Cervical Joint Research Articles

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

BackgroundThe past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet...

Nontraumatic Atlantoaxial Rotatory Subluxation: A Rare Complication of COVID-19 in Elderly Patient

Introduction: Nontraumatic Atlantoaxial Rotatory Subluxation (NAAS) or Atlantoaxial Rotatory Subluxation (AARS) without trauma or concomitant bone pathology was first described by Sir Charles Bell in 1830 in a patient with syphilis and pharyngitis, who developed lethal outcome due to spinal compression. The syndrome was named after Grisel who described two cases of pharyngitis and atlantoaxial subluxation in 1951. However, this is an uncommon condition of uncertain etiology characterized by NAAS, usually seen in children secondary to an infection and inflammation in the head and neck region or otolaryngeal procedures. Patients generally complain about neck stiffness and pain, and sometimes dysphagia may occur. Diagnosis is established based on the clinical and radiological findings. The etiopathogenesis and the underlying pathomechanics have not been clearly explained. A hematogenous spread of infection from the posterior pharynx to the cervical spine, according to the recent literature, with hyperemia and abnormal relaxation of the atlantoaxial ligaments is a widely accepted theory. The vascular plexus providing the drainage of poster superior pharyngeal area is responsible. The periodontoid plexus is connected with posterior nasopharyngeal veins via the pharyngovertebral vein. Any infective embolism may spread from superior pharyngeal area to upper cervical joints due to this plexus which does not have any lymph node, thus providing an anatomical explanation for the atlantoaxial hyperemia reported in Grisel's syndrome; however, the clinical picture and complications of COVID-19 are unclear until now and every day new symptoms and findings are reported as early and late complications.
 Methodology: An 86-year-old male presented to our clinic in KKT, Jeddah from Yanbu (which is 330 km away) with a complaint of neck stiffness in anterior-lateral position after recovery from COVID-19 six months back. The patient was treated at home without admission in hospital. He had no history of trauma. During the physical examination, the patient's neck was stiff, and there was neck pain with palpation and left-sided torticollis. The patient’s weight was 58 kg, height 160 cm, blood pressure 140/75 mmHg with a pulse rate of 72, SPO2 95, and BMI 22.7. There was no sign of fever or any type of inflammation in his body. The patient had previously consulted neurosurgeons at three different hospitals in Jeddah and was advised a medication with a cervical collar for a clinical follow-up. After three weeks of follow-up, they advised him to start physiotherapy for one month with no benefits seen in clinical finding, the patient then came to us. Direct radiogram of the cervical region showed suspicious findings at the atlantoaxial joint. Anterior view of the cervical radiography revealed tilted position of the head over neck, while the lateral view showed no thickening of the parapharyngeal soft tissue. The distance between the axis and dens was within normal values for his age (ADI = 3–4 mm). This confirms our diagnosis of type 1 atlantoaxial subluxation according to Fielding and Hawkins classification.
 Result: Based on the patient’s history and physical examination, there was no infection or neck operation causing an inflammation in the neck except the COVID-19 six months prior to the neck stiffness. With this case, we would like to highlight that atlantoaxial subluxation should be kept in mind when neck stiffness is seen in elderly patient without history of trauma but with a history of COVID-19 as a rare complication.
 Conclusion: NAAS is a rare but major complication that can often go unnoticed in its early and late phase, which can be a major cause of morbidity following COVID-19 infections, thus early recognition and diagnosis is mandatory especially in adult and elderly patients recovering form COVID-19.

A Case Report of Silent Cervical Spondylosis with Neck Pain

Background: Cervical Spondylosis, commonly known as Cervical Osteoarthritis, is a kind of degenerative osteoarthritis of the joints between the spinal vertebrae's and the neural foramina. It's a condition characterized by changes in the cervical bones, discs, and joints as a result of regular aging wear and tear. Spondylosis of the cervical spine is most common in 40s and 50s.
 Case Presentation: A 65 years old male came to physiotherapy department with complaints of pain in left upper limb and neck and weakness in his left upper back muscles and unilateral since 2 months. Clinical impression showed cervical non radiculopathy. X-ray of cervical spine revealed osteophytosis and narrowed inter- vertebral space, seen in C6 and C7 cervical vertebral bodies with straightening of cervical spine. Cervical Distraction and compression test was positive.
 Conclusion: A well planned physical therapy intervention has shown significant improvement in cases with cervical spondylosis in relieving the symptoms and improving quality of life.

Computed Tomography Osteoabsorptiometry Evaluation of Cervical Endplate Subchondral Bone Mineral Density.

Basic Science. Poor subchondral bone mineral density (sBMD) has been linked with subsidence of cervical interbody devices or grafts, which are traditionally placed centrally on the endplates. Considering that sBMD reflects long-term stress distributions, we hypothesize that the cervical uncovertebral joints are denser than the central endplate region. This study sought to investigate density distributions using computed tomography osteoabsorptiometry (CT-OAM). Twelve human cervical spines from C3-C7 (60 vertebrae, 120 endplates) were imaged with CT and segmented to create 3D reconstructions. The superior and inferior endplates were isolated, and the sBMD of the whole endplate, endplate center, and uncus was evaluated using CT-OAM. Density distributions were compared across the subaxial cervical spine. The uncinate region of the inferior and superior endplates was significantly denser than the central endplate across all vertebral levels (P < .01). When comparing sBMD of the whole inferior and superior endplates, the superior endplate was significantly denser than the inferior endplate (P < .0001). However, the inferior uncus was denser than the superior uncus (P = .035). When assessing sBMD by vertebral level, peak densities were observed at C4 and C5, while C7 was, on average, significantly less dense than all other vertebrae. The subchondral bone of the cervical uncovertebral joints is significantly denser than the central endplates. While the superior endplate in its entirety is denser than the inferior endplate, the inverse was true for the uncovertebral joints. This study serves as a basis for future investigations of new implant designs and their implications on subsidence.

Unilateral degenerative joint disease of a cervical articular process joint between the fourth and fifth cervical vertebrae causing asymmetrical ataxia in a young horse

SummaryA 5‐year‐old horse was examined for investigation of asymmetrical, quadrilateral ataxia and paresis. Clinical examination was unremarkable, and a thorough neurological examination localised the lesion to the cervical spine. Following this, magnetic motor evoked potentials were acquired to allow for latency times to be determined. Abnormal conduction times were found to the right thoracic and right pelvic limbs, confirming that the horse had an asymmetrical cervical spinal myelopathy. Radiographs were acquired to ensure that the horse had no significant pathology which would contraindicate general anaesthesia. There were no abnormalities noted on these, so the horse underwent contrast‐enhanced computed tomography of its cervical spine which revealed enlargement of the right articular process joint between C4 and C5 with dorsolateral impingement of the spinal canal and cord. Due to the poor prognosis for future performance, the horse was subsequently euthanised. A post‐mortem examination confirmed the findings of degenerative joint disease, with some unexpected changes seen on histology of the spinal cord. The unilateral right‐sided compression had caused degenerative changes to ascending and descending tract bilaterally indicating a dynamic component to this lesion, which would be more commonly understood to be static.

Cervical medial branch block progression to radiofrequency neurotomy: A retrospective clinical audit

BackgroundChronic axial neck pain (CANP) due to zygapophysial joint arthropathy is best diagnosed via cervical medial branch block (MBB). However, the paradigm by which MBB is used to select patients for cervical radiofrequency neurotomy (RFN) is contested. Dual diagnostic cervical MBB with a minimum of ≥80% pain relief to diagnose cervical zygapophysial joint pain has been accepted by some Medicare Local Coverage Determinations as the method for selecting patients for cervical RFN. There are some who would argue that the utility of the dual diagnostic MBB and the ≥80% pain relief cut off lacks utility in clinical practice. The suspicion being those who progress from MBB1 to MBB2 will then flow from MBB2 to RFN without fail. Does clinical practice using dual diagnostic MBBs and using an ≥80% pain relief cut off reduce patient eligibility for cervical RFN after both MBB1 and MBB2? MethodsA retrospective clinical audit was carried out at an academic institution spine center from January 1st to December 31st, 2019. Charts were selected based on Current Procedural Terminology codes for MBB, then included if the cervical medial branches were targeted. Charts were then reviewed for procedural progression. Results21/51 (24%, 95% Confidence Interval 12-35%) patients progressed from MBB1 to MBB2. Of those 21 patients, 13 patients progressed from MBB2 to RFN (62%, 95% CI 41-83%). In total, 13/51 (14%, 95% CI 14-37%) patients who were initially suspected to have CANP due to zygapophysial joint pain progressed to RFN. Both MBB1 and MBB2 hindered the progression of 30/51 patients (59%, 95% CI 45-72%) and 8/21 patients (38%, 95% CI 17-59%), respectively. ConclusionBoth MBB1 and MBB2 served to filter patients from progression to RFN using dual MBBs with an ≥80% pain relief cutoff.

Electromyography-Assisted Neuromusculoskeletal Models Can Estimate Physiological Muscle Activations and Joint Moments Across the Neck Before Impacts.

Knowledge of neck muscle activation strategies before sporting impacts is crucial for investigating mechanisms of severe spinal injuries. However, measurement of muscle activations during impacts is experimentally challenging and computational estimations are not often guided by experimental measurements. We investigated neck muscle activations before impacts with the use of electromyography (EMG)-assisted neuromusculoskeletal models. Kinematics and EMG recordings from four major neck muscles of a rugby player were experimentally measured during rugby activities. A subject-specific musculoskeletal model was created with muscle parameters informed from MRI measurements. The model was used in the calibrated EMG-informed neuromusculoskeletal modeling toolbox and three neural solutions were compared: (i) static optimization (SO), (ii) EMG-assisted (EMGa), and (iii) MRI-informed EMG-assisted (EMGaMRI). EMGaMRI and EMGa significantly (p < 0.01) outperformed SO when tracking cervical spine net joint moments from inverse dynamics in flexion/extension (RMSE = 0.95, 1.14, and 2.32 N·m) but not in lateral bending (RMSE = 1.07, 2.07, and 0.84 N·m). EMG-assisted solutions generated physiological muscle activation patterns and maintained experimental cocontractions significantly (p < 0.01) outperforming SO, which was characterized by saturation and nonphysiological "on-off" patterns. This study showed for the first time that physiological neck muscle activations and cervical spine net joint moments can be estimated without assumed a priori objective criteria before impacts. Future studies could use this technique to provide detailed initial loading conditions for theoretical simulations of neck injury during impacts.

S2168 A Rare Cause of Progressive Dysphagia

Introduction: Esophageal diverticulum is a rare entity resulting from outpouching of the mucosa through the muscularis layer. Often times patients present with symptoms of dysphagia or regurgitation. We present an unusual case of long-standing dysphagia as a complication of prior cervical discectomy and fusion. Case Description/Methods: 73-year-old female presented with a one-year history of progressive dysphagia to solids and liquids. Her past medical history was significant for cervical degenerative joint disease status post anterior cervical discectomy and fusion 13 years ago, as well as breast cancer treated with chemoradiation about 4 years prior. A barium esophagram demonstrated a large filling diverticulum in the upper esophagus consistent with a Zenker’s diverticulum. Further endoscopic evaluation revealed a small esophageal diverticulum with evidence of a metal plate and screws within the diverticulum (Image A). Her long-standing symptoms were likely due to the perforating hardware rather than the small size diverticulum. She underwent surgical removal of previous hardware with repair of the diverticulum. Intraoperative findings were consistent with a traction diverticulum. Discussion: Esophageal diverticula can be characterized based on their mechanism of formation. A traction diverticulum occurs secondary to an external force which adheres and pulls the wall of the esophagus creating a defect. Conversely pulsion diverticulum, a Zenker diverticulum, is formed due to increased intraluminal pressure resulting in the outpouching.Figure 1.: Endoscopic image of esophageal diverticulum with screws and metal plate.

Watching Your Neck: The Influence of Real-Time Visual Feedback on Cervical Joint Position Sense in Chronic Neck Pain.

Patients with neck pain demonstrate a variety of sensorimotor impairments, such as decreased cervical joint position sense (CJPS) acuity, which might also be associated with an impaired internal body representation. The present study evaluated the effect of real-time visual feedback of the individual's own neck on CJPS compared to observing a book. Twenty-three patients with neck pain participated in the experiment and received the interventions in randomized order on separate days in a within-subject pretest-posttest design. Before and immediately after each intervention, CJPS was measured by a therapist blinded to the intervention. The results demonstrate a significantly different development of CJPS (p = .04), with increased CJPS acuity after observing one's own neck and decreased acuity after observing a book. Real-time visual feedback of the neck improved CJPS acuity in patients with neck pain without active movements of the neck, indicating the importance of central nervous system processing for CJPS acuity.

3D motion analysis of cervical spine joints of dental hygiene students and dental hygienists during scaling operation

3D motion analysis of cervical spine joints of dental hygiene students and dental hygienists during scaling operation

Intradiscal Pressure Responses to Cervical Spine Posterior-Anterior Mobilization to Promote Disc Nutrition

Research Objectives To investigate in cadaveric specimens if cervical PA mobilizations produce changes in CIDP. Causes for age-related degeneration include lack of IVD nutrition and prolonged intradiscal pressure. While studies have shown changes in cervical intradiscal pressure (CIDP) with cervical range of motion (ROM), traction and manipulation, no study has evaluated effects of cervical spine joint mobilizations on CIDP. Design Intraclass correlation coefficient [ICC (3,k)] was calculated. To assess the effect of cervical mobilizations on CIDP at different time intervals, four separate 3 (TIME: before/during/immediately following mobilization) X 2 (25 N and 45 N) repeated measures ANOVAs (Friedman) were used for each cervical level. Setting Department of Anatomy at the Université du Québec à Trois-Rivières. Participants Seven un-embalmed cadaveric specimens. Interventions Cervical PA mobilizations on cadaveric specimens using a servo-controlled linear actuator to provide 25 and 45 N forces. Measurements of CIDP were conducted using fiberoptic catheter systems at C4-5, C5-6, C6-7, and C7-T1 IVD levels. The FISO system recorded CIDP for each IVD cervical level before, during and immediately following mobilization. Main Outcome Measures Measurements of CIDP including means, standard deviation and medians. Results Reliability coefficients for CIDP measurements during, immediately after mobilization were ICC(3,k)>.98, 95% CI. Mean CIDP varied from -7.3±18.8 to 11±37.9 mmHg and from -6.5±16 to 22.8±84.5 mmHg during 25 and 45N PA mobilizations (p>.4), respectively. There was no CIDP changes during and following PA mobilizations, with exception of C5-6 CIDP at 25N or 45N (p=.05 and .018, respectively). Conclusions Cervical PA mobilizations produced substantial CIDP changes at adjacent and remote cervical segments. In vivo investigations are warranted. Author(s) Disclosures No disclosures or conflicts noted. To investigate in cadaveric specimens if cervical PA mobilizations produce changes in CIDP. Causes for age-related degeneration include lack of IVD nutrition and prolonged intradiscal pressure. While studies have shown changes in cervical intradiscal pressure (CIDP) with cervical range of motion (ROM), traction and manipulation, no study has evaluated effects of cervical spine joint mobilizations on CIDP. Intraclass correlation coefficient [ICC (3,k)] was calculated. To assess the effect of cervical mobilizations on CIDP at different time intervals, four separate 3 (TIME: before/during/immediately following mobilization) X 2 (25 N and 45 N) repeated measures ANOVAs (Friedman) were used for each cervical level. Department of Anatomy at the Université du Québec à Trois-Rivières. Seven un-embalmed cadaveric specimens. Cervical PA mobilizations on cadaveric specimens using a servo-controlled linear actuator to provide 25 and 45 N forces. Measurements of CIDP were conducted using fiberoptic catheter systems at C4-5, C5-6, C6-7, and C7-T1 IVD levels. The FISO system recorded CIDP for each IVD cervical level before, during and immediately following mobilization. Measurements of CIDP including means, standard deviation and medians. Reliability coefficients for CIDP measurements during, immediately after mobilization were ICC(3,k)>.98, 95% CI. Mean CIDP varied from -7.3±18.8 to 11±37.9 mmHg and from -6.5±16 to 22.8±84.5 mmHg during 25 and 45N PA mobilizations (p>.4), respectively. There was no CIDP changes during and following PA mobilizations, with exception of C5-6 CIDP at 25N or 45N (p=.05 and .018, respectively). Cervical PA mobilizations produced substantial CIDP changes at adjacent and remote cervical segments. In vivo investigations are warranted.

Calcium pyrophosphate crystal deposition in a cohort of 57 patients with Gitelman syndrome.

Gitelman syndrome (GS) is the most frequent salt-wasting genetic tubulopathy and a source of hypokalaemia and hypomagnesemia. Chondrocalcinosis (CC) is a frequent feature of GS. The aim of our study was to determine the prevalence, distribution patterns, clinical phenotypes and risk factors for CC in GS. This prospective study of a cohort of 57 patients with GS included a systematic screening for CC by peripheral joint radiography, cervical spine CT and joint US. The prevalence of cervical C1-C2 CC by CT was compared between 33 GS patients and sex- and age-matched controls. Clinical and biochemical features were analysed to identify factors associated with CC. Mean (s.d.) age of patients was 46.5 (12.4) years, 66.7% were women and 93.0% carried SLC12A3 mutations. Mean serum magnesium level was 0.60 (0.30) mmol/l. CC was observed in 79% of patients, with the highest prevalence at the cervical spine (81.8%) followed by the knee (52.6%), wrist (50.9%), ankle (38.6%), TM joint (36.4%), shoulder (33.3%), hip (22.8%), elbow (14.0%) and sclerochoroid (12.1%). Prevalence of CC at the C1-C2 level was higher in the GS cohort than control group (72.7% vs 9.1%) (adjusted odds ratio 21.0, 95% CI 2.8, 156.1, P = 0.003). Independent factors associated with CC were low serum magnesium level and age. GS was associated with widespread CC, favoured by aging and hypomagnesemia. The C1-C2 level was the most affected site. Follow-up of this unique cohort will help understanding the clinical consequences of CC, especially the precise characterization of pyrophosphate arthropathy.

Effects of dry needling of the obliquus capitis inferior on sensorimotor control and cervical mobility in people with neck pain: A double-blind, randomized sham-controlled trial

BackgroundImpairments of sensorimotor control relating to head and eye movement control and postural stability are often present in people with neck pain. The upper cervical spine and particularly the obliquus capitis inferior (OCI) play an important proprioceptive role; and its impairment may alter cervical sensorimotor control. Dry needling (DN) is a valid technique to target the OCI. ObjectivesTo investigate if a single DN session of the OCI muscle improves head and eye movement control-related outcomes, postural stability, and cervical mobility in people with neck pain. MethodsForty people with neck pain were randomly assigned to receive a single session of DN or sham needling of the OCI. Cervical joint position error (JPE), cervical movement sense, standing balance and oculomotor control were examined at baseline, immediately post-intervention, and at one-week follow-up. Active cervical rotation range of motion and the flexion rotation test were used to examine the global and upper cervical rotation mobility, respectively. ResultsLinear mixed-models revealed that the DN group showed a decrease of JPE immediately post-intervention compared to the sham group (mean difference [MD]= -0.93°; 95% confidence interval [CI]: -1.85, -0.02) which was maintained at one-week follow-up (MD= -1.64°; 95%CI: -2.85, -0.43). No effects on standing balance or cervical movement sense were observed in both groups. Upper cervical mobility showed an increase immediately after DN compared to the sham group (MD= 5.14°; 95%CI: 0.77, 9.75) which remained stable at one-week follow-up (MD= 6.98°; 95%CI: 1.31, 12.40). Both group showed an immediate increase in global cervical mobility (MD= -0.14°; 95%CI: -5.29, 4.89). ConclusionThe results from the current study suggest that a single session of DN of the OCI reduces JPE deficits and increases upper cervical mobility in patients with neck pain. Future trials should examine if the addition of this technique to sensorimotor control training add further benefits in the management of neck pain.

EFFECT OF 6 WEEKS GREEVA SANCHALAN ON CERVICAL SPINE HEALTH AMONG MALE IT PROFESSIONALS

Purpose of present research was to study the effect of 6 weeks Greeva Sanchalan on Cervical Spine Health or work-related neck pain among male IT professionals. Quasi Pre-test Post-test Non-Equivalent research design used to achieve this objective. Non-Probability based Judgemental Sampling Technique, was used to screen samples from 2 different IT firms from Pune city, who were falling under the criteria of using laptop/desktop/computer for ≥5hours/day, between 30-50years of age group, experiencing neck pain/stiffness and were willing to participate in study. Neck Disability Index Questionnaire (NDI) includes 10 measuring sections such as neck pain, personal care, headache, lifting, reading, concentration, sleeping, work, driving, and recreation was used to collecting data. Using ABBA method, total selected 26 IT professionals, were divided into two groups, i.e., experimental (n=13) and control group (n=13). 6 weeks Greeva Sanchalan intervention was developed and implemented to experimental group’s IT professionals only. After 6 weeks, post-test NDI scores were collected for all 26 IT professionals. NDI pre and post test scores were statistically analysed through Descriptive and Inferential statistics using SPSS software. Mean of pre and post NDI scores for experimental group was 7.92 (±1.89) and 5.62 (±1.26) respectively. Similarly Mean of pre and post NDI scores for control group was 7.54 (±2.44) and 7.77 (± 2.98) respectively. On comparing the Mean of pre and post NDI scores with Neck Disability Index standard norms, all 26 IT professionals were falling within mild neck disability category. Mean of change in performance for experimental and control group’s IT professionals were 2.31 (±2.06) and 0.23 (±1.74) respectively. Calculated mean difference of change in performance was 2.54 for 26 IT professionals. Calculated t-value was 3.40(24) at 0.05 significance level (p=0.002; p less than 0.05). According to statistical outcome, 6 weeks Greeva Sanchalan intervention benefitted in reducing neck pain/stiffness related to work among IT professionals, which relieved muscular tension of neck-shoulder region. It improves range of motion (CROM) of cervical pivot joint along with regaining neck muscles flexibility, which also strengthens neck muscles.

Comparison of the effectiveness of dry needling with dry cupping at upper trapezius muscle in patients with myofascial trigger points.

Background: Trigger points are palpable nodules or irritable spots present in the skeletal muscles, painful upon pressure. This study is concerned with the pain in the upper Trapezius muscle due to the formation of myofascial trigger points and to make a comparison of the effectiveness of dry needling with dry cupping for treating upper trapezius myofascial trigger points.&#x0D; Methodology: Myofascial trigger points were diagnosed in 30 individuals in the upper trapezius. Subjects were randomized into Group-A (n=15) and Group-B (n=15) using the coin toss method. Patients were evaluated at baseline and after the termination of intervention using the Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI) and cervical joint range of motions (ROM). Patients from both groups received three sessions of treatment on alternate days in one week.&#x0D; Results: Patients with both interventions resulted in significant improvement of NPRS (p=0.001), NDI (p=0.001), and cervical ranges of motion (p=0.001). However, between groups comparison of outcome measure showed no significant difference in NPRS (p=0.990), NDI (p=0.359), cervical flexion (p=0.457), cervical extension (p=0.382), right cervical lateral flexion (p=0.250), left cervical lateral flexion (p=0.792), right cervical rotation (p=0.336), and left cervical rotation (p=0.242) of motion.&#x0D; Conclusion: The pre-and post-intervention results have concluded that both treatment methods effectively treat myofascial trigger points. There was no significant difference between the two groups for numeric pain rating scale, neck disability index scoring and cervical range of motions.

Exploring the Relationship Between Musculoskeletal Injury and Clinical Outcome Measures of Cervical Sensorimotor Function

The objective of this study was to explore the correlation between preseason measures of cervical sensorimotor function and musculoskeletal injury rates across a contact sport season. The authors hypothesized that athletes with higher sensorimotor dysfunction at baseline would be more likely to suffer an injury. The authors further hypothesized that contact sport participation would lead to greater changes in cervical sensorimotor function across a sport season compared with noncontact controls. Forty-nine collegiate club athletes (26 rugby and 23 noncontact controls) participated in a cohort study. Low positive correlations between baseline sign and symptom severity (r = .383), and score (r = .344), and cervical joint position error (r = .385–.425) and time loss injury were observed. Combining sign and symptom severity score and the neck reposition error predicted musculoskeletal injury status with 80.8% accuracy (area under the curve = 0.80, p = .003). The results suggest preseason deficits in cervical sensorimotor function may be related to future musculoskeletal injury risk. Sign and symptom severity score, Neck Disability Index score, and cervical joint position error can help identify athletes requiring more comprehensive cervical spine assessment that may benefit from preventative intervention.

Immediate Effects of Diaphragmatic Breathing with Cervical Spine Mobilization on the Pulmonary Function and Craniovertebral Angle in Patients with Chronic Stroke.

Background and Objectives: Patients with stroke have a forward neck posture due to neurological damage and often have impaired pulmonary function. This study investigated the effect of diaphragmatic breathing with cervical mobilization to improve pulmonary function cervical alignments. Materials and Methods: This study used a one-group pre-test–post-test design including 20 patients with stroke. Two types of cervical joint mobilization techniques, consisting of left and right lateral glide mobilization and posterior–anterior mobilization, were utilized. During joint mobilization, the patients performed diaphragmatic breathing. The measurements were performed immediately after the intervention. Pulmonary function was evaluated using a spirometer to measure the forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). The craniovertebral angle (CVA) was measured using lateral photographs. Results: After diaphragm breathing with cervical joint mobilization, subjects had significantly increased FEV1, FVC, PEF and CVA. Conclusion: Diaphragm breathing with cervical joint mobilization are possible interventions to increase pulmonary function and improve the craniovertebral angle in patients with stroke. However, a complete conclusion can be reached only after a follow-up study has been conducted with a comparison of more subjects and controls.

Obesity Factors on The Incidence of Joint Pain of Elderly

Aging is a process that will be experienced by humans according to the cycle of growth and development. Changes both physically and psychologically often cause disorders and health problems that must be resolved. Problems with the physical aspect of the elderly, one of which is a decrease in musculoskeletal function, especially in the joints, often manifest the appearance of joint pain. The presence of joint cartilage damage due to inflammation, as well as an increase in the load on the joints due to excess body weight (obesity) is other factors that often arise. The hip, lumbal, cervical and knee joints are the parts that support the body's weight, so they experience the most problems. The purpose of this study was to determine the correlation between obesity and the incidence of knee joint pain in the elderly. The design of the study was correlational analytic with a cross sectional approach. The sampling was purposive sampling with 50 respondents as the sample. The instrument used was an observation sheet to measure the respondent's obesity variable and to determine the presence of joint pain using an interview form. The measurement results were then processed and bivariate analysis was carried out using the chi square test. The results of the research analysis Showed the value of p = 0.004 and α = 0.05, this meant that p &lt; 0.05, so there was a correlation between the level of obesity and the occurrence of joint pain. This was because not only age but also  increasing body weight cause joint paint.  The ability of the knee joint to support the body as a whole was getting heavier due to friction of the joint cartilage. From these studies, it can be concluded that in the elderly, excess body weight can affect to the ability of bones and joints and result in joint pain. The health workers should support the elderly so that the elderly avoid the stress.

Risk Factors of Persistently Active Disease among Filipino Children with Systemic Juvenile Idiopathic Arthritis: a 10-Year Study in a Tertiary Hospital

Background: Systemic juvenile idiopathic arthritis (SJIA) is one of the most common subtypes of arthritis among children in southeast Asia with higher progression of disease activity. Unsuccessful control of the disease may lead to long-term disability resulting in functional limitations that would affect productivity of the individual. Objective: The study determined the risk factors for persistently active disease among Filipino children aged 2 weeks to 18 years diagnosed with SJIA seen in the Section of Pediatric Rheumatology of the University of Santo Tomas Hospital (USTH) from June 2009 to June 2019. Methodology: A retrospective cohort study was done involving chart review of both clinical division and private division patients. The following parameters were determined: sex, age at diagnosis, time elapsed from symptom onset to diagnosis, joint involvement, inflammatory markers and extra-articular manifestation. Statistical analysis included frequencies, percentages and logistic regression for the risk factors of interest. Results: One hundred twenty-seven patients with SJIA who were appropriately treated for at least three years were included. Among which, 88 (69%) developed persistently active disease. Among them, 36 (41%) were diagnosed at 1-5 years old. Many were diagnosed (n=54, 61%) after five weeks. The most commonly affected joints were the wrists, knees and ankles. The most common contracture noted involved the cervical joint. Only 33 (26%) patients received biologic agents. Risk factors identified for the development of persistent disease activity were low hemoglobin levels at the time of diagnosis and after one month of treatment, elevated platelet count after a month, substantial joint count after three months and increased ESR after 6 months. Conclusion: The change or improvement of the joint count and in hemoglobin, platelet count and ESR levels after appropriate treatment may determine the risk for persistently active disease in Filipino children with SJIA.

Modeling intervertebral articulation: The rotule à doigt mechanical joint (RAD) in birds and mammals.

The vertebrate skeleton is composed of articulated bones. Most of the articulations are classically described using mechanical joints, except the intervertebral joint. The aim of this study was to identify a joint model with the same mechanical features as the cervical joints. On the neck vertebrae, six articular surfaces participate in the joint: the cranial part of the centrum and the facets of the two prezygapophyses of a vertebra articulate on the caudal part of the centrum and the two articular facets of the postzygapophyses of the previous vertebra. We used the intervertebral joints of the birds neck to identify the mechanical joint representing intervertebral linkage. This link was described in the literature as a joint allowing two or three rotations and no translation. These features correspond to the rotule à doigt (RAD) joint, a ball and socket joint with a pin. We compared the RAD joint to the postaxial intervertebral joints of the avian neck and found it a suitable model to determine the geometrical features involved in the joint mobility. The difference in the angles of virtual axes linking the geometrical center of the centrum to the zygapophysis surfaces determines the mean dorsoventral flexion of the joint. It also helps to limit longitudinal rotation. The orientation of the zygapophysis surfaces determines the range of motion in both dorsoventral and lateral flexion. The overall system prevents dislocation. The model was validated on 13 joints of a vulture neck and 11 joints of a swallow neck and on one joint (C6-C7) in each of three mammal species: the wolf (Canis lupus), mole (Talpa europaea), and human (Homo sapiens). The RAD mechanical joint was found in all vertebral articulations. This validation of the model on different species shows that the RAD intervertebral joint model makes it possible to extract the parameters that guide and limit the mobility of the cervical spine from the complex shape of the vertebrae and to compare them in interspecific studies.