CAUSES OF NECK AND BACK PAIN
SOURCES OF REFERRED
(a) cardiac (b) pulmonary (c) diaphragm
(iii) Entrapment neuropathy
(a) arm (b) forearm (c) cervical rib
(iv) Shoulder joint
i. A.C. joint
(v) Sternoclavicular joint
ulcer / pancreatitis
(ii) renal pathology
(iii) gynecological problems
(iv) Retro-peritoneal pathology
(v) Hip and sacroiliac joint pathology
Neck pain in the absence
of neurologic signs are the most common symptoms of cervical disk degeneration.
Patients generally complain of aching, stiffness, and limited motion.
The pain is commonly posterior and paracentral but may be referred into
the trapezius, rhomboids, and interscapular area. Associated pain commonly
occurs in one or both shoulders (71%), arm (44%), forearm (31%), and hands
(28%). Headaches, typically suboccipital or temporal, are reported by
one-third of patients.
Branches from the
dorsal and ventral rami of the spinal nerves innervate surrounding structures
such as the annulus fibrosus, anterior and posterior longitudinal ligaments,
periosteum, and facet capsules. Primary muscle afferents also travel with
motor nerves to the paraspinal, shoulder girdle, and scapular muscles.
Reproduction of axial pain during provocative procedures such as discography
or direct stimulation of the facet joints or annulus fibrosus.
The neck pain of cervical
disk degeneration is frequently precipitated, aggravated, and perpetuated
by motion, especially neck extension. The pain is relieved by rest. Activities
such as shaving, putting on socks and shoes, reading with bifocals, vacuuming,
reaching for high shelves, and maintaining incorrect posture while driving
or using the telephone can all precipitate or aggravate degenerative symptoms.
The pain also can be exacerbated by fatigue, anxiety, or stress.
The patient commonly
assumes a slightly flexed position to maximize comfort. In cervical disk
degeneration, extension is the first movement lost.
is the most common cause of myelopathy in middle-aged and elderly patients.
A combination of several factors contributes to the development of the
myelopathy. When cervical spondylosis (which includes annular bulging,
osteophyte formation, facet hypertrophy, and ligamentum flavum infolding)
is superimposed on a developmentally narrow cervical canal, myelopathy
is most likely to develop. The excessive reduction in cross-sectional
area available for the spinal cord causes clinically significant compression
of the spinal cord and production of the signs and symptoms of myelopathy
is a clinical diagnosis based on a sclerotomal distribution of motor and/or
sensory changes or complaints. Any process in the cervical spine that
causes impingement of exiting nerve roots can lead to a radiculopathy.
Impingement may be brought about by acute pathologic changes or by progressive
degenerative changes, as seen with cervical spondylosis. Nerve root compression
due to a soft disk herniation is the most common cause of cervical radiculopathy
in young adults. In older patients, spondylosis, manifested by annular
bulging and uncovertebral oseophytes, compresses the nerve root anteriorly,
causing a radicular syndrome.
Acute Low Backache
Pathological fractures accompanied by
Infections constitutional symptoms
tumour LOA, L.O.W
Predominant leg pain
with minimal back pain - sciatica
Failed back surgery
Low Back Pain
low back pain also may be described as “simple backache,”
the everyday bodily symptom that most adults get at some time in their
life. This is the common “mechanical” back pain of musculoskeletal
origin in which symptoms vary with physical activity. Clinically simple
backache commonly is related to physical “strains”, although
these often are normal daily activities, and perhaps in reality, it usually
develops spontaneously. Nonspecific low back pain may be very painful
and often spreads as referred pain to one or both buttocks or thighs,
but it is a benign, self-limiting condition.
(iii) Repetitive lifting
(iv) Use of jackhammers and heavy machinery
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