Epidemiology, physical examination, and neurodiagnostics.
The overall frequency of troublesome neck pain is estimated to be approximately 34%, and it was observed that the frequency of complaints lasting 1 month or longer was higher in women than in men. The prevalence increased with age with regard to both pain duration and chronic pain. A total of approximately 14% of a randomly selected population meets the criteria for chronic neck pain, with complaints lasting for more than 6 months. It could be that the structural transformation of the intervertebral disc, the uncovertebral processes, and the zygapophyseal joints is a process accompanied by disturbed function, ultimately inducing pain. For diagnosis of radicular and myelopathic syndromes, the physical and neurologic examination is enhanced by neurophysiologic assessment. Electromyography, performed with needle electrodes, is the oldest method to diagnose nerve root compression syndromes and is claimed to have no false positive results. Electromyography for radiculopathy is justified if clinical symptoms, such as muscular weakness, don't correlate with clinical findings (diminished or absent reflex), or for documentation of muscle activity if difficult decompressive surgery is expected. For diagnosis of cervical myelopathy by routine examination, the sensory evoked potentials by stimulation of tibial nerve as well as motor evoked potentials from upper and lower extremities are recommended because clinically "silent" myelopathy can be verified by abnormalities in evoked potentials. During history taking, the symptoms possibly attributed to radiculopathy or myelopathy should be differentiated from primary systemic neurologic disorders such as shoulder angiotrophy ("plexus neuritis"), multiple sclerosis, amyotrophic laterals sclerosis, and peripheral neuropathy. The assessment of range of motion, the functional status of shoulder and neck muscles, and palpatory examination of soft tissue is widely used to determine non-operative therapeutic procedures. However, scientifically, the validity of the different testing procedures has not been evaluated satisfactorily.
Dvorák
J
J
Department of Neurology, Schulthess Clinic, Zürich, Switzerland. Dvorák@KWS.CH
D002574:Cervical Vertebrae / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D010808:Physical Examination; D016059:Range of Motion, Articular / Q000502:physiology; D013122:Spinal Diseases / Q000175:diagnosis* / Q000453:epidemiology*