Spine, Back, and Musculoskeletal




© Springer International Publishing Switzerland 2017
Maggi A. Budd, Sigmund Hough, Stephen T. Wegener and William Stiers (eds.)Practical Psychology in Medical Rehabilitation10.1007/978-3-319-34034-0_18


18. Spine, Back, and Musculoskeletal



Ellen H. Zhan1, 2  


(1)
VA Boston Healthcare System, VA Boston Healthcare System, Boston, MA, USA

(2)
Harvard Medical School, Boston, MA, USA

 



 

Ellen H. Zhan

Email:


Keywords
MusculoskeletalNeckPainBackDisorders



Topic


Musculoskeletal pain can be caused by disorders of bones, joints, muscles, tendons, ligaments, bursa, or in combination. The human spine is formed by 30 vertebrae including: 7 cervical, 12 thoracic, 5 lumbar, 5 sacrum (fused together), and 1 coccygeal vertebrae along with intervertebral discs. The spine protects the spinal cord, which issues 31 pairs of spinal nerves that innervate trunk and all extremities. The brain and spinal cord comprise the “central nervous system ” and both innervate the whole body.

The cervical and lumber spines are quite mobile with less support compared to thoracic and sacrococygeal spine. Therefore, the cervical and lumbar spine are particularly predisposed to injury and degenerative changes (e.g., arthritis, mal-alignment, and dislocation). This chapter will then review some common neck and back anatomy and some problems that frequently present for medical rehabilitation.


  1. A.


    Neck Issues : Introduction , Prevalence, and Causes

    Cervical spinal problems have been described by Egyptian physicians in ancient times, more than 5000 years ago [1]. The neck is the most mobile portion in the whole spine and is only supported by ligaments and neck muscles.


    1. 1.


      Anatomy

      The cervical spine comprises seven vertebrae and intervertebral discs. The joint between the occiput and the first cervical vertebra (the atlantooccipital joint) allows for approximately one-third of flexion and extension and one-half of lateral bending of the neck. The C1-C2 cervical vertebrae (the atlantoaxial joint) allows for 40–50 % of rotational range of motion. The C3-C7 joints allow for approximately two-thirds of flexion and extension, 50 % of rotation and lateral bending but the more lateral bending occurs at C3-C4 and C4-C5; the greatest amount of flexion is at C4-C5 and C5-C6 [1]. The normal cervical spine has a shallow lordosis, maintained by the neck muscles and this lordosis can be decreased in patients with degenerative changes.

       

    2. 2.


      Range of Motion ( ROM )

      The cervical spine can rotate about 90°, laterally bend at 45°; forward flex to 60° and extend backward 75°.

       

    3. 3.


      Eight Cervical Spine Nerves

      Each spinal nerve arises from the spinal cord by two roots, the ventral and dorsal spinal roots. The ventral root carries motor fibers and the dorsal root carries primary sensory fibers, both of the spinal roots combine to form the spinal nerve.

       

    4. 4.


      Prevalence of Neck Pain

      With or without upper limb pain occurs from 9 to 18 % in the general population. One out of three individuals report at least one incidence of neck pain in their lifetime [1].

       

    5. 5.


      Causes

      The etiologies of neck pain can be varied and could be due to systemic or local causes as listed partially as below:



      • Some systemic diseases, such as rheumatoid arthritis, spondyloarthritis, polymyalgia rheumatica, or bone metastases.


      • Some focal problems can include cervical strain, sprain, internal disc disruption (discogenic pain), or cervical spinal degenerative change, cervical “whiplash” syndrome, and myofascial pain.


      • Cervical degenerative changes are the most common cause of acute and chronic neck pain.


      • The main cause extremity symptoms and neurological dysfunction include cervical radiculopathy and cervical spondylotic myelopathy.


      • The most severe injuries and greatest wear and tear occur between C4 and C7 [2]. The foraminal narrowing is a common cause of cervical radiculopathy [3].

       

     



  1. B.


    Neck Injuries and Conditions


    1. 1.


      Cervical Sprain and Strain

      A sprain is an overstretching or tearing of ligaments and/or tendons with microscopic contusion or hemorrhage or both.

      A strain may result from an injury to the neck muscle and ligaments with associated spasm of the cervical and upper back muscles. The cervical strain can also be caused by accumulated physical stresses of everyday life, including poor posture and poor sleeping habits.

      The typical symptoms are experienced as pain, stiffness, and tightness in the upper back or shoulder, and can last for up to 4–6 weeks.

       

    2. 2.


      Cervical Whiplash Syndrome

      The diagnosis of cervical strain is based on the patient’s history of having a traumatic incident with the acute onset of pain on neck and upper back muscles without abnormal neurological dysfunction.



      • Caused by a traumatic event with an abrupt flexion/extension movement to the cervical spine.


      • Whiplash injury is a typical example of cervical sprain and strain.


      • Symptoms of whiplash include severe neck pain, spasm, range of motion loss in the neck, and occipital headache.


      • Pain can be persistent with little identifiable abnormality seen on MRI, CT, X-ray, or bone scan imaging.


      • Often multiple structures can be injured including soft tissues, spinal nerve, intervertebral disc, posterior longitudinal ligament, interspinous ligaments, facet joints, or other osseous structures.


      • After the traumatic incidence, 60 % of the patients can get better within the 1st year, 32 % on 2nd year, 8 % have permanent problems [4–6].


      • Eight risk factors are identified: female, young age, prior history of neck pain, rear collision, stationary vehicle, severity of collision, not being at fault, and monotonous work [7].

       

    3. 3.


      Cervical Spondylosis



      • Caused by degenerative changes and/or inflammation in the intervertebral disc and vertebral body.


      • Degenerative changes in the cervical spine are apparent on radiographs of many adults over the age of 30 but the degree of radiographic change is poorly correlated with the presence or severity of pain [8].


      • The degenerative process that occurs in the intervertebral disc is thought associated with an inability to effectively distribute pressures between the disc, vertebral endplates, and facet joints.


      • Usually axial pain is more severe than extremity pain in cervical discogenic pain. Symptoms are often exacerbated when the neck is held in one position for prolonged periods, such as occurs with driving, reading, or working at a computer.


      • Factors that contribute to degenerative changes of the spine: aging, trauma, work-related activities and genetics.


      • Usually causes osteoarthritis in the zygapophyseal (facet) and unconvertebral joints.


      • Caused osteophytes formation along the vertebral bodies, facet joints, and laminal arches, resulted in foraminal stenosis and central spinal canal stenosis.

       

    4. 4.


      Cervical Radiculopathy



      • Cervical radiculopathy refers to dysfunction of the spinal nerve root that may manifest with pain, weakness, reflex changes, or sensory changes.


      • Multiple conditions can cause cervical radiculopathy, including cervical foraminal stenosis, cervical herniated disc, herpes zoster, lyme radiculopathy, diabetic polyradiculopathy but degenerative changes in the spine are overwhelmingly more common than the other causes, accounting for 70–90 % of cases.


      • Spurling’s maneuver can reproduce the patient’s radicular pain, which is a sudden electric shock like paresthesia extending down from neck to the ipsilateral arm with flexed neck, this illustrates a positive Lhermitte’s sign.

       

    5. 5.


      Cervical Spondylotic Myelopathy



      • Defined by degenerative changes narrowing the spinal canal, resulting in cervical spinal cord injury or dysfunction.


      • Consider when patient presents neck pain with following neurological complaints: tingling, numbness, weakness, coordination impairment, gait disturbance, bowel or bladder retention or incontinence, and sexual dysfunction.

       

    6. 6.


      Cervical Facet Syndrome



      • The zygapophyseal joint is commonly called the facet joint and can cause axial pain.


      • The most common cause of whiplash-related neck pain and headaches.


      • Patients often have a history of trauma with an abrupt flexion–extension type injury, or an occupation which leads to repeatedly positioning the neck in extension.


      • There is no specific examination, or imaging finding, that provides confirmatory diagnosis.


      • A fluoroscopically guided intra-articular injection with anesthetic drug into the innervation of the joint resulting in relief is considered the definitive diagnostic tests.

       

    7. 7.


      Cervical Myofascial Pain



      • Regional pain with associated trigger points, taut bands, and pressure sensitivity.


      • Myofascial pain can be a nonspecific manifestation of any pathologic condition that causes pain from the neck to the shoulder and can also be associated with muscle sensitivity, depression, anxiety, insomnia, and likely represents a less generalized variant of fibromyalgia.


      • Chronic muscle overuse or direct trauma may play a role in the development of myofascial pain and trigger points [9].

       

     



  1. C.


    Low Back


    1. 1.


      Anatomy

      The spine of the “low back” comprises five lumbar vertebrae and intervertebral disc, which consists of internal nucleus pulposus (gelatin-like material) and the outer of annulus fibrosis, as well as supporting muscles, ligaments, and joints. It permits lumbar spine flexion, extension, lateral bending, and twisting. About 90 % of spinal flexion and extension occurs at the L4-L5 and L5-S1 level, which explains the high incidence of disc problem at these levels.

       

    2. 2.

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Jun 25, 2017 | Posted by in PSYCHOLOGY | Comments Off on Spine, Back, and Musculoskeletal

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