Acute Neck Research Articles

SLAM-family receptors come of age as a potential molecular target in cancer immunotherapy.

The signaling lymphocytic activation molecule (SLAM) family receptors were discovered in immune cells for the first time. The SLAM-family receptors are a significant player in cytotoxicity, humoral immune responses, autoimmune diseases, lymphocyte development, cell survival, and cell adhesion. There is growing evidence that SLAM-family receptors have been involved in cancer progression and heralded as a novel immune checkpoint on T cells. Previous studies have reported the role of SLAMs in tumor immunity in various cancers, including chronic lymphocytic leukemia, lymphoma, multiple myeloma, acute myeloid leukemia, hepatocellular carcinoma, head and neck squamous cell carcinoma, pancreas, lung, and melanoma. Evidence has deciphered that the SLAM-family receptors may be targeted for cancer immunotherapy. However, our understanding in this regard is not complete. This review will discuss the role of SLAM-family receptors in cancer immunotherapy. It will also provide an update on recent advances in SLAM-based targeted immunotherapies.

Functional Outcomes of Anterior-Based Muscle Sparing Approach Compared to Direct Lateral Approach for Total HIP Arthroplasty Following Acute Femoral Neck Fractures.

Total hip arthroplasty (THA) performed for femoral neck fractures (FNFs) is becoming a more frequent treatment in the active elderly population. Since there is limited research available presenting clinical outcomes after THA using the anterior-based muscle sparing (ABMS) approach, the aim of this study was to compare this surgical approach to the direct lateral (DL) approach in patients treated by THA for FNFs. We retrospectively reviewed the data prospectively collected as a part of our "Hip Fracture Unit" and included 163 patients who underwent THA from January 2016 to January 2019 for acute displaced FNFs. A total of 132 patients who completed a minimum 2-years follow up (69 in the ABMS group and 63 in DL group) were included. The ABMS group demonstrated significantly shorter time to reach milestone for hospital discharge (1.5Days vs 2.1 days, P = .018), while no statistically significant differences were detected in peri-operative complications. At 3months, the timed up and go test, the Harris Hip Score (HHS) and the Oxford ip Score (OHS) were significantly better (P = .024, .032 and .034, respectively) in the ABMS group compared to the DL group. No differences were found in functional outcomes (HHS and OHS) nor in complication rate at 6, 12 and 24months. This is one of the first studies to analyze functional results of THA performed for FNFs through an ABMS approach. Results are in line with those already present in the Literature. ABMS approach allows earlier mobilization and better early functional outcomes, compared to DL approach, in patients undergoing THA for acute displaced FNF. No differences are found after 6months in functional results and complications rate.

Predictors of persistent pain in patients with acute neck pain treated with physical therapy: A prospective study with 2years follow up.

Clinicians specialising in musculoskeletal medicine have observed that patients with neck pain often seek repeat consultations because of recurring neck pain. Despite this pattern, there is a lack of research exploring the persistence nature of neck pain. Understanding potential predictors of persistent neck pain could help clinicians develop effective treatment approaches to prevent the chronicity of these conditions. The current study investigated the potential predictors of persistent neck pain over a 2-year period among patients with acute neck pain treated with physical therapy. A longitudinal study design was employed. Data were collected at baseline and at 2-year follow-up from 152 acute neck pain patients aged (29.2±6.7). Patients were recruited from physiotherapy clinics. Logistic regression was used for analysis. At 2-year follow-up, participants were reassessed for their pain intensity (Dependent variable) and categorised as recovered or reporting persistent neck pain. Baseline acute neck pain intensity, sleep quality, disability, depression, anxiety, and sleepiness were used as potential predictors. Among 152 participants, 51 (33.6%) patients with acute neck pain reported persistent neck pain at 2-year follow-up. 43% of the variation in the dependent variable was explained by the model. Despite the strong correlations between persistent pain at follow-up with all potential predictors, only sleep quality 95% CI (1.1,1.6), and anxiety 95% CI (1.1,1.4) were the significant predictors of persistent neck pain. Our results suggest that poor sleep quality and anxiety may serve as potential predictors of persistent neck pain. The findings highlight the importance of a comprehensive approach to managing neck pain that addresses both physical and psychological factors. By targeting these co-morbidities, healthcare providers may be able to improve outcomes and prevent the progression of the case.

Effectiveness of psychological interventions delivered by physiotherapists in the management of neck pain: a systematic review with meta-analysis.

Physiotherapists are increasingly using psychological treatments for musculoskeletal conditions. We assessed the effects of physiotherapist-delivered psychological interventions on pain, disability, and quality of life in neck pain. We evaluated quality of intervention reporting. We searched databases for randomized controlled trials (RCTs) comprising individuals with acute or chronic whiplash-associated disorder (WAD) or nontraumatic neck pain (NTNP), comparing physiotherapist-delivered psychological interventions to standard care or no treatment. Data were extracted regarding study characteristics and outcomes. Standardised mean difference (SMD) was calculated by random-effects meta-analysis. We evaluated certainty of evidence using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) and intervention reporting using TIDieR. Fourteen RCTs (18 articles-4 detail additional outcome/follow-up data) were included comprising 2028 patients, examining acute WAD (n = 4), subacute/mixed NTNP (n = 3), chronic WAD (n = 2), and chronic NTNP (n = 5). Treatment effects on pain favoured psychological interventions in chronic NTNP at short-term (SMD -0.40 [95% CI -0.73, -0.07]), medium-term (SMD -0.29 [95% CI -0.57, 0.00]), and long-term (SMD -0.32 [95% CI -0.60, -0.05]) follow-up. For disability, effects favoured psychological interventions in acute WAD at short-term follow-up (SMD -0.39 [95% CI -0.72, -0.07]) and chronic NTNP at short-term (SMD -0.53 [95% CI -0.91, -0.15]), medium-term (SMD -0.49 [95% CI -0.77, -0.21]), and long-term (SMD -0.60 [95% CI -0.94, -0.26]) follow-up. GRADE ratings were typically moderate, and intervention reporting often lacked provision of trial materials and procedural descriptions. Psychological interventions delivered by physiotherapists were more effective than standard physiotherapy for chronic NTNP (small-to-medium effects) and, in the short term, acute WAD.

Efficacy and safety of aceclofenac in musculoskeletal diseases

Musculoskeletal system pathology is one of the main causes of morbidity and disability worldwide. Inflammation plays the leading role in the genesis of these diseases. Pain is the most important factor leading to a critical decrease in the quality of life and limitation of daily activities. Most current international guidelines for the treatment of acute and chronic low back and neck pain, osteoarthritis, rheumatoid arthritis and other diseases recommend oral non-steroidal anti-inflammatory drugs as first-line therapy. The article presents data from the latest domestic and international studies, including the results of the largest SOS study, which demonstrated the high efficacy and safety of aceclofenac (Aertal) in acute and chronic neck and back pain.

Trends in incidence, health care consumption, and costs for proximal femoral fractures in the Netherlands between 2000 and 2019: a nationwide study

SummaryThis study evaluated the incidence rates and societal burden of hip fractures in The Netherlands. Although incidence in the elderly population is decreasing and hospital stay is at an all-time low, the burden of medical costs and crude numbers of proximal femoral fractures are still rising in our aging population.PurposeThe aim of this nationwide study was to provide an overview of the incidence rate and economic burden of acute femoral neck and trochanteric fractures in The Netherlands.MethodsData of patients who sustained acute proximal femoral fractures in the period January 1, 2000, to December 31, 2019, were extracted from the National Medical Registration of the Dutch Hospital Database. The incidence rate, hospital length of stay (HLOS), health care and lost productivity costs, and years lived with disability (YLD) were calculated for age- and sex-specific groups.ResultsA total of 357,073 patients were included. The overall incidence rate increased by 22% over the 20-year study period from 16.4 to 27.1/100,000 person-years (py). The age-specific incidence rate in elderly > 65 years decreased by 16% (from 649.1 to 547.6/100,000 py). The incidence rate in men aged > 90 has surpassed the incidence rate in women. HLOS decreased in all age groups, hip fracture subtypes, and sexes from a mean of 18.5 to 7.2 days. The mean health care costs, over the 2015–2019 period, were lower for men (€17,723) than for women (€23,351) and increased with age to €26,639 in women aged > 80. Annual cumulative costs reached €425M, of which 73% was spent on women.ConclusionThe total incidence of hip fractures in The Netherlands has increased by 22%. Although incidence in the elderly population is decreasing and HLOS is at an all-time low, the burden of medical costs and crude numbers of proximal femoral fractures are still rising in our aging population.

Long-term results of a post-partum bilateral Garden 4 femoral neck fracture in a young woman with transient osteoporosis treated with closed reduction and internal fixation

Bilateral femoral neck fractures are very rare conditions. In our knowledge, only five cases were reported of bilateral acute femoral neck fracture secondary to transient osteoporosis. The present case is the first with a long-term follow up after treatment with closed reduction and internal fixation. A 32-year-old women was admitted to the emergency orthopedic clinic due to severe pain in both hips and an inability to walk one-day post-partum. Clinical examination revealed bilateral externally rotated legs and X-ray showed bilateral Garden 4 displaced subcapital fracture of the neck of the femur. The patient was operated on urgently by closed reduction and internal fixation. Osteoporosis was found in the measurements of bone mineral density and bisphosphonate with vitamin D medication was started. 6 years after surgery the patient can carry out her daily activities without limitation. His Harris hip score was 97 points/right and 95 points/left; and the X-ray was normal regarding osteoarthritis and avascular necrosis. Internal fixation should be the primary choice for the treatment of a bilateral femoral neck fractures with a high degree of displacement in young adults even with reversible poor bone quality condition such transient osteoporosis.

Inpatient Decongestive Therapy for Lymphedema in Acute Postsurgical Head and Neck Cancer Patients*

Introduction Head and neck lymphedema is an omnipresent morbidity related to head and neck cancer therapies. Studies on therapy for these patients in the acute postsurgical population have not been published to date. Objective To assess changes in the measurements of lymphedema in surgical head and neck cancer patients during the hospital stay with implementation of modified decongestive therapy (MDT). Methods Patients aged > 18 years undergoing neck dissection with or without primary-site resection or laryngectomy between 2016 and 2019 were included. Facial measurements were obtained prior to beginning MDT and again prior to discharge. A total facial composite measurement was calculated and used to assess change over time. Rates ≥ 2% of change were considered significant. Results A total of 38 patients were included (subsites: larynx = 27; thyroid = 4; oral cavity = 3; and neck = 4). The mean number of days between surgery and the start of lymphedema therapy was 3.0 days. The mean number of days between measurements was 5.2 days. Reduction in the total composite score was observed in 37 (97%) patients, and 35 (92%) patients had a total composite reduction score > 2%. Tumor subsite and surgery type did not portend toward greater percent change, except for those patients treated with total laryngectomy, regional flap reconstruction, and neck dissection ( p = 0.02). Conclusion Acute postsurgical inpatient MDT was associated with reduced total composite measurements in patients after head and neck surgery. As the first published study on lymphedema therapy in this acute postsurgical period, further prospective case-control studies are warranted to explore further benefits of acute therapy.

External validation and updating of prognostic models for predicting recovery of disability in people with (sub)acute neck pain was successful: broad external validation in a new prospective cohort

Can existing post-treatment prognostic models for predicting neck pain recovery (primarily in terms of disability and secondarily in terms of pain intensity and perceived improvement) be externally validated and updated at the end of the treatment period and at 6 and 12 weeks of follow-up in a new Dutch cohort of people with neck pain treated with guideline-based usual care physiotherapy? External validation and model updating in a new prospective cohort of three previously developed prognostic models. People with (sub)acute neck pain and registered for primary care physiotherapy treatment. Recovery of disability, pain intensity, and perceived recovery at 6 and 12 weeks and at the end of the treatment period. Discriminative performance (c-statistic) of the disability model at 6 weeks was 0.73 (95% CI 0.69 to 0.77) and reasonably well calibrated after intercept recalibration. The disability model at 12 weeks and at the end of the treatment period showed discriminative c-statistic performance values of 0.69 (95% CI 0.64 to 0.73) and 0.68 (95% CI 0.63 to 0.72), respectively, and was well calibrated. Pain models and perceived recovery models did not reach acceptable performance. Cervical mobility added value to the disability models and pain catastrophising to the disability and pain models at 6 weeks. Broad external validation of the disability model was successful in people with (sub)acute neck pain and clinicians may use this model in clinical practice with reasonable accuracy. Further research is required to assess the disability model's clinical impact and generalisability, and to identify additional valuable model predictors. https://osf.io/a6r3k/.

Spinal artery infarction.

Spinal cord infarctions are rare, and the symptoms vary depending on location and size. One patient presented with severe neck pain and paresis of the left arm. Compression of a cervical nerve root was initially suspected, but the progression of symptoms and MRI findings gradually suggested a different aetiology.

Relationship between backpack weight and incidence of low back pain in senior high students

Low back pain (LBP) is one of the most common musculoskeletal disorders that can impair daily activities. The causes of LBP are mostly non-specific, including the abnormalities in the soft tissues or form of muscles, ligament injuries, and muscle spasms or fat igue. One of the causes of LBP is carrying excess weight. If the load carried exceeds 15% of body weight, the person who carried the weight will experience musculoskeletal disorders. Students may carry a backpack with a weight that exceeds the recommended weight and this weight will put pressures on the muscles, ligaments, and tendons, causing tension and acute neck pain. These students then will have a higher risk of suffering LBP. The aimed of this study was to identify the relationship between the backpack load and the incidence of low back pain in students. Using the cross-sectional analytical method, this study was performed on a total of 63 students from a senior high school in Cimahi, Indonesia. Subjects were selected using the multistage random sampling and data on the sociodemographic, backpack load, and low back pain were collected and analyzed using the chi-square test. Results showed that 45 students (71.4%) experienced LBP, while the average weight of the backpack carried by these students 6.59 kg (p <0.001). Thus, there is a significant relationship between the excessive backpack weight and the incidence of LBP among students

Immediate Effects of a Single Session of Cervical Spine Manipulation on Cervical Movement Patterns in People With Nonspecific Neck Pain: A Randomized Controlled Trial

ObjectiveThe aim of the present study was to assess the immediate effects of a single session of cervical spine manipulation on cervical movement patterns, disability, and the patient's perceived improvement in people with nonspecific neck pain. MethodsA single-blinded, randomized, sham-controlled trial was carried out at a biomechanics institute. Fifty participants diagnosed with acute and chronic nonspecific neck pain (minimum duration of the symptoms being 1 month) were randomized to an experimental group (EG, n = 25) or a sham-control group (CG, n = 25, 23 of whom completed the study). EG received a single cervical spine manipulation session; CG received a single placebo intervention. Both groups received manipulation or sham from the same physiotherapist. Main outcome measures were neck kinematics (ie, range of motion and movement harmony) during cyclic movements, self-reported neck disability, and impression of change assessed before and 5 minutes after treatment. ResultsThe EG showed no significant improvements (P > .05) in any of the studied biomechanical variables, except for right-side bending and left rotation, in which we found a range of motion significant mean difference of 1.97° and 1.95°, respectively (P < .05). The CG showed enhanced harmonic motion during flexion (P < .05). Both groups showed a significant decrease in self-reported neck disability after treatment (P < .05), and EG participants perceived a significantly larger improvement after manipulation compared with the CG (P < .05). ConclusionsA single session of cervical manipulation provided by a physiotherapist had no impact on cervical motion during cyclic movements, but rather induced self-reported perceived improvement in neck disability and impression of change after treatment in people with nonspecific neck pain.

Dynamic Muscle Stimulation for Pain, Tenderness, and Stiffness on Upper Back Muscles: A Novel Approach and Analysis on Shear-wave Elastography

Abstract Upper back myalgia is a complaint of pain, stiffness, and tightness in the upper back muscles. It is characterized by acute or persistent neck–shoulder pain. We report the case of a 24-year-old male who presented with pain and swelling in the neck and upper back region, along with gradual restriction in cervical range of motion (ROM) for 2 months. The pretreatment assessment revealed severe tightness of the middle fibers of the trapezius and upper fibers of the rhomboid major muscle. Pretreatment elastography revealed high elasticity contrast index (ECI) values of 8.59 and 9.01, respectively, and a red region indicative of increased stiffness of the muscle fibers. The patient was treated with Naqvi’s-Dynamic Electrical Therapy Approach (Naqvi’s DELTA) which is a novel method of using interferential current with a dynamic stimulation probe for 15 min using ultrasound gel on the affected area and examining the patient for the effect of the DELTA on muscle elongation by shear wave elastography which is a unique variation in ultrasound imaging. The pre- and posttreatment findings revealed a significant reduction in stiffness of the muscle fibers, indicated by decreased ECI values of 2.14 and 0.94, respectively, in the blue region. In addition, posttreatment also had an impact on pain reduction and a significant increment in the overall cervical ROM.

The effectiveness of mobilization and manual therapy on non-specific neck pain – A literature review

Non-specific neck pain is one of the common musculoskeletal problems that affects most working age. Non-specific neck pain causes problems as it relates to disability. Pain is the typical worrying sign for the patient. The prevalence is highest in middle age, with women being affected more than men. The prevalence of nonspecific neck pain varies, with a mean point prevalence of 7.6% (range 5.9–38.7%) and mean lifetime prevalence of 48.5% (range 14.2–71.0%). Methods: The aim of this study was to perform a systematic review of the literature of the effectiveness of manual therapy and mobilization for non-specific neck pain. A literature search of PubMed and CINAHL was performed. Inclusion criteria included randomized controlled trials of manual therapy and mobilization interventions in acute neck pain. Like Outcomes were used pain relief, disability/function, (Disability) and patient satisfaction. The PEDro scale was used for quality assessment of eligible studies. Results: The search identified 29 articles and 6 full-text articles were assessed. Two studies met the inclusion criteria. According to the pedro scale the study of Ruud Groeneweg et al met all the criteria and was evaluated with 11 points. Conclusion: Both articular mobilization and manual therapy are effective in non-specific neck pain. In future studies, a larger number of studies should be taken into consideration to increase the level of reliability. Keywords: Non-Specific neck pain, RCT (Randomized controlled trial), reviews study, manual therapy, PEDro scale.

Evaluation of the conservative management of acute neck infections in children during COVID-19 pandemic

Evaluation of the conservative management of acute neck infections in children during COVID-19 pandemic

A Benign Mimic of Dangerous Neck Pathology: A Case Report of Longus Colli Calcific Tendonitis.

Longus colli calcific tendonitis (LCCT) is a calcium deposition disease that causes acute or subacute atraumatic neck pain. It is important for the emergency physician to consider LCCT in the differential diagnosis because the clinical presentation of this benign condition may mimic life-threatening disease processes that require invasive diagnostic measures. We present a case of a 63-year-old female with atraumatic right-sided neck pain. On exam she had tenderness to palpation in the neck, as well as difficulty ranging her neck and opening her mouth. She underwent computed tomography of her neck with intravenous contrast, which showed calcific tendonitis of the longus colli muscle with retropharyngeal edema. She was seen by otolaryngology, underwent nasopharyngolaryngoscopy, and ultimately was discharged with antibiotics and corticosteroids. The presentation of LCCT can mimic symptoms of dangerous causes of neck pain including retropharyngeal abscess and meningitis. Early diagnosis in the ED can potentially avoid more invasive diagnostic and therapeutic measures. While LCCT is thought to be self-limiting, it can be treated with non-steroidal anti-inflammatory medications and corticosteroids. If pain is controlled, patients can be discharged from the ED with no specialist follow-up required.

Prevalence of Work-related Musculoskeletal Disorders and its Correlation with Ergonomic Risk Assessment among Tailors: A Cross-sectional Study

Background: The most significant factor contributing to discomfort at work for tailors is musculoskeletal disorders. Once musculoskeletal discomfort manifests in any area, it often lasts for a year or more. Implementing ergonomics research can boost productivity while giving workers a better, more pleasant working environment. A tool called REBA is used to evaluate a person's ergonomic risk factors. Its goal is to construct a posture analysis system to identify musculoskeletal concerns in a range of tasks by segmenting the body and separately coding each part. The influence and severity of musculoskeletal symptoms on occupational groups have been evaluated using the NMQ. Aims of the Study: To find out the prevalence of work-related Musculoskeletal Disorders and its correlation with Ergonomic risk assessment among Tailors from south Gujarat. Objective of Study: Primary Objective: To find out prevalence of work-related MSDs in tailors. Secondary Objective: To find out its correlation of work-related MSDs with Ergonomic risk assessment among tailors. Materials and Method: In this cross-sectional study, total 150 tailors were taken based on inclusion criteria. Convenient sampling method is selected with age group 25 to 50 years. Work related Musculoskeletal disorders assessed by Nordic whereas Ergonomics risk assessment done by REBA. Result: The result shows that there is high prevalence of lower back pain (34%) in acute work-related MSD and neck pain (26%) in chronic work-related MSD. There are significant correlation of acute neck, shoulder and lower back pain with Rapid Entire Body Assessment (REBA) score and significant correlation of chronic neck, shoulder, elbow, wrist and lower back pain with REBA.

Conservative Therapy for Acute and Subacute Back or Neck Pain

Conservative Therapy for Acute and Subacute Back or Neck Pain

Clinical performance of the Femoral Neck System within 1 year in 125 patients with acute femoral neck fractures, a prospective observational case series

IntroductionOsteosynthesis of femoral neck fractures (FNFs) is an important treatment option, especially for younger patients. We aimed to assess the rate of early implant-related complications in FNF osteosynthesis using the Femoral Neck System (FNS).Patients and methodsConsecutive patients diagnosed with displaced or nondisplaced FNFs were treated with FNS in this prospective, observational, multicenter investigation. Patients were followed up for minimally 3 months and up to 12 months if radiologic bone union and no pain was not achieved beforehand. Predefined treatment-related adverse events (AEs, defined as implant failure, loss of reduction, iatrogenic fractures, deep infection, and surgical revision), radiologic bone union, and patient-reported Harris hip score (HHS) and EQ-5D-5L index score were assessed.ResultsOne hundred and twenty-five patients were included in the study. Thirty-eight (30.4%) fractures were displaced (Garden III and IV), and 37 (29.6%) were vertical fractures (Pauwels type III). Predefined treatment-related AE rate at 3 months was 8 patients, 6.4% (95% CI, 2.8–12.2), and at 12 months, 11 patients, 8.8% (95% CI, 4.5–15.2). Cumulative incidences of bone union were 68% at 3 months, 90% at 6 months, and 98% at 12 months. The mean changes of HHS and EQ-5D-5L index score between preinjury and at 12 months were -7.5 (95% CI, [ – 21.1] to [6.2]) and – 0.03 (95% CI, [ – 0.21] to [0.15]), respectively; neither were statistically significant.ConclusionThe current study on osteosynthesis of FNFs with the FNS resulted in treatment-related complication rates of 6.4% (95% CI, 2.8–12.2) at 3 months and 8.8% (95% CI, 4.5–15.2) at 12 months. On average, patients returned to preinjury function and quality of life. The current study may also indicate that the conventional wisdom of treating stable FNF in patients aged between 60 and 80 years with osteosynthesis may need to be reconsidered.RegistrationThe study is registered with ClinicalTrials.gov (registration number: NCT02422355).

Managing the acutely threatened airway following head and neck trauma – Requiem for cricothyroidotomy?

• Paucity of skills to establish a surgical airway in patients presenting with head and neck trauma. • 242 patients required a surgical airway; 98% surgical tracheostomy, 2% surgical cricothyroidotomy. • The use of cricothyroidotomy in modern trauma appears to be very limited. Trauma to the head and neck results in acute facial trauma and swelling, which may occlude the airway and result in fatal hypoxia. The management is the establishment of a definitive airway. This paper reviews our experience with this clinical scenario. A retrospective study was conducted over a seven-year period from December 2012 to January 2020 at a major trauma centre in South Africa on all adult trauma patients who required a surgical airway procedure (surgical cricothyroidotomy (SC) or surgical tracheostomy (ST)). From December 2012 to January 2020, 12243 trauma patients were admitted. Of those, 242 patients required a surgical airway: 98% (238/242) underwent ST and 2% (4/242) underwent SC. A total of 3271 patients sustained trauma predominantly confined to the face and neck. The mechanism was penetrating trauma in 1077 and blunt trauma in 2194. Total of 51 patients required an emergency airway for acute head and neck trauma. There were four SC's and 47 ST's. Of the four SC, three were inserted secondary to multiple failed attempts at intubation and one was inserted directly into an open tracheal injury. All of these were performed in the resuscitation room. The 47 ST's were performed under conscious sedation in the operating theatre. There were eight failed intubations in the 51 patients with head and neck trauma, and of those three required an emergency SC and five required an emergency ST. The use of cricothyroidotomy in modern trauma care in our environment appears to be very limited.