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Dr.Hasib Pain Clinic, M K Medical Center, Peshawar (2025)

15/03/2019

When Neck Stiffness May Mean Meningitis

By Stefano M. Sinicropi, MD, FAAOS

Meningitis is a serious condition that occurs when the meninges—protective membranes covering the brain and spinal cord—become infected and inflamed. Early symptoms can be similar to the flu. However, having a stiff neck in addition to flu-like symptoms could be a key clue that meningitis is the problem and should be checked by a doctor.

Patients should seek immediate medical attention if a stiff neck is accompanied by a fever, headache and/or nausea. See When Is a Stiff Neck Serious?

There are several types of meningitis, but this article focuses on the two most common ones: viral and bacterial. In cases where someone has contracted bacterial meningitis, finding medical attention immediately (within a few hours of initial symptoms) can be the difference between making a full recovery and permanent disability or death.

Article continues below

Common Symptoms

Meningitis can start suddenly, and early symptoms may include one or more of the following:

Fever. Running a fever is a common part of the immune system’s defense against infections. A fever with meningitis will usually be above 103 degrees, but not always.Headache. A headache caused by meningitis is typically described as severe and unrelenting. It does not subside by taking an aspirin.

Stiff neck. This symptom most commonly involves a reduced ability to flex the neck forward, also called nuchal rigidity. Depending on the severity of the nuchal rigidity, the neck might be able to flex about half of what it could do before, or it might hardly flex at all.

As time goes on, other symptoms can develop, such as nausea, vomiting, sensitivity to light or noises, cognitive problems with concentration and memory, and many other latter-stage symptoms.

In addition, it should be noted that bacterial and viral meningitis are both contagious, so they are more likely to be contracted and spread in areas where people live in close quarters, such as college dorms or military barracks.

Because meningitis is such a serious condition, patients with symptoms of the disease will often start treatment before an official diagnosis is confirmed through diagnostic tests.

Meningitis Diagnosis

Diagnosing meningitis is difficult and requires the insight of a medical professional. If meningitis is suspected based on the patient history and physical exam, diagnostic tests will need to be done. These tests could include one or more of the following:

Spinal tap. A spinal tap, also called a lumbar puncture, involves inserting a needle into the spinal canal in the lower back (a safe distance beneath the spinal cord) and drawing a sample of cerebrospinal fluid. Numerous lab tests will be run on the cerebrospinal fluid, such as to measure glucose, protein, red and white blood cell counts, and to determine which specific bacteria, virus, or other microorganisms might be present. The spinal tap and its associated tests are critical to achieving an official meningitis diagnosis.Blood tests. Before the spinal tap, typically blood tests will be done for a quick analysis to look for inflammatory markers suggestive of an infection or other illness. In some cases, a blood test could indicate meningitis is unlikely, preventing the need for the patient to undergo an invasive spinal tap.Imaging study. A CT scan or MRI scan of the brain is usually done before the spinal tap, especially if symptoms include any neurological deficits such as confusion or light sensitivity. An imaging study may show brain swelling and whether it is safe for a spinal tap to be performed. If it is determined that a change in cerebrospinal fluid (CSF) pressure from a spinal tap could cause the brain to herniate and move downward, the procedure will need to be delayed until the pressure on the brain is reduced.

The spinal tap’s lab results for potential bacterial or viral cultures can take a few days for enough growth to be analyzed, which is why an official meningitis diagnosis cannot typically be made the same day. However, faster tests are being researched and may be available in the future.

Treatment for Meningitis

Minutes matter when it comes to treating bacterial meningitis. As such, doctors cannot wait several hours or days to see if a lab test comes back positive for bacterial meningitis. If meningitis is suspected and cannot be ruled out by the initial examination, doctors will usually start treating the patient with a broad-spectrum antibiotic to prevent any potential bacterial meningitis from growing out of control.

After the test results come back, the doctor will know if meningitis is the official diagnosis, as well as what type. For viral meningitis, there is typically no specific treatment aside from getting rest and trying to maintain a healthy intake of fluids and nutrition. For bacterial meningitis, the broad-spectrum antibiotic will be replaced by an antibiotic that targets the specific bacteria causing the meningitis.

Depending on the patient and severity of the meningitis, other medications may also be used.

31/12/2018

What's Causing My Knee Pain?

The hinge-like movement of your knee is supported by a network of bones, muscles, ligaments, and tendons.
But these tissues can cause knee pain if they are overused, become inflamed, or are subject to a blow or other injury. Each element of the knee is susceptible to some common sports injuries.

The bones and soft tissues of the knee work together to allow its hinge-like movement.

Many of the symptoms for knee injuries are similar, which is why the diagnosis of a doctor or sports specialist is important to say definitely what's causing your knee pain.

But if you know the main causes of knee pain—and the occasional distinctive symptoms—you're closer to the diagnosis and treatment you need.

Bone or kneecap injuries

Bone dislocation can occur if the femur (thigh bone) or tibia (shin bone) get out of alignment, or if the patella (kneecap) slips out of place. The patella can also be fractured. These are almost always as a result of severe trauma, such as a fall or car accident.

See What Is a Dislocated Kneecap?

Both patellar fractures and dislocations cause knee pain, but the pattern is slightly different: For a dislocation, the pain will be sharp but fade with rest. Patellar fractures, on the other hand, tend to cause sharp pain immediately after injury, then remain consistently aching throughout healing.

See About Acute Patellar Injuries

Ligament injuries

The anterior cruciate ligament (ACL) crisscrosses with one other ligament in the knee. It keeps the knee aligned and prevents it from slipping forward or backward. However, it's prone to rips or tears, particularly when the knee twists sideways. An ACL tear is a common sports injury, and women are more prone to it.

See Anterior Cruciate Ligament (ACL) Injuries

ACL injuries almost always occur after a sudden blow or pivot. They can also occur when the knee is hyperextended. People hear a "pop," then experience pain and a feeling of the knee "giving out" from under them.

See Understanding Knee Hyperextension

The ACL is the most common ligament injured, but three other knee ligaments can also cause problems when injured, usually as a result of a blow to the front or side of the knee.

See The 4 Types of Knee Sprains

Tendon injuries

Two tendons in the knee can also cause knee pain if injured. The patellar tendon attaches your kneecap to your tibia. It can become inflamed and cause pain when it's jarred from below repeatedly; this is why it's also known as "jumper's knee."

See Symptoms and Diagnosis of Jumper’s Knee

Pain can also originate from the tendon between the kneecap and femur. This is patellofemoral pain syndrome (PPS) or "runner's knee."

See What You Need to Know About Runner’s Knee

As these nicknames imply, tendons are often injured through overuse. Pain may be minor and felt only when exercising, but more severe cases can affect daily activities. Tendon injuries may also cause swelling, redness, or warmth.

Cartilage injuries

The C-shaped pad of cartilage between the femur and tibia is known as the meniscus. The meniscus can be torn either through a single traumatic injury or a series of smaller traumas over time. A torn meniscus causes knee pain, swelling, stiffness, and sometimes locking or instability of the knee.

See Symptoms of Meniscal Tears

Knee pain from arthritis

Knee pain can also be the result of damage to the knee joint from arthritis. Knee osteoarthritis risk factors include age, being overweight, family history, or a history of knee trauma, such as one of the injuries listed above.

If you're experiencing knee pain or stiffness that comes and goes, or pain that gets worse after inactivity (such as when you get up in the morning), this may be the result of arthritis.

To learn more about the ways arthritis can affect the knees, visit Arthritis-health's article: What Is Knee Osteoarthritis?

Both knee injuries and knee arthritis have treatment options that can decrease pain and help you maintain mobility and strength.

14/11/2018

Sciatic Nerve Pain in management

Lumbar disk syndrome includes diseases resulting from disk disorder, either herniation or degenerative change (spondylosis). Massive disk protrusion may rarely lead to paralysis in the lower extremity, a condition termed cauda equina syndrome. Gradual narrowing of the spinal canal (lumbar stenosis), usually from spondylosis, may also cause lower extremity symptoms.

PHYSICAL FINDINGS & CLINICAL

PRESENTATION

Overlapping clinical syndromes that may result:Mild herniation without nerve root compression Herniation with nerve root compression Cauda equina syndromeChronic degenerative disease with or without leg symptomsSpinal stenosis

Low back pain, often worsened by activity or coughing and sneezingLocal lumbar or lumbosacral tenderness Paresthesias, usually unilateral Restricted low back motion Increased pain on bending toward affected side Weakness and reflex changes (L4—knee jerk and quadriceps, L5—extensor hallucis longus, S1—ankle jerk and toe walking)Sensory examination usually not helpfulLumbar stenosis that possibly produces symptoms (pseudoclaudication), which are often misinterpreted as being vascular. Pseudoclaudication usually recovers quickly with sitting or spine flexion. Vascular disease is unaffected by spine position and is typically associated with atrophic skin changes and diminished pulses.)Positive straight leg raising test if nerve root compression is present

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS

Soft tissue strain or sprain Tumor Degenerative arthritis of hip Insufficiency fracture of hip or pelvis

WORKUP

In most cases the diagnosis can be established on a clinical basis alone.

IMAGING STUDIES

Imaging is not warranted for most patients with acute low back pain.Plain roentgenograms may be indicated within the first few weeks for persistent pain; they are usually normal in soft disk herniation, but with chronic degenerative disk disease loss of height of the disk space and osteophyte formation can occur.MRI may be indicated in patients whose symptoms do not resolve or when other spinal pathology may be suspected.Electrodiagnostic studies may confirm the diagnosis or rule out peripheral nerve disorders.

TREATMENT

NONPHARMACOLOGIC THERAPY

Short course (3 to 5 days) of limited physical activity for acute disk herniation with leg painPhysical therapy for modalities plus a careful gradual exercise program. Physical therapists generally use the McKenzie method for the treatment of low back pain.Lumbosacral corset brace during rehabilitation process in conjunction with exercise program is beneficial only in some cases.Percutaneous electrical nerve stimulation may be beneficial in selected patients with chronic back pain.

ACUTE GENERAL Rx

NSAIDs Muscle relaxants for sedative effect Analgesics Epidural steroid injection for leg symptoms in selected patients

10/11/2018

Is Your Sleep Position Harming Your Rotator Cuff?

Many people have evening routines to help them drift off to sleep—rituals like brushing their teeth or reading for 20 minutes. Most also have a favorite sleep position.

But if you sleep on your side every night—on the sameside—you may be at risk for an injured shoulder.

See: Rotator Cuff Injuries

Rotator cuff injuries are typically caused by trauma, tissue degeneration, or shoulder impingement.
Read: How Do Rotator Cuff Injuries Occur?

What causes rotator cuff injuries?

A group of muscles and tendons stabilize the ball-and-socket joint of the shoulder with a "cuff." These muscles and tendons can be injured from acute causes (a fall or accident) or chronic causes (repetition or overuse).

See: Treating Acute Sports and Exercise Injuries in the First 24 to 72 Hours

If you always sleep on your right or left side, the constant nightly pressure on that shoulder's tendons against underlying bone can cause them to become inflamed or fray. This is known as rotator cuff tendinitis or impingement syndrome.

What Is the Difference Between Tendonitis, Tendinosis, and Tendinopathy?

Symptoms of tendinitis can start with mild pain and stiffness in the shoulder, which you may first notice when you lift your arm or put pressure on your shoulder. Rotator cuff pain is usually felt in the front of the shoulder and stops before the elbow.

See: Rotator Cuff Injuries: Symptoms

Shoulder pain can be treated—sometimes fairly easily

Fortunately, the answer to preventing tendinitis from side-sleeping is easy: You have to switch up your sleep position. If you sleep on your side, keep switching up which side you sleep on. Or you can avoid side-sleeping altogether and sleep on your back.

See: Rotator Cuff Injuries: Initial Treatment

If you are struggling to sleep in a new position, try propping up your pillow higher so there's less pressure on your shoulder.

Switching sleep positions will also help if you're already experiencing pain or stiffness from tendinitis. Resting the affected joint is the answer to treating it, along with icing and immobilizing the joint.

See: The P.R.I.C.E. Protocol Principles

Shoulder pain can also be caused by arthritis, bursitis, nerve problems, or other soft tissue injuries like a shoulder sprain or SLAP tear.

06/11/2018

Headache:

INTRODUCTION
Description:
The tension headache is the most common form of headache. Tension headaches are caused by abnormal neuronal sensitivity and pain facilitation and or contracted muscles of the neck and scalp.

Cluster headaches are a type of recurrent headache characterized as unilateral and “stabbing” that are associated with symptoms of histamine release such as nasal stuffiness.
These occur in episodic waves of frequent headaches separated by days, weeks, or years of remission.

Migraine headaches are recurrent severe headaches that last 4 to 72 hours and are accompanied by neurologic, gastrointestinal, and autonomic changes. These may or may not be preceded by a characteristic aura.

Prevalence:

Ninety percent of women experience tension headaches.
Cluster headaches occur in 4 of 100,000
women per year.
Migraine headaches affect 15% to 20% of women. Approximately 10% of tension headache sufferers also have migraine headaches.
Predominant Age:
Tensions headaches—any age, 60% begin after age 20, rarely do they start after age 50.
Cluster headaches—ages 20 to 30.
Migraine headaches— ages 25 to 55 (peak 30 to 49), first attack generally between adolescence and 20.

Genetics:

Women are more often affected by tension headaches than men (88% versus 69%); 40% have a family history of headache. Cluster headaches are four times more common in women than in men; migraines are three times more common in women. Of migraine sufferers, 89% have a family history of headache.

ETIOLOGY AND PATHOGENESIS
Causes:
Tension headache—abnormal neuronal sensitivity and pain facilitation; no correlation to muscle contraction. They generally build in intensity in relation to stress.

Cluster headache—unknown; postulated: disorders of histamine release or sensitivity, serotonin metabolism or transmission, hypothalamic circadian rhythm, or cerebral artery autoregulation.

Migraine headache— unknown; postulated: genetically linked vascular disruption
secondary to neurochemical change, serotonin or norepinephrine metabolism, or tachykinin abnormality.
These alterations may result in distention of and inflammation of cranial blood vessels. A strong relationship
with female s*x hormones is suspected.

Risk Factors:

Tension headache—physical or emotional
stress, poor posture, depression, obstructive sleep apnea, excess caffeine.
Cluster headache—allergies, alcohol, to***co, nitroglycerine, high altitudes, sleep-cycle disruption, stress.
Migraine headache—more common in
upper-income patients (1.6 times), 60% to 70% of women note a link with menstruation (14% of women
have migraine headaches only during me**es). Precipitating factors: some foods, stress or stress relief (let down), missed meals, excessive sleep.

CLINICAL CHARACTERISTICS
Signs and Symptoms
Tension headache—dull, aching, and constant pain of mild to moderate intensity lasting from 30 minutes to 7 days, often located in the temples, around the head in a band, or up the back of the neck. It is rare, but some patients experience chronic tension-type headaches characterized by occurring 15 days/month for 6 months or longer.
• Pressing or tightening quality (nonpulsating)
• Bilateral symmetry
• Not aggravated by physical activity
• No nausea or vomiting, photophobia or phonophobia (may have one but not both)
• Teeth grinding common Cluster headache—unilateral or orbital distribution (90% of headaches recur on the same side)
• Sharp, stabbing, or “ice pick” in character
• Symptoms of histamine release (nasal stuffiness and rhinorrhea, facial fl ushing, lacrimation, edema of eyelids)
• Symptoms are relieved when the patient is moving
around
• Strong association with sleep
• Duration of less than 1 hour
• No aura or prodrome
• Annual recurrence common
Migraine headache—May be preceded by aura (20%)
• May begin with dull ache
• Unilateral pain (30% to 40%, may switch sides from attack to attack)
• Pulsating quality (60%), rapid onset
• Moderate to severe intensity
• Made worse by activity
• Frequently accompanied by nausea (90%), vomiting (60%), photophobia (80%), blurred vision, scalp tenderness and neck stiffness, restlessness, irritability, nasal congestion, facial edema
• Menstrual migraine is characterized by onset between 1 day before and 4 days after menstruation. (First day is most common.) This pattern is found in 15% of patients.

DIAGNOSTIC APPROACH
Differential Diagnosis
• Depression
• Cervical spondylosis
• Temporomandibular joint syndrome
• Analgesic dependency
• Anemia
• Medication or toxin exposure
• Dental disease
• Chronic sinusitis (cluster, migraine)
• Temporal arteritis
• Trigeminal neuralgia
• Pheochromocytoma

02/11/2018

what is a migraine and how do you treat it ?

Introduction
A migraine is a type of a headache which usually occurs in adolescents or young adults.Headache of a migraine occur on one side of the head or in the whole head and 60-80% of a migraine headache are familial.A migraine is more common in female than in males.A migraine headache occurs in attacks and each attacks of a headache usually last from a few hours to 2 days while the frequency of attacks may vary from one or more attacks in a week to one attack in a year.A migraine is usually precipitated by emotional or physical stress apart from this migraine can also be precipitated by missed meals, sleep disturbances, menstrual periods, alcohol, foods and oral contraceptives.The severity of A headache varies in different patients it may he throbbing pain or sometimes it may be dull.migrain may also be associated with vomiting and nausea.it may be preceded or accompanied by certain neurological symptoms such as luminous visual hallucination.A migraine occurs due to the involvement of trigeminal the perivascular spaces.This perivascular edema may cause the stretching of pain receptors in the dural membrane, causing a headache of a migraine.Also, it has been found that sometimes during a migraine, the amplitude of pulsation of temporal arteries is increased.During aura, there is an abnormal release of serotonin from the platelets, but during headache of migraine serum serotonin fall below normal.There is another type of a migraine headache which is more common in males than in females which are called Cluster Headache in this type of a headache there is very severe pain around an eye with redness of the eye and watering from the nose and eye.Usually, occurs in people age 30 or more and its attack usually occurs after every 12-18 months.Attack occurs usually at night and each attack last 1-2 hours.They remain for one to three weeks during each cluster.

Classification Of Migraine Drugs
There are two group of Migraine Medication /s Which are,

(A) Drugs For the treatment of Acute Attack

(1)5-HT1 Agonist:

Zolmitriptan
Sumatriptan
Rizatriptan
Naratriptan

(2)Other Migraine Medication /s

Ergotamine
Paracetamol
Opioids
Dihydroergotamine
NSAIDs

(B)Prophylactic Drugs

Aspirin
Pizotifine
Propranolol
Amitryptyline
Fluoxetine
Flunarizine
Cyproheptadine
Clonidine
Methylsergide
Sertraline

Ergotamine

Ergotamine is one of the best Migraine Medication and It is an alkaloid obtained from a fungus known as cleviceps purpurea.This Fungus infest the rye and some other grains and grasses.

Pharmacokinetics

It is given orally,sublingually,inhalationaly,by re**al route and by intramuscular injection.When given orally it is absorb from the intestine and its absorption is variable.After metabolism the drugs is excreted in urine.Caffeine increases its absorption from the intestine.

Adverse Effects:

Nausea ,vomiting and diarrhea are the most common adverse effects.
Large doses can cause spasm of the blood vessels of the arms and legs thatmay lead to their gangrene.Rarely gangrene of intestine can occur due to spasm of mesentric artieries.

Contraindications

Perilheral vascular disease such as Reynaud disease and buerger disease.in these disease arteries of the limb are narrowed .
Collagen disease.
Ischemic heart disease
Its better to avoid in pregnant women though there is no evidence of harmful effects.

Triptans

These are a group of drugs that are recently being most commonly used in acute attack of migraine.Their mechanism of action appears to be similar to that of ergot alkaloids.

Sumatriptan

It is a 5HT1B and 5HT1D agonist and it is a great Migraine Medication which is effective in both migraine headache and cluster headache.its effectivenessin these conditions is equal to or more than that of ergot alkaloids.

Pharmacokinetics
When given orally only 15% of sumitriptan is absorbed into the systemic circulation.its plasma half life is two to three hours.it can be used orally,subcutaneously and as a nasal spray.

Adverse effects:
Sumitriptan is well tolerated .it can cause mild degree of abnormal sensation such as dizziness,muscle weakness,tingling,pain in the chest ,pain in the neck and pain at the site of injection.
As it is short acting several doses of drug maybe need during a prolonged attack of migraine.However no more than two doses should be given per day.

Other triptansNaratriptan

It is also a 5HT1B and 5HT1D agonist.
Use 2.5mg of naratriptan orally after an attack of migraine .
When used orally 40-70% of drug is absorbed from the intestine into systemic circulation.
If migraine recurs then 2.5mg can be used again after 4 hours of intial dose.
If the patient doesn’t respond to the first dose don’t use it again for the same attack.
A maximum of 5mg can be used per day.
Not recommended for patient below 18 year of age.
Plasma half life is about 6 hours
Mechanism and adverse reactions are similar to that of sumitriptan.

Rizatriptan

This drug is also a 5HT1B and 5HT1D agonist and is also a best Migraine Medication .
Mechanism and adverse effect are similar to that of sumatriptan.
when used orally 40-70% absorbed from the small intestine into the systemic circulation.
10mg can be used orally at the onset of an attack and if the migraine recurs then a second dose can be given after 2 hours of the first dose.
Keep that mind if the patient doesn’t respond to first dose then second dose is not used.
Maximum daily dose is 20mg and it is not recommended for children below 18 years.

Almotriptan

Daily recommended Dose is 25 mg.
It is used in a dose of 12.5mg orally as soon as possible after the onset of migraine attack.
For recurrence of migraine a second dose should not be given before 2 hours of the first dose.
If there is no response to the first dose,second dose is not given for the same attack .
It is not recommended in children below 18 years.

Eletriptan

It is used in a dose of 40mg orally as soon as possible after the onset of migraine attack and repeated after 2 hours if recurs.
A second dose is not used if there is no response to the first dose.

Contraindications of triptans

Almotriptan is contraindicated in severe hypertension.

All of 5HT1 Agonist are contraindicated in agina pectoris,because they produce spasm of coronary arteries.

Zolmitriptan is contraindicated in wolf-parkinson-white syndrome.

Sumatriptan,rizatriptan,almotriptan,eletriptan,and zolmitriptan are short acting drugs and therefore several doses of these drugs are required during a prolonged attack.

Noratriptan and almotriptan are contraindicated in severe hepatic and renal diseases and in peripheral vascular diseases.

NSAIDS

All NSAIDs can be used as a Migraine Medications in the treatment of acute attack of migraine.
Opioids may be used in severe cases of migraine not responding to other drugs.As they cause addiction ,care should be taken during their use.

Prophylactic Migraine Medication /s

Following are the important Migraine Medication /s that can be used in the prevention of migraine.

Drugs Prophylactic Dose
Aspirin 300mg twice daily
Prpranolol 80-240mg/Day in 3-4 doses
Imipramine 10-150mg daily in single dose
Amitriptyline 10-150mg daily in single dose
Fluoxetine 20-60mg in a single dose
Sertraline 50-200mg in a single dose
Clonidine 0.2-0.6mg daily
Mrthylsergide maleate 4-8 mg daily
Verapamil 80-160mg daily
Ergonovine maleate 0.6-2mg daily
Cyprophetadine 12-20mg daily.

25/10/2018

Burning sensation in feet :

The burning sensation level of discomfort can range from mild numbness to severe pain, which may impact sleep and wellness. At times, feelings of “pins and needles”–medically called paresthesia–will also be felt with burning feet, increasing feelings of discomfort.

What Causes the Burning Sensation in Feet?

There are a number of different reasons for this condition, but in most cases a common condition called neuropathy is the underlying cause. Neuropathy is damage to or disease affecting nerves, which may impair sensation, movement, gland or organ function, or other aspects of health, depending on the type of nerve affected. Neuropathy can be caused by a number of different factors, from poor diet, to diabetes, to overuse of alcohol.

Other conditions that can contribute to burning sensation in feet include:

Vitamin deficiency (particularly B12 and B6)Chronic kidney diseaseLyme diseaseHypothyroidism (low thyroid levels)Vasculitis (inflamed blood vessels)SarcoidosisHIV/AIDSErythromelalgiaMetal poisoning (specifically lead, mercury, and arsenic)Guillain-Barre syndromeAmyloid polyneuropathyHigh blood pressure (hypertension)Fluid retention (edema)Drug side effects (particularly chemotherapy, HIV medications, and a number of others)

23/10/2018

Cervical Disc Herniation :Causes, Symptoms, Diagnosisand and Treatment:

Cervical Disc Herniation: Cervical disc herniation is a common cause of neck and upper body pain.A cervical herniated disc is diagnosed when the inner core of a disc in the neck herniates or leaks out of the disc, and presses on an adjacent nerve root. Pain may exhibit dull or sharp in the neck, within the shoulder blades, and may radiate down into the arms, hands, and fingers. Some positions and movement can increase and aggravate pain.It normally happens in the 30-to-50-year-old age group.If a cervical herniated disc can cause spinal cord compression, this is a much more serious condition and may need a more aggressive treatment plan. Spinal cord compression symptoms involve- stumbling gait, difficulty with fine motor skills in the hands and arms, and shock type feelings down the torso or into the legs.

Causes of Cervical Disc Herniation

Most herniations in the cervical region occur as a consequence of sudden stress, during in sudden flexion, extension, or twisting of the neck. Sometimes herniations occur gradually, over the weeks or months. However, some risk factors that can contribute to the chances of a disc herniation-

As we get older, discs gradually dry out, that affecting their strength and resiliency.History of extreme or minor trauma to the cervical spine.Shortage of regular exercise, not consuming a well-balanced diet, and to***co use considerably contribute to poor disc health.Poor posture on the cervical spine.

Stages of a Cervical Herniated Disc

Symptoms of Cervical Disc Herniation

A herniated disc in the neck can cause a variety of symptoms in the neck, arm, hand, and fingers, as well as parts of the shoulder. The symptoms of a cervical herniated disc might include:

Shock-like or burning pain.Dull or sharp pain in the neck or between the shoulder blades, which can intensify in certain positions or after certain movements.Pins-and-needles tingling.Pain that radiates down the arm to the hand or fingers (radiculopathy).Numbness in the shoulder or arm, which may or may not include tingling.Weakness, which could affect shoulder, arm, and also hand strength.

The pain patterns and neurological deficits are largely determined by the location of the herniated disc.For example-

A C4-C5 (C5 nerve root)disc herniation at this level can cause shoulder pain and weakness in the deltoid muscle and does not usually cause numbness or tingling.

A C5-C6 (C6 nerve root) herniation can cause weakness in the biceps muscle and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is the several common levels of a cervical disc herniation.

A C6-C7 (C7 nerve root) disc herniation can cause weakness in the triceps muscle. Numbness and tingling along with pain can transmit below the triceps and into the middle finger. This level is also the usual common areas for a cervical disc herniation.

A C7-T1 (C8 nerve root) disc herniation this level can cause weakness with the handgrip, along with numbness and tingling and pain that spreads below the arm to the little finger side of the hand.

Cervical Disc Herniation :Causes,Symptoms,Diagnosis & Treatment

January 23, 2018Condition ,

On this page:

Causes of Cervical Disc HerniationSymptoms of Cervical Disc HerniationDiagnosis of Cervical Disc HerniationTreatment of Cervical Disc HerniationPrevention of Cervical Disc Herniation

Cervical Disc Herniation: Cervical disc herniation is a common cause of neck and upper body pain.A cervical herniated disc is diagnosed when the inner core of a disc in the neck herniates or leaks out of the disc, and presses on an adjacent nerve root. Pain may exhibit dull or sharp in the neck, within the shoulder blades, and may radiate down into the arms, hands, and fingers. Some positions and movement can increase and aggravate pain.It normally happens in the 30-to-50-year-old age group.If a cervical herniated disc can cause spinal cord compression, this is a much more serious condition and may need a more aggressive treatment plan. Spinal cord compression symptoms involve- stumbling gait, difficulty with fine motor skills in the hands and arms, and shock type feelings down the torso or into the legs.

Causes of Cervical Disc Herniation

Most herniations in the cervical region occur as a consequence of sudden stress, during in sudden flexion, extension, or twisting of the neck. Sometimes herniations occur gradually, over the weeks or months. However, some risk factors that can contribute to the chances of a disc herniation-

As we get older, discs gradually dry out, that affecting their strength and resiliency.History of extreme or minor trauma to the cervical spine.Shortage of regular exercise, not consuming a well-balanced diet, and to***co use considerably contribute to poor disc health.Poor posture on the cervical spine.

Stages of a Cervical Herniated Disc

Symptoms of Cervical Disc Herniation

A herniated disc in the neck can cause a variety of symptoms in the neck, arm, hand, and fingers, as well as parts of the shoulder. The symptoms of a cervical herniated disc might include:

Shock-like or burning pain.Dull or sharp pain in the neck or between the shoulder blades, which can intensify in certain positions or after certain movements.Pins-and-needles tingling.Pain that radiates down the arm to the hand or fingers (radiculopathy).Numbness in the shoulder or arm, which may or may not include tingling.Weakness, which could affect shoulder, arm, and also hand strength.

The pain patterns and neurological deficits are largely determined by the location of the herniated disc.For example-

A C4-C5 (C5 nerve root)disc herniation at this level can cause shoulder pain and weakness in the deltoid muscle and does not usually cause numbness or tingling.

A C5-C6 (C6 nerve root) herniation can cause weakness in the biceps muscle and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is the several common levels of a cervical disc herniation.

A C6-C7 (C7 nerve root) disc herniation can cause weakness in the triceps muscle. Numbness and tingling along with pain can transmit below the triceps and into the middle finger. This level is also the usual common areas for a cervical disc herniation.

A C7-T1 (C8 nerve root) disc herniation this level can cause weakness with the handgrip, along with numbness and tingling and pain that spreads below the arm to the little finger side of the hand.

Diagnosis of Cervical Disc Herniation

Good treatment is always based on a specific diagnosis. The complete diagnostic process includes-

Your physician will talk about your symptoms, how severe they are, and what procedures you have previously undertaken. You will be thoroughly examined for limitations of movement, problems with balance, and pain. Through this exam, the physician will also look for impairment of reflexes in the extremities, muscle weakness, impairment of sensation or other manifestations of spinal cord damage.

Generally, physicians start with plain x-ray, which rules out other problems such as infections. CT scans and MRIs are further employed to give three-dimensional views of the lumbar spine and can help distinguish herniated discs.

Treatment of Cervical Disc Herniation

Nonsurgical Treatment Options

The most cases of cervical disc herniation do not require surgery. Often, within 4 to 6 weeks most patients find nonsurgical treatments relieve pain and symptoms. There are a number of non-surgical treatments that can help relieve symptoms. These include the following:

Pain medications such as a nonsteroidal anti-inflammatory drug to reduce swelling, the muscle relaxant to ease spasms, and/or a pain reliever.

Heat/cold therapy, especially during the first 24-48 hours.

Physical therapy may include cold and heat treatment, gentle massage, stretching, and neck bracing or traction to decrease pain and increase flexibility.

In conjunction with these treatments, to maintain the healthy posture, good body mechanics, and suitable exercises.

Be optimistic about your treatment plan and remember that less than 5% of neck problems require surgery.

Surgical Treatment Options

If non-operative measures do not work, surgery may be recommended. If the herniated disc is compressing the spinal cord (cervical myelopathy), surgery may be necessary. An anterior cervical discectomy is the usual common surgical method to manage injured cervical discs.

Sometimes it is required to access the herniated disc from behind by removing a portion of the lamina. The name of the procedure is laminotomy (posterior laminotomy).Favorably, each method can be done minimally invasive and tiny specialized instruments such as microscopes and endoscopes, and sometimes in an outpatient spine operation center.

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