data from all groups were paired and compared using the chi test. The level of significance was 5% in 2-tailed tests. RESULTS: Relative to controls, participants with EM and CM were significantly more likely to have tenderness in the masticatory muscles [controls=28%, migraine=54%, (OR=3.0, 95% CI=1.1-8.9), CM=73% (OR=6.9, 95% CI=2.3-21.2)], and in the temporomandibular joint [controls=25%, migraine=61%, (OR=4.7, 95% CI=1.5-14.5), CM=61% (OR=4.8, 95% CI=1.6-14.5)]. They were numerically (but nonsignificantly) more likely to have limited lateral jaw movements (CM=34%; EM=26%; NP=18%), joint sounds (CM=44%; EM=29%; NP=28%), and tenderness in neck muscles (CM=64%; EM=51%; NP=35%). CONCLUSION: In a tertiary care population, individuals with EM and CM are more likely to have tenderness at the temporomandibular joint and on the masticatory muscles, relative to controls. Studies are needed to investigate whether treatment of 1 disorder will improve the other.