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Is cervical spondylosis an occupational hazard for urologists?

Amongst 248 urologists who spend a substantial amount of their operative work performing endoscopic procedures and who were surveyed with reference to symptoms of cervical spondylosis, 118 admitted that they were, or had been, troubled by such symptoms (47.6%). A control group of 113 General Practitioners matched for age at qualification had no significantly fewer symptoms (43.4%). Similar numbers in each group had a history of neck injury, often of a sporting nature, and also had similar incidences of symptoms including pain down the arm. Significantly more urologists have current severe symptoms and more frequent attacks of trouble. Urologists offered a variety of advice on how to ameliorate these symptoms, which included attention to posture, the need for self-controlled motorised endoscopic tables, an endoscopic stool with wheels and the limitation of the number of transurethral prostatectomies per operating list.

Adult↗

Cognitive symptoms in patients with posttraumatic headache.

A variety of symptoms (postconcussion symptoms) have been consistently reported following mild head or neck injury. One symptom which may have been under reported is cognitive impairment. We conducted a retrospective study of 100 patients presenting for evaluation and treatment of posttraumatic headache at our headache clinic. Sixty-five percent reported difficulties with either memory, concentration, and/or thinking. The most common cognitive symptoms reported were concentration+memory problems, concentration + memory + thinking difficulties, concentration disturbances, and difficulty remembering, respectively. Subjects in both groups (with cognitive symptoms and without cognitive symptoms) were similar in age, but females seemed more predisposed than males to cognitive impairment following mild head injury. It is suggested that clinicians thoroughly evaluate patients for cognitive symptoms, particularly when patients have a permanent condition and are subsequently involved in litigation.

Adult↗

Design and assessment of an adaptive intermittent cervical traction modality with EMG biofeedback.

An intermittent cervical traction modality with closed-loop traction force control based on EMG biofeedback was developed and used for clinical study. This system consists of a EMG scanner, on-line self-adjusted traction force controller, audio/video alarm system, real time therapeutic status display, computer interface hardware, and control software. Twenty-four subjects with diagnosed cervical radiculopathy and muscle spasm symptom who were randomly divided into two groups served as subjects in this study. The control and experimental groups were treated with conventional open loop and new EMG biofeedback closed loop traction control protocols respectively. The results of this study indicate that the average reductions in paraspinal EMG signal during traction after 7 weeks treatment for experimental and control groups were 71 and 50 percent, respectively (p < 0.001). These results not only support the clinical use of intermittent, sitting traction to produce cervical paraspinal muscle relaxation, but also revealed that the average myoelectric activity of cervical paraspinal muscle during traction was reduced as traction force increased over the 7-week duration of traction treatment. Through EMG biofeedback traction force control, muscle injury, neck soreness, or pain after traction may be avoided.

Adult↗

Carotid artery dissection after treadmill running.

The case is presented of carotid artery dissection causing Horner's syndrome in a 25 year old woman after treadmill running. She presented with characteristic eye signs and mild pain. Early diagnosis and treatment was associated with no long term, serious complications. It is now recognised that carotid artery dissection is more common than previously thought. Better imaging of the carotid artery has facilitated the diagnosis, and it is now essential to rule out this potentially fatal condition in patients presenting with postganglionic Horner's syndrome. It is accepted that relatively trivial trauma can cause a carotid artery dissection, and many sporting activities may place young, fit, healthy people at risk.

Adult↗

Dysphagia and deformity after undetected odontoid fracture in elderly patients.

Trauma in elderly patients is often difficult to evaluate and neck injuries are probably more common than is documented. A case is described of a missed odontoid peg fracture with the unusual presentation of dysphagia and a rapidly developing cervicodorsal kyphos (head falling forward), which may well have been anticipated at several points in the management chain. The lessons to be learned are outlined, together with the subsequent management of this patient.

Accidental Falls↗

Werner Goldsmith: life and work (1924-2003).

Werner Goldsmith, one of the foremost authorities on the mechanics of impact and the biomechanics of head and neck injuries, died peacefully at home in Oakland, California, on August 23, 2003, at age 79 after a short, courageous battle with leukemia, ending a long and very distinguished career in mechanics, dynamics, and biomechanics, and an almost six-decades-long association with the University of California, Berkeley. He was one of the pioneering, eminent solid and fluid mechanicians who made an early transition to biomechanics, and in rising to equal distinction in their new fields, added great credibility to biomechanics as a discipline in its own right. He was also a distinguished and influential figure in bioengineering education at his own institution, and, more broadly, in the United States and abroad. An emeritus professor for over a decade, he continued to be active in research and teaching until the very last days of his life.

Biomedical Engineering↗

Localized spinal cord atrophy: significance of its demonstration.

Localized spinal cord atrophy was demonstrated in 6 cases by gas myelography. All of the patients had neck injuries with subsequent impairment of neurological function. Three representative cases are reported in full, and the remainder tabulated. The significance of the demonstration of this condition is discussed.

Adult↗

Correlation between stroboscopy and electromyography in laryngeal paralysis.

Twenty patients with vocal fold motion impairment were reviewed to correlate the findings of electromyography (EMG) and stroboscopy. The causes of motion impairment were idiopathic, previous surgery with recurrent laryngeal nerve injury, neck and skull base trauma, and neoplasm. The EMG studies were analyzed to assess the status of innervation of the immobile vocal fold. The presence or absence of the mucosal wave prior to therapeutic intervention was determined with stroboscopic examination. Eight of 10 patients with EMG evidence of reinnervation or partial denervation were found to have mucosal waves, and 3 of 10 patients with EMG evidence of denervation were found to have mucosal waves. Six patients developed mucosal waves after surgical medialization, despite evidence of denervation by EMG criteria. These findings support the premise that tension and subglottic pressure, rather than status of innervation, determine the presence of the mucosal wave.

Adult↗

The axial load teardrop fracture. A biomechanical, clinical and roentgenographic analysis.

The anteroinferior cervical vertebral body corner fracture was originally described by Schneider and Cann as the "teardrop" fracture. This report analyzes the biomechanical, clinical, and roentgenographic features of 55 such fractures obtained from the National Football Head and Neck Injury Registry. Teardrop fractures resulting from tackle football characteristically occurred in players attempting to make a tackle in which initial contact was made with the top or crown of the helmet. There were two fracture patterns associated with the anteroinferior corner (teardrop) fracture fragment: 1) the isolated fracture, which is usually not associated with permanent neurologic sequelae; and 2) the three-part, two-plane fracture in which there is an associated sagittal vertebral body fracture as well as fracture of the posterior neural arch. This latter pattern was almost always associated with permanent neurologic sequelae, specifically quadriplegia. Axial loading of the cervical spine was clearly identified as a mechanism of injury for both fracture patterns. Roentgenographic examination must include both anteroposterior and lateral views with computed tomography or tomography as necessary to determine the presence of the sagittal vertebral body fracture and the integrity of the posterior neural arch.

Biomechanical Phenomena↗

Spear tackler's spine. An entity precluding participation in tackle football and collision activities that expose the cervical spine to axial energy inputs.

We describe spear tackler's spine, a clinical entity that constitutes an absolute contraindication to participation in tackle football and other collision activities that expose the cervical spine to axial energy inputs. A subset of football players were identified who demonstrated: 1) developmental narrowing (stenosis) of the cervical canal; 2) persistent straightening or reversal of the normal cervical lordotic curve on erect lateral roentgenograms obtained in the neutral position; 3) concomitant preexisting posttraumatic roentgenographic abnormalities of the cervical spine; and 4) documentation of having employed spear tackling techniques. From data obtained by the National Football Head and Neck Injury Registry and the senior author's practice, 15 cases of spear tackler's spine were identified during 1987 to 1990. All 15 cases were evaluated because of complaints referable to the cervical spine or brachial plexus resulting from football injuries. Of these, 11 had complete neurologic recovery without permanent sequelae. Four cases resulted in permanent neurologic deficits: quadriplegia, 2; incomplete hemiplegia, 1; and residual long track signs, 1. Permanent neurologic injury occurred as the result of axial loading of a persistently straightened cervical spine from use of head-impact playing techniques. We suggest that individuals who possess the aforementioned characteristics of spear tackler's spine be precluded from participation in collision activities that expose the cervical spine to axial energy inputs.

Adolescent↗

EEG features in post-traumatic syndrome.

Standard and 24-hour ambulatory EEG recordings were performed on 54 patients with post-traumatic syndrome that developed after minor closed head trauma or whiplash neck injuries. Paroxysmal activity occurred in 9.2% of patients, either specific or non-specific. While being monitored, 24 patients experienced symptoms typical of this disorder without concurrent EEG abnormalities. No patient exhibited abnormalities in the 24-hour ambulatory recording alone. The symptoms of post-traumatic syndrome were not epileptogenic and the overall incidence of EEG abnormalities in this disorder was low, contradicting some previous reports.

Adolescent↗

Evaluation of cervical range of motion and isometric neck muscle strength: reliability and validity.

OBJECTIVE: To examine the test-retest reliability and construct validity of cervical active range of motion and isometric neck muscle strength as measured by the Multi Cervical Rehabilitation Unit (Hanoun Medical Inc., Ontario). DESIGN: A cross-sectional study. SETTING: Institutional practice. SUBJECTS: Twenty-one patients with neck pain and 25 healthy volunteers. METHODS: After a trial-run session, active range of motion (AROM) was measured in the subsequent two sessions, with 2-3 days in between. During each session, three measurements were taken for each direction (flexion, extension, lateral flexions and rotations). The measurement of isometric strength was after a 15-minute break following completion of the measurement of AROM. Three measurements were made for each of the six directions (flexion, extension, lateral flexions, protraction and retraction). The software of the Multi Cervical Rehabilitation Unit automatically recorded and calculated the maximum AROM and isometric strength. RESULTS: There was a good to high level of reliability in the measurement of AROM for both groups of subjects, with intraclass correlation coefficients (ICCs) ranging from 0.81 to 0.96. Results also demonstrated very good to excellent reliability in isometric strength measurement (ICCs ranged from 0.92 to 0.99). Moreover, there was a significant difference in isometric neck muscle strength (p = 0.001) and in AROM (p = 0.034) between the two groups. CONCLUSIONS: The Multi Cervical Rehabilitation Unit was found to be reliable and valid for testing the cervical active range of motion and isometric neck muscle strength for both normal and patient subjects.

Adult↗

Swimming injuries. An overview.

Most injuries and complaints encountered in swimming athletes are repetitive microtrauma or overuse, and successful management does not usually require surgical intervention. Rest and other measures to reduce inflammation are often required. Many injuries originate from faulty techniques or mechanisms, and an assessment must be made of the swimming biomechanics of any injured athlete to identify faults that may contribute to injury. It is also important to look at the total training programme of the athlete to identify other factors, such as weight training or dry land programmes, that may be contributing to injury. It is important to understand that, while rest or reduced training may be necessary, every effort to keep the swimmer "in the water' should be made, as cessation of training may lead to a rapid detraining effect.

Axillary Vein↗

Youth football injuries.

A paucity of literature exists on the subject of youth football with the majority of research concentrating on athletes of high-school age or older. Youth football participants include those athletes who compete in organised football prior to high school. Injury rate and severity for youth players is surprisingly low when compared with those competitors who have passed through puberty. As children mature they become bigger, faster and stronger, which is accompanied by an increased injury risk. Quarterbacks and running backs are injured almost five times more often than offensive linemen and linebackers. The knee is the most common site of injury followed by the ankle, wrist and hand. Fortunately, traumatic brain and cervical spine injuries are exceedingly rare. In this article, we review the youth football literature, identify the most common injuries by anatomical location, discuss the differential diagnoses and outline treatment options.

Adolescent↗

Median and ulnar neuropathies in university guitarists.

STUDY DESIGN: Descriptive study. OBJECTIVES: To determine the presence of median and ulnar neuropathies in both upper extremities of university guitarists. BACKGROUND: Peripheral nerve entrapment syndromes of the upper extremities are well documented in musicians. Guitarists and plucked-string musicians are at risk for entrapment neuropathies in the upper extremities and are prone to mild neurologic deficits. METHODS AND MEASURES: Twenty-four volunteer male and female guitarists (age range, 18-26 years) were recruited from the Belmont University School of Music and the Vanderbilt University Blair School of Music. Individuals were excluded if they were pregnant or had a history of recent upper extremity or neck injury. Subjects completed a history form, were interviewed, and underwent a physical examination. Nerve conduction status of the median and ulnar nerves of both upper extremities was obtained by performing motor, sensory, and F-wave (central) nerve conduction studies. Descriptive statistics of the nerve conduction study variables were computed using Microsoft Excel. RESULTS: Six subjects had positive findings on provocative testing of the median and ulnar nerves. Otherwise, these guitarists had normal upper extremity neural and musculoskeletal function based on the history and physical examinations. When comparing the subjects' nerve conduction study values with a chart of normal nerve conduction studies values, 2 subjects had prolonged distal motor latencies (DMLs) of the left median nerve of 4.3 and 4.7 milliseconds (normal, < 4.2 milliseconds). Prolonged DMLs are compatible with median neuropathy at or distal to the wrist. Otherwise, all electrophysiological variables were within normal limits for motor, sensory, and F-wave (central) values. However, comparison studies of median and ulnar motor latencies in the same hand demonstrated prolonged differences of greater than 1.0 milliseconds that affected the median nerve in 2 additional subjects, and identified contralateral limb involvement in a subject with a prolonged distal latency. The other 20 subjects demonstrated normal comparison studies of the median and ulnar nerves in both upper extremities. CONCLUSIONS: In this descriptive study of a population of 24 university guitarists, 4 musicians (17%) were found to have electrophysiologic evidence of median neuropathy at or distal to the wrist or carpal tunnel syndrome. Ulnar nerve electrophysiological function was within normal limits for all subjects examined.

Adolescent↗