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Chronic neck pain syndromes are recognized as myofascial disorders in the main. Often such syndromes follow trauma, and there are significant psychological and secondary gain issues that impact on the outcome of therapy. Comparison with cervical radicular syndromes is discussed.
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The articular facets of the cervical spine have been well addressed; however, little information is available on the relationship of the superior facets of the cervical spine to traumatic dislocation in the literature. Morphometric analyses of the superior facets of 30 dried cervical spines from C3 to C7 were performed to determine any morphological differences. The angle of the superior facet with respect to the transverse plane was also measured on computed tomography (CT) scans of 30 patients having neck injury without fracture/dislocation. The vertical and surface lengths of the superior facet were significantly lower (P < 0.01) at C6-C7 levels than at C3-5 levels. The anteroposterior diameter of the superior facet was smaller (P < 0.05) at C6 and C7 levels compared to C3-5 levels. Although the superior facet joint surface is in a more coronal orientation in lower cervical vertebrae, the inclination of the superior facet is more horizontal relative to the transverse plane when measured in vivo. A combination of lower height, smaller anteroposterior diameter of the superior facet, and a more horizontally oriented superior facet at C6 and C7 levels in vivo may explain the predilection of translation relative to one another in the lower cervical spine.
An unusual case of myositis ossificans traumatica lesion located in the paraspinal region is reported. Despite the contiguity of the lesion with the cervical vertebrae and ominous appearance of the biopsy material, the history of antecedent trauma and computed tomography findings allowed preoperative accurate diagnosis. To our knowledge, myositis ossificans traumatica located in the cervical paraspinal region is very rare.
The diagnosis of a gunshot wound can be difficult especially if the morphology is not typical. In the case presented a neck injury was not recognised as a gunshot wound by several clinicians and radiologists although the bullet could be seen at the base of the patient's tongue and on all X-rays taken. This misinterpretation may have been caused by a "professional blinkers phenomenon".
The highly variable clinical course of cervical artery dissections still poses a major challenge to the treating physician. This study was conducted (1) to describe the differences in clinical and angiographic presentation of patients with carotid and vertebral artery dissections (CAD, VAD), (2) to define the circumstances that are related to bilateral arterial dissections, and (3) to determine factors that predict a poor outcome. Retrospectively and by standardised interview, we studied 126 patients with cervical artery dissections. Preceding traumata, vascular risk factors, presenting local and ischemic symptoms, and patient-outcome were evaluated. Patients with CAD presented more often with a partial Horner's syndrome and had a higher prevalence of fibromuscular dysplasia than patients with VAD. Patients with VAD complained more often of neck pain, more frequently reported a preceding chiropractic manipulation and had a higher incidence of bilateral dissections than patients with CAD. Bilateral VAD was significantly related to a preceding chiropractic manipulation. Multivariate analysis showed that the variables stroke and arterial occlusion were the only independent factors associated with a poor outcome. This study emphasises the potential dangers of chiropractic manipulation of the cervical spine. Probably owing to the systematic use of forceful neck-rotation to both sides, this treatment was significantly associated with bilateral VAD. Patients with dissection-related cervical artery occlusion had a significantly increased risk of suffering a disabling stroke.
The influence of different seat properties on the head-neck motion during a low-velocity rear-end impact was tested using a Hybrid III-dummy fitted with a modified neck (RID-neck). The results show that by modifying the properties of the seat-back and head-restraint it is possible to influence the head-neck kinematics to a great extent. It was possible to virtually eliminate the neck extension motion during a rear-impact. This will hopefully result in a significant decrease in neck injury risk in real world rear-impacts.
Over the last few years there have been various reports of the use of tissue expanders as an adjunct to microvascular free transfer of tissue. This study looks at the effect of expanding the actual flap prior to transfer. Two case reports are given and it is proposed that expanded free flaps are large and thin. They have a capsule which enables them to be safely sutured under tension. They are "delayed" by the expansion process and the donor deformity is minimal. It is suggested that tissue expansion is a useful technique prior to free flap transfer for the reconstruction of large defects.
The effect of legislation for the compulsory wearing of seat belts by car drivers and front seat passengers was prospectively analysed in the county of Skaraborg, Sweden. After legislation fewer vehicle occupants were admitted to the hospitals, depsite a 40 per cent increase in crashes reported to insurance companies in the country. The frequency of seat belt wearing among injured victims was considerably lower than that recorded in regular traffic surveys. Significantly fewer head and neck injuries were suffered by restrained drivers than by unrestrained. Restrained front seat passengers had more thoracic injuries than unrestrained, but the degree of severity was less. The frequency of seat belt wearing by rear seat passengers was low, but they were injured as severely as front seat occupants. It seems important to insist on an increase in seat belt wearing for this category.
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Consecutive road traffic accidents attenders with multiple or 'whiplash' neck injuries were assessed following the accident, at 3 months and 1 year. Considerable changes in vehicle-driving behaviour and in attitudes to travel were reported. Concern about travel as a driver and as a passenger was usual. A sizeable proportion of subjects suffered severe and persistent anxiety associated with limitations of everyday life. The findings have implications for clinical assessment and treatment, road safety, and medical reports in compensation proceedings.
Trauma from motor vehicle accidents is one of the leading causes of death in the United States; moreover, the costs related to personal harm are only second to cancer. Head and neck injuries predominate and involve contact with the vehicle's interior (80%), contact with the vehicle's exterior (12%), or noncontact with the vehicle (8%). The patient with maxillofacial defects resulting from motor vehicle accident will have numerous soft tissue and hard tissue injuries ranging from neurologic involvement to fractures and/or avulsions of the temporomandibular joint, maxillae, mandible, teeth, and supporting structures. Tooth avulsions, pulpitis, and fractures without pulpitis have been found in a 4:2:1 ratio. The prosthodontist plays an important team role by anticipating the increased functional demands that may be placed on the required prostheses and by anticipating the preprosthetic procedures and counseling that may be necessary to assist in the total treatment.
The physiological and physical principles involved in the management of facial lacerations are reviewed. Because there have been no previously published descriptions of the actual problems encountered in clinical practice in A & E Departments, a prospective clinical survey of 100 consecutive patients with facial lacerations repaired by oral & maxillofacial house surgeons was undertaken and a series of lacerations was studied in detail. These included periorbital, nasal, labial and neck injuries. High magnification revealed irregularity of wound margins in almost all cases, frequent localised ischaemia, necrosis, localised dehiscence and infection or inadequate closure. Because all of these problems are likely to increase scarring and deformity, this study suggests the need for a re-appraisal of the management of facial lacerations, particularly in relation to local skin edge excision, prevention of infection, and the use of magnification during closure.
Fractures of the hyoid bone are known to occur in 17-71% of fatalities following manual strangulation, but are infrequently recognised in survivors. Two cases are presented of attempted manual strangulation in young women (aged 30 and 35 years) in which lateral neck X-rays disclosed an isolated fracture of the greater horn of the hyoid bone. In both cases the X-rays were performed because the victim complained of symptoms: one victim complained of pain on swallowing and on neck movement. The other complained of pain on speaking and swallowing. Radiological demonstration of an isolated hyoid fracture is of great evidential value in criminal proceedings in cases of attempted manual strangulation, especially when presentation to the police authorities is delayed and external evidence of neck injury may be minimal. Consideration should be given to obtaining X-rays in those cases where symptoms persist.
INTRODUCTION: The aim of this project was to determine whether there is a statistically significant difference between the means of static and dynamic (measured during walking) measurements of head posture. METHODS: The sample consisted of 50 subjects, 25 women and 25 men, 20 to 25 years of age. None had a history of orthodontic treatment, head or neck injury, or nasal breathing problems, and none wore eyeglasses to correct vision. Static measurement of head position was recorded by using the self-balance position. Dynamic measurements of head position were made with an inclinometer device with the subject walking in a relaxed manner for 5 minutes. The data, measured in degrees, were stored in a pocket data logger. Recorded static and dynamic head posture data were transferred to a computer for analysis. The means of the measurements were statistically compared with the t test (alpha = .05). The mean walking head position was tipped forward relative to the mean static head position. RESULTS: The mean value of static position minus walking head position measurements was +4.60 degrees . The differences between the 2 recordings were statistically significant (P < .001). CONCLUSIONS: Static and walking head position measurements are not interchangeable. Therefore, it might be advisable to use the mean dynamic measurement of head position to represent natural head position for positioning when taking case records such as lateral and posteroanterior cephalograms, clinical extraoral photography, or 3-dimensional imaging.
OBJECTIVE: To improve clinical decision making in posttraumatic neck pain by investigating the additional value of fear-avoidance variables in predicting chronic neck pain disability. DESIGN: An inception cohort with baseline assessment 1 week posttrauma and outcome assessment 24 weeks posttrauma. Predictive factors include pain intensity, Neck Disability Index (NDI), catastrophizing, fear of movement (Tampa Scale for Kinesiophobia [TSK]), and avoidance muscle behavior. SETTING: Hospital emergency department of a general hospital. PARTICIPANTS: A consecutive sample of 90 people reporting of pain in neck or head region after a motor vehicle collision. Eighty-two subjects (91.1%) of the sample provided 24-week follow-up on the outcome. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The NDI assessing physical disability of subjects with neck pain. RESULTS: By using a combination of the baseline NDI and TSK, it appears to be possible to predict chronic disability with a probability of 54.3% (95% confidence interval [CI], 35.2%-72.3%) after entering the NDI (cutoff, 15) as a first test, and with a probability of 83.3% (95% CI, 70.3%-91.3%) after entering the TSK (cutoff, 40) in a second test. CONCLUSIONS: A simple rating of baseline neck pain disability within a week of the trauma, separately or in combination with a test for fear of movement, can be used to predict future outcome. Patients showing fear of movement can be offered an intervention that focuses on reduction of this fear.
There will always be an inherent risk to participation in contact sports. Appropriate education of coaches, players, and parents is important. Recurrence rate is high in the athlete who has experienced transient quadriplegia or any neck injury. The athlete and his family should be made aware of this risk. Counseling is even more important, both from a medical and legal standpoint, in the patient with underlying spinal stenosis, found either incidentally or following an episode of transient quadriplegia. In these situations, consideration of consultation with a neurologist or neurosurgeon is prudent.