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Judy is a 38-year-old secretary who has worked for a large suburban school
for nine years. She sits at a computer almost all day at work. For a number
of months, she has been experiencing neck pain accompanied by soreness and stiffness
in her upper back. She became concerned when she began to experience numbness
and tingling in her left arm, especially at night. Episodes of neck and upper
back pain seem to be getting more frequent and her symptoms more intense.
Patient History and Examination
When Judy sees her chiropractor, she takes a complete history of her current
complaints and reviews her past history. The chiropractor wants to know - has
been any weakness in her arms? Judy says "no". Has there been any arm pain?
"A little", says Judy. The doctor wants to know about her sitting arrangement
at work and she asks Judy to describe her work routine.
When she examines Judy, the chiropractor is pleased to find that all neurological
signs are normal. Generally Judy has full range of motion in her neck, except
for some restriction when she bends her head to the left. The doctor palpates
tight and very tender muscles in the upper back and along both side of the neck,
more on the left. Static and motion palpation of the cervical spinal joints
indicates restrictions in the mid-cervical spine in extension and lateral flexion.
There are also joint restrictions in the middle back.
Radiographic Imaging
The chiropractor takes x-rays of Judy's neck, including a view that will allow
her to examine the bony openings where the spinal nerves exit the spinal joint.
These openings are called the foramen. The foramen may become smaller due to
the formation of additional bone as part of degeneration; a response to wear
and tear in the spine.
The doctor is aware that changes in the foramen have to correlate closely with
physical findings, since degenerative changes of all kinds can be found in many
people who do not have neck pain or arm symptoms. Fortunately, Judy's x-rays
were normal.
Making a Diagnosis
The chiropractor's diagnosis of Judy's problem is "cervical neck strain". In
her notes, Judy's chiropractor writes a fuller diagnostic description that will
be more helpful clinically. A more exact diagnosis of Judy's condition is: cervical
neck strain with spinal joint fixations, or subluxations secondary to postural
stress with possible nerve entrapment. Let's take a closer look at this diagnosis
to better understand how a chiropractor diagnoses neck conditions.
Neck strain is a broad term. For a chiropractor it means there is
mechanical dysfunction in the neck with accompanying tightness and inflammation
in the muscles.
Spinal joint fixations are an important characteristic of a spinal
subluxation. In Judy's examination, the chiropractor found spinal joint "fixations"
or restrictions in the left side of cervical spine accompanied by tightness
and tenderness. In Judy's case, these joint restrictions were part of a complicated
response on the part of the body to months of extra strain during her work
activities. In trying to respond to unusual mechanical stress, the body tightened
muscles at these spinal joints, which in turn became part of the mechanical
dysfunction. This complex of factors often occurs in spinal problems. The
body responds to a stress through the nervous system and tightens muscles
or ligaments or shifts posture and then these responses -- originally intended
to help matters become part of the problem itself.
Postural stress is a way of describing the strain on the nerves, blood
vessels, and soft tissues resulting from Judy's work habits. Mechanical stress
from sitting for long hours a day can lead to tight muscles, chronic soft
tissue inflammation, and arm symptoms. The chiropractor found that Judy, like
many whose work day is primarily spent sitting in front of a computer, slumped
her shoulders and put extra stress on the upper back as she worked.
Nerve entrapment describes a "trapping" of a nerve or pressure against
a nerve due to tight muscles. Judy's "postural stress" caused a tightening
of the trapezius muscles in the upper shoulders. In this area, there is a
group of nerve and blood vessels called the brachial plexus. Judy's tight
muscles disturbed these nerves and blood vessels resulting in arm tingling
and pain.
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