Neck pain and back pain to dentists

8/12/2019 Neck pain and back pain to dentists

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2.3.1.1:Higher cervical spine c1,c2)The higher cervical spine consists

Of the atlas (C1) and the axis (C2).

These two vertebras have

Distinct features from the other whole of cervical region.

The first vertebra atlas form a joint superiorly with the

Occipital region by forming joint called as Atlanta occipital joint and

inferiorly articulates with the second vertebra through the atlantoaxial joint.


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The joint between C1 andC2 takes part in fifty percent of cervical rotation

while the atlanto-occipital joint takes part in fifty percent of flexion and

extension for movements in saggital plane(flex & ext)

Atlas C1) The C1 vertebra is ring-shape with a body. It is consists anterior and

posterior arcs, two lateral masses, and two transverse processes, the

foramen in vertebra for passage of vertebral artery superior and

inferior facets are present on lateral masses. The superior articular

facets concave, and facing up and inward. These facets are forming

joints with the superior condyles of occiput and faced downward and

outward. Inferior articular facets are flat and are facing downward and

inward for articulation with the superior facets of C1 vertebra.

AXIS C2):C2 is consist of greater body with odontoid process( known as dens

that articulates with the atlas through the anterior articular facet thick

pedicles, transverse processes and laminae).Lower cervical spine:

The C3, C4 spinal process are usually bifid, whereas the C7 spinal

process is usually no bifid. .(Bogduk N ,et al 1991)

Facet joints:The facet joints of the cervical spine basically movable joint that have

synovial fluid within joint and having a layer of fibro cartilage. The capsules

surrounding the joints in lower part of cervical spine are looser as

compared to upper cervical spine and allow gliding movement at facet


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joints. Thejoints are inclined at an angle of 45and85 from the transverse

plane and the sagittal plane thus preventing excessive anterior translation(

Robert E W,1987)[14,15,16]

2.3.1.2Intervertebral disksspecific discs are positioned between the vertebras from C2-C7.this

specific disk is made up of four parts that is including nucleus pulposus in

mid , nucleus pulposis is covered with annulus fibrosis , and second

plates are attach to surroundings vertebral bodies. The basic function of


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disk is transfer the compressive forces during all possible movements.

Anterior region of disk is higher thick when it is compared with posterior

region it is play important role to maintain whole spinal curve .The

intervertebral disks are involved in cervical spine movements , stability, and

load bearing .(Bogduk N ,et al 1991)The annular fibers vulnerable to injury by

rotational forces.[17].

LigamentsThe cervical spine is consist of two columns anterior, and posterior

columns. It can also be useful to think in terms of a third (middle) column,

as follows:

The anterior column consists of the anterior longitudinal ligament andthe anterior two thirds of the vertebral bodies, the annulus fibrosus,

and the intervertebral disks


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The middle column is composed of the posterior longitudinal ligamentand the posterior one third of the vertebral bodies, the annulus

fibrosus, and the intervertebral disks

The posterior column is made up of the posterior arches, includingthe pedicles, transverse processes, articulating facets, laminae, and

spinous processes

1)The longitudinal ligamentsmaintains the integrity of the spinal column2) the anterior and posterior longitudinal ligamentsplay role in

maintaining the structural integrity of the anterior and middle

columns,[17]3) the posterior column alignmentis stabilized by the nuchal and

capsular ligaments, and the ligamentum flavum.

4) The transverse ligamentis the most important ligament for preventingabnormal anterior translation. (Fielding JW, et al 1974)[18]

5)The alar ligamentsrun from the lateral aspects of the dens to theipsilateral medial condyles of occiput and to the ipsilateral atlas. Alar

ligament prevent excessive lateral and rotational movement and

allowing flexion and extension.

6)The supraspinous ligament(runs along the tips of the spinousprocesses) the interspinous ligaments(run between adjacent spinous

processes )and the ligamentum flavum (runs from the anterior

surface of the cephalad vertebra to the posterior surface of the

caudad vertebra )maintain stability between the vertebral arches. The

ligamentum flavum and (interspinous ligament prevent hyper flexion

and anterior translation. Panjabi MM, et al )[19,20,21]


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2.3.1.3: MusclesMuscles of neck & spine includes

1)SternocleidomastoidThe originis the manubrium and the the medial 1/3 of the clavicle.Insertion:into the mastoid process

Function;

Flexion to same side and extension to opposite side.


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2)Scalenes

The origin of the scales are the transverseprocess of the cervical vertebraeInsertion: into the first and second ribs.

Function:When the scalenes contract they help elevate

the top two rib during inspiration and also playa role in flexion of the neck and rotating it.
http://antranik.org/wp-content/uploads/2011/10/sternocleidomastoid-and-scalenes-muscles-of-the-neck.jpg?e24adfhttp://antranik.org/wp-content/uploads/2011/10/sternocleidomastoid-and-scalenes-muscles-of-the-neck.jpg?e24adfhttp://antranik.org/wp-content/uploads/2011/10/sternocleidomastoid-and-scalenes-muscles-of-the-neck.jpg?e24adf


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3)Splenius musclesThey origin:

runs from the nuchal ridges of the

occipital bone all the way to C7.

Insertion:into the mastoid process.

Function:it helps rotate the head to the same side

and laterally flex the head to the same side.

4)Erector Spinae: lateral to medial: iliocostalis, longissimus,spinalis)

These are 3 separate, long columns of muscles on

either side of the vertebral column that extend the

back and help return the trunk to an upright position.
http://antranik.org/wp-content/uploads/2011/10/splenius-muscles-capitis-and-cervicis.jpg?e24adfhttp://antranik.org/wp-content/uploads/2011/10/splenius-muscles-capitis-and-cervicis.jpg?e24adf


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1)The iliocostalis runs from the iliac crest to the ribs.2)The longissimus runs medial to the iliocostalis. It runs from the

spinous processes of the lumbar vertebrae to the ribs.

3)The spinalis runs medial to longissimus. It runs from onespinous process to the one above it on the lumbar and thoracic

vertebrae.

Function:They are literally what help straighten your back up.

Antranik,Muscles of neck and vertebral column.antranik.org 2011;)
http://antranik.org/wp-content/uploads/2011/10/erector-spinae-iliocostalis-longissimus-spinalis.jpg?e24adf


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2.4: Biomechanics of NeckMovements of neck: There are various types of movements at neck That

are included

Flexionit is the type of neck movement that show chin is movedownward toward chest. This is known as neck flexion

Extension it is the type of movement in which the neck extends, andlooking up towards the roof this is known as extension of neck


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Lateral rotation of neck ,to the left side and to the right side it is thetype of movements in which simply direct lateral rotation of neck to either

side is occur

Lateral flexion can be define as it is a type of movment in which attempts

to place the ear on the shoulder by a lateral movement of the neck, try to

leading the ear to the tip of the shoulder .


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There are total six movements of neck that can directly perform if patienthad no any type of fusion.

The movements of neck play important role in activities of daily living with

full ranges.(Timothy, et al)

Biomechanics of the Neck2.4.1: Neck injury mechanismsThe human neck is consist of very complicated mechanics , which is

contain very essential neurological system ,vascular system and

respiration mechanism and seven cervical vertebra and spinal contents .

The total neck injury chanches that are occur in road accidentsseemsrelatively less when compared to head injury, except for specific accident

in which the collision occurs is greater than 50% in

The cervical spine is most important segment of the whole body. Neck is

the slender column that can be affected various types of bending loads with

axial loads. the injury mode of neck region can be classified in to

Compression injuries of neck Tension flexion injuries of neck Tension extension injuries of neck Compression extension injuries of neck Compression flexion injuries of neck Lateral bending injuries of neck


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2.4.1.1: Compression injuries.It is a type of injury that is occur due to crown

impact of head that is produce compression load on the neck which is

associated with bending load and are depended on the head

orientation,. Neck configuration , and friction of surface , in compression

injuries compression may comes from the total body mass that is

followed by the head, and is stopped by resistanting type of force.

2.4.1.2:Tension Extension injuriesTension extension injuries are the injuries that are most

commonly occur in neck. these are included

Whiplashed injuries

Hangman s fractures

Structural injuries of the spine2.4.1.3: Tension Flexion Injuries:It is a type of injury that are uncommon because the complain of chronic

severe pain in neck by belted occupants that are involve in the frontal

crashe . in case of severs frontal crashe atlento-occupit separation can

occur at neck.


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2.4.1.4 Compression Extension injuries:It's the kind of injuries that occur when the head hits the windscreen

Neck is place in forward and backward direction at the same time. Such

type of sudden impact is sustained the one or more spinous processes

fractures, and injuries of the pedicles, or injuries of facets, and lamina.

2.4.1.5: Compression Flexion injuries:In this kind of injuries the vertebra(vertebral body ) compression is

resulted due to combination of excessive flexion and compressive loads of

vertebral segment s that is occur due to compressive stresses.2.4.1.6: Lateral Bending Injuries:

It is a type of injuries that are occur due to side or oblique impact and also

associated with shear and axial loading. This type of loading leads toward

the lateral wedge fracture and fracture of posterior element of vertebral

column.[22]

2.5: Neck painNeck pain is discomfort in the muscles, nerves, bones (vertebrae), and the

intervertebral disks

2.5.1: CausesNeck pain can result from a variety of causes, including:


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Whiplash Muscle strain. Degenerative disc disease Herniated disc Cervical spondylosis Cervical spinal canal stenosis Rheumatoid and osteoarthritis Tumor/cancer/systemic .( Melbourne,.Therapeutic Guideline 2012

Nov.)

2.5.2: ClassificationNeck pain is classified in to different catagrioy most commonoly

classification is based on

Neck pain Duration

Neck pain Causes

Classifcation based on Duration. Acute neckache. Chronic neckache Acute neck pain Acute neck pain can be define as the neck pain ranges from I to 6

weeks

Chronic neck pain


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Chronic neck pain can be define as neck pain ranges from more

than 6 to 12 weeks. (Encyclopedia of pain)

Classification based on cause.

Non specific causes of pain Specfic causes of pain

Non specific causes of neckache.

In non specific causes of neckache it is including Radiculopathy or

narrowing of spinal canal

Specfic causes of neck ache.

In specific causes of neckache there is including any type 0f infection

or cancer. .( Curtis W. Slipman, et al)

Non specific pain is type of pain which shows that the basic causeof pain not known accurately . but it is believe that pain is araises

from the soft tissues structures such asmuscles,fascia,andligaments..( Curtis W. S, et al)[23,24]

2.6: Assessment of neck pain include
http://en.wikipedia.org/wiki/Muscleshttp://en.wikipedia.org/wiki/Muscleshttp://en.wikipedia.org/wiki/Muscleshttp://en.wikipedia.org/wiki/Fasciahttp://en.wikipedia.org/wiki/Fasciahttp://en.wikipedia.org/wiki/Fasciahttp://en.wikipedia.org/wiki/Ligamenthttp://en.wikipedia.org/wiki/Ligamenthttp://en.wikipedia.org/wiki/Ligamenthttp://en.wikipedia.org/wiki/Fasciahttp://en.wikipedia.org/wiki/Muscles


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Subjective History Objective history Investigation

Subjective historyinclude name,sex,occupation,Occupation, past medicalhistory,past surgical history , history of fever,psychological

history,occupational history sould be considered.because mostly neck pain

is occupational related and common in dentists , industrial, and agricultural

workers [25,26].Objective history

Includes inspection, palpation (tenderness), and assessment ofrange of motion (ROM).

Questions about Pain characteristicsintensity,duration,frequency,relieving factors,aggravating

factors and its quality.

Any abnormality in appearance ,ROM, and a tenderness atcervical spine indicates that there is any cervical spine

pathology. In case of neck pain nuchal rigidity is also assessed

and this is assessed by following two tests Kernig's sign and

Brudzinski's sign (reflective flexion of the knees when patient is

on his/her back and the neck is bent forwards) are tests used to

demonstrate nuchal rigidity. Examination of upper limb is also

important for the exclusion of cause neck pain.

Neurological exam:Includes testing of dermatomes ,myotomesor strength, reflexes, The hallmark sign of cervical


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radiculopathies are pain, loss of sensation and weakness in

motor activities. Spurling test: It is a type of test that May be

performed to test for cervical nerve releated pain .if the pain isradiated in to upper extremity on the same side toward head is

rotated then spurling test will be positive . A +ve test is highly

suggestive of cervical radiculopathy.[27,28,29,30]
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Neck pain and back pain to dentists

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