Left Lateral Rotation Research Articles

Effects of cervicothoracic mobility programme on pain, range of motion and function in patients with chronic back pain.

To determine the effects of the cervicothoracic mobility programme on pain, range of motion and function in patients with chronic back pain. The randomised controlled trial was conducted from April to November 2022 at the Physiotherapy Department of Syed Medical Complex, Sialkot, Pakistan, and comprised patients of either gender aged 18-50 years who had a minimum of 6 months of chronic back pain with moderate disability. They were randomly allocated to experimental group A and control group B. Group A subjects received cervical and thoracic mobilisation with conventional physical therapy, while group B subjects received conventional physical therapy alone. The treatment duration was 45 minutes per session, with 3 sessions per week for 3 weeks. Numeric Pain Rating Scale, Oswestry Disability Index and a goniometer was used to assess pain, disability and for the range of motion. Data was analysed using SPSS 25. Of the 44 patients, 22(50%) were in each of the 2 groups. Group A had 14(63.6%) females and 8(36.4%) males with overall mean age 36.45±10.80 years, while group B had 16(72.7%) females and 6(27.3%) males with overall mean age 35.77±11.05 years. There was a significant inter-group difference in terms of pain, function and flexion (p<0.05), while the difference was not significant in terms of extension, right and left lateral rotation (p>0.05). Intragroup analysis showed significant improvement in both groups (p<0.05). Cervicothoracic mobilisation was more effective in improving pain, functionality and range of motion in patients with chronic low back pain. NCT05347251.

Influence of different head and neck positions on performance characteristics of second generation supraglottic airway devices

BackgroundVarious head and neck positions alter the performance of supraglottic airway devices (SAD). We compared the influence of flexion, extension, neutral and rotation of the neck on performance characteristics of second generation airway devices namely Proseal (PLMA), i-gel and Auragain laryngeal mask. MethodsThis study was conducted in 90 ASA physical status I and II patients 18–65 years of age. Patients were randomised into three groups with 30 patients in each: PLMA, i-gel and Auragain. The primary objective was to compare oropharyngeal leak pressure (OPLP) among PLMA, i-gel and Auragain in neutral, flexion, extension and lateral rotation of the neck. The secondary objective was to compare Peak inspiratory pressure (PIP), ventilation score, expired tidal volume, fiberoptic grading of laryngeal view, end tidal carbon dioxide and OPLP-PIP difference. ResultsPLMA, i-gel and Auragain have the highest OPLP in flexion (34.4 ± 2.5, 31.6 ± 2.3, 32.8 ± 1.7) followed by neutral, left lateral rotation and lowest in extension (26.7 ± 1.6, 25.4 ± 3.19, 29.6 ± 1.0) respectively. PLMA and Auragain have significantly higher OPLP when compared to i-gel in all positions p < 0.05. In extension, OPLP with Auragain (29.6 + 1.0) was significantly higher than PLMA (26.7 + 1.6) and i-gel (25.4 + 3.1), p < 0.001. PIP was significantly higher in flexion position for all the three devices. No significant difference in fibre optic grading and ventilation score was seen for three devices in various neck positions. ConclusionsPLMA and Auragain have better sealing pressure than i-gel in all the positions. Flexion position during surgery is best for maintaining OPLP. Auragain should be preferred over PLMA and i-gel in surgeries involving extension of neck.

Effects of acupuncture at myofascial trigger points combined with sling exercise therapy on clinical recovery and cervical spine biomechanics in patients with cervical spondylotic radiculopathy

Objective This research aimed to ascertain the effects of acupuncture at myofascial trigger points (MTrPs) in combination with sling exercise therapy (SET) on the clinical recovery and cervical spine biomechanics in patients with cervical spondylotic radiculopathy (CRS). Methods Eighty patients with CSR were divided into Group A and Group B. Group A was treated with acupuncture at MTrPs, and Group B was treated with acupuncture at MTrPs combined with SET. The cervical spine function, pain level, cervical spine biomechanics and the occurrence of complications were compared between the two groups before and after treatment. Results After treatment, the Japanese Orthopaedic Association scores, Clinical Assessment Scale for Cervical Spondylosis scores, cervical forward flexion angle, posterior extension angle, left lateral flexion angle, right lateral flexion angle, left lateral rotation angle, and right lateral rotation angle of the Group B were raised, and the Neck Disability index, Visual Analogue Scale scores, and Neck Pain Questionnaire scores were reduced versus those of the Group A. The difference in complication rates between the two groups was not of statistical significance. Conclusion Acupuncture at MTrPs combined with SET promotes functional recovery of the cervical spine, reduces pain, and improves cervical spine biomechanics in patients with CRS.

Influence of Different Head and Neck Positions on Oropharyngeal Leak Pressure with the LMA Protector Airway: A Cross-over Study

Introduction: The assessment of seal pressure or leak pressure in supraglottic devices has commonly been used to confirm device functionality and for research purposes regarding laryngeal mask airways (LMAs). When used for controlled ventilation, the LMA Protector provides a better oropharyngeal seal pressure. Materials and Methods: In this cross-over study, thirty-five patients of either sex, aged 18 to 70 years, American Society of Anaesthesiology (ASA) class I and II, with a weight range of 50-70 kg, scheduled for elective surgery under general anaesthesia where a supraglottic airway device was indicated, were enrolled. In all 35 patients, the position of the patient’s head and neck was changed from neutral to flexion, extension, and right and left lateral rotation. The primary objective of the study was to compare the differences in oropharyngeal leak pressure (OLP) with changes in head and neck positions using the LMA Protector airway device. Results: The mean age of the participants was 42.26 years, and the average weight was 63.34 kg. The LMA Protector was placed in 18 females and 17 males. A Mallampati grade of I was noted in 16 patients, while a grade of II was observed in 19 patients. The OLP achieved in this study was higher, providing adequate ventilation and oxygenation in all positions. The OLP and tidal volume in flexion were higher compared to the seal pressure in the neutral position (31.89 cm H2O, SD 5.080 cm H2O vs. 34.49 cm H2O, SD 4.804 cm H2O, p&lt;0.05). No significant difference in OLP was observed when changing to different head positions, i.e., in extension, right lateral, and left lateral positions. Conclusion: The LMA Protector is an effective device in terms of achieving high oropharyngeal seal pressure. It produced better oropharyngeal seal pressure in the flexion position compared to the neutral position.

Relationship of Endotracheal Tube Cuff Pressures with Changes in Body Positions of Critically Ill Patients on Mechanical Ventilation: An Observational Study.

Endotracheal tube cuff pressure (ETCP) is an important factor to determine the development of complications associated with invasive mechanical ventilation. To avoid preventable complications arising out of immobilization, frequent changes in body positioning are necessary. Such variations in body position can affect ETCP in critically ill patients who are on mechanical ventilation. So, our study aimed to assess the effect of changes in body position on ETCP in patients who are on mechanical ventilation. This prospective observational study included 31 critically ill intubated patients. Each study subject was first placed in a neutral starting position with a 30º head elevation. Then, they were subjected to a sequential change in body position based on the 16 most used positions as part of the critical care unit's (CCUs) daily routine. Endotracheal tube cuff pressure was measured after each position change. Data were analyzed using standard statistical tests. Statistically significant difference in ETCP was observed during anteflexion of neck, hyperextension of neck, left lateral flexion of neck, right lateral flexion of neck, left lateral rotation of neck, right lateral rotation of neck, 10o recumbent position, supine position, Trendelenburg position, and right lateral 30° and 45° positions. Maximum increase in ETCP was seen during anteflexion of neck (31 ± 4.5; 22-42 cm H2O). Our study demonstrates significant deviations in ETCP from the recommended range following changes in the body position of mechanically ventilated patients, highlighting the need for the measurement of ETCP after each position change and maintenance of the same within the target range. Roy O, Dasgupta S, Chandra A, Biswas P, Choudhury A, Ghosh S, et al. Relationship of Endotracheal Tube Cuff Pressures with Changes in Body Positions of Critically Ill Patients on Mechanical Ventilation: An Observational Study. Indian J Crit Care Med 2024;28(1):36-40.

Biomechanical evaluation and optimal design of a pedicle screw with double bent rods internal fixation system based on PE-PLIF fusion

Problems, such as broken screws, broken rods, and cage subsidence after clinical spinal fusion surgery affect the success rate of fusion surgery and the fixation effect of fusion segments, and these problems still affect the treatment and postoperative recovery of patients. In this study, we used the biomechanical finite element analysis method to analyze and study the fixation effect of three kinds of spinal internal fixation systems on L4–L5 lumbar spine segments in percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF). The three different fixation systems compared in this study include bilateral pedicle screw fixation (M1); bilateral pedicle screw with cross-link fixation (M2); bilateral pedicle screws with double bent rods fixation (M3). The internal fixation systems with different structures were analyzed with the help of Hypermesh, and Abaqus. It was found that the internal fixation system with double bent rods reduced screw stresses by 23.8 and 22.2% in right and left axial rotation than the traditional bilateral pedicle screw system, while titanium rod stresses were reduced by 9.6, 3.7, 9.6, and 2.9% in flexion, left and right lateral bending, and right axial rotation, respectively, and L5 upper endplate stresses were reduced by 35.5, 18.9, 38.4, 10.2, and 48.3% in flexion, left and right lateral bending, and left and right axial rotation, respectively. The spinal range of motion (ROM) of the M3 internal fixation system was less than that of the M1 and M2 internal fixation systems in left lateral bending, left lateral rotation, and right axial rotation, and the intact vertebral ROM was reduced by 93.7, 94.9, and 90.9%, respectively. The double bent rod structure of the spinal internal fixation system has better biomechanical properties, which can effectively reduce the risk of screw breakage, loosening, cage subsidence, and endplate collapse after fusion surgery.

Intrarater reliability of cervical range of motion device in measuring cervical active range of motion in patients with chronic neck pain and respiratory dysfunction

Methodology: We enrolled 30 patients (14 males and 16 females) with chronic neck pain and respiratory dysfunction fulfilling inclusion criteria. Two trials of CAROM measurement for flexion, extension, left and right lateral flexion and left and right rotation were performed, with a gap of one week to measure test retest reliability of CROM device. Intraclass correlation coefficient (ICC), standard errors of measurement (SEM) and minimal detectable change (MDC) were calculated to test the intrarater reliability.&#x0D; Results: Intrarater reliability of repeated measurements of CAROM using the CROM device was found to be good. The ICC values ranged between 0.88-0.97 for flexion, 0.93-0.98 for extension, 0.92-0.98 for right lateral flexion,0.93-0.98 for left lateral flexion. For right rotation it was 0.88-0.97, for left lateral rotation it was 0.95-0.99. The standard error of measurement for these movements ranged from 1.5° to 2.9°. Minimal detectable change ranged from 3.5°for extension to 6.8°for left lateral flexion.&#x0D; Conclusion: Cervical range of motion device is a reliable tool for measuring cervical active range of motion in patients simultaneously suffering from chronic neck pain and respiratory dysfunction.&#x0D; Abbreviations: CAROM - cervical active range of motion; CROM - cervical range of motion; ICC - Intraclass correlation coefficient; SEM - standard errors of measurement; MDC - minimal detectable change&#x0D; Key words: Adult; Exercise Therapy / methods; Female; Humans; Male; Neck Pain / physiopathology; Neck Pain / therapy; Pain Measurement; Pulmonary function; Range of Motion, Articular; Reliability&#x0D; Citation: Anwar S, Arsalan SA, Zafar H, Ahmad A, Gillani SA, Hanif A. Intrarater reliability of cervical range of motion device in measuring cervical active range of motion in patients with chronic neck pain and respiratory dysfunction. Anaesth. pain intensive care 2022;26(4):503-509; DOI: 10.35975/apic.v26i4.1957&#x0D; Received: September 29, 2021; Reviewed: April 21, 2022; Accepted: May 10, 2022

Investigation of Joint Position Sense and Balance in Individuals With Chronic Idiopathic Neck Pain: A Cross-Sectional Study

ObjectiveThe aim of this study was to determine the relationship between joint position sense and static and dynamic balance in female patients with chronic neck pain compared with healthy controls. MethodsThe study sample comprised 25 female patients with chronic neck pain and 25 healthy (asymptomatic) female controls. Pain severity with the visual analog scale, joint position sense with the laser pointer method, static balance with the Single-Leg Balance Test, and dynamic balance with the Y Balance Test were assessed. ResultsThe deviation in cervical joint position sense was greater in extension (P < .001), right rotation (P < .001), and left lateral rotation (P < .05) in the patients with chronic neck pain compared with the healthy controls. The results of the patients with chronic neck pain were worse than the healthy controls in the Single-Leg Balance Test with both eyes open (P < .05) and eyes closed (P < .05). The patients with chronic neck pain had worse dynamic balance only in the anterior direction reach of the left leg (P < .05). ConclusionCervical joint position sense and static balance were worse in female patients with chronic idiopathic neck pain when compared with asymptomatic controls. Dynamic balance in all other directions except for the anterior direction was not negatively affected in individuals with chronic idiopathic neck pain.

Short-term Effect of Mulligan SNAGs on Pain Intensity, Cervical Range of Motion and Craniovertebral Angle in Patients with Non Specific Neck Pain: A Quasi-experimental Study

Introduction: The extended use of smartphone, laptops and computers alters the posture of the neck which results in non specific neck pain. Though the physical therapy modalities give symptomatic relief, the forward head posture is left uncorrected. Mulligan Sustained Natural Apophyseal Glides (SNAGs) stimulate the mechanoreceptors and proprioceptors around the joints that might correct the faulty posture of neck. Aim: To evaluate the short-term effect of mulligan SNAGs on pain intensity, cervical range of motion and craniovertebral angle in patients with non specific neck pain. Materials and Methods: This quasi-experimental study was conducted in Department of Physical Medicine and Rehabilitation at Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India, from August 2021 to October 2021. Total 20 patients diagnosed having non specific neck pain and Craniovertebral angle (CV) angle less than 45 degrees were included in the study. The participants were randomly allotted into two groups. Group A received interferential therapy and static neck exercises. Whereas, group B received Mulligan SNAGs in addition to interferential therapy and static neck exercises and serves as the experimental group. Mulligan SNAGs was given to each cervical movement as six repetitions× two sets/ session ×three sessions/week. The intervention was given for 2 weeks. preintervention and postintervention evaluation of pain intensity, cervical range of motion and CV angle was made and statistically analysed using Paired t-test for within group analysis and independent t-test for between group analysis at 5% level of significance (p-value &lt;0.05). Results: The mean age the participants in group A was (32.2±6.3 years) and group B was (32.7±6.03). Within group analysis was made and it was observed that group A and B showed significant reduction in Numerical Pain Rating Scale (NPRS) score (p-value=0.004, p-value=0.005), improvement in CV angle (p-value=0.001, p-value=0.001) and increased cervical range of flexion (p-value=0.001, p-value=0.001), cervical extension (p-value=0.004, p-value=0.001) and rotation movements (p-value &lt;0.05), respectively. The between group analysis of pre-post mean differences in the NPRS score (3.30±0.67, 4.60±0.96), CV angle (0.46±0.24, 5.62±1.21), cervical movement of flexion (10±2.36, 19±4.59), extension (6.50±2.53, 21±8.23), right lateral rotation (8±2.58, 15±4.08) and left lateral rotation (8.5±2.49, 16±4.24) was made using Independent samples t-test. It was observed that, all the outcomes showed significant difference. The mean difference in the outcome measures were significantly greater in group B who received mulligan SNAGs than group A. Conclusion: Thus, the short-term application of Mulligan SNAGs along with conventional physiotherapy proves good in reducing pain, improving cervical range of motion and normalizing the reduced CV angle in patients with non specific neck pain.

Finite Element Based-Analysis for Pre and Post Lumbar Fusion of Adult Degenerative Scoliosis Patients

Study DesignPre-post cohort finite elements (FE). ObjectivesTo investigate the effect of adjacent load transfer pre and post fusion surgery of lumbar scoliotic spines using FE models. Summary of Background DataAdult degenerative scoliosis (ADS) results from age-related changes, leading to segmental instability, deformity, and stenosis. FE study is capable of capturing the biomechanical parameters internal to the bones and connective soft tissues of the spine, which is difficult to measure by experimental approaches. Literature that describes the underlying mechanisms responsible for spinal fusion in scoliosis patients is limited, and FE study with larger subject sample size should be conducted. MethodsTwenty three-dimensional nonlinear FE models of the lumbosacral spine were created from pre (Cobb angle: 28.1° ± 10.5°) and post scoliosis surgery in vivo CT scans. During surgery, pedicle screws and rods were implanted at lumbar and sacral levels. A compressive load and six different moments (flexion, extension, right lateral bending, left lateral bending, right axial rotation, left axial rotation) were applied to the top level of each model. Outcome measures were range of motion (RoM), intradiscal pressure (IDP), and facet joint forces (FJF). Spinal fusion did alter the mechanical function of the scoliotic spine. ResultsScoliotic spine presented abnormal and asymmetrical kinetic and kinematic behavior. RoM: At the adjacent level, spinal fusion surgery produced a statically significantly increased left and right later bending intersegmental rotation (p < .006) in comparison to presurgical scoliosis models. At the fused level, spinal fusion surgery produced a statically significantly reduced intersegmental rotation in all the loading conditions (p = .001) in comparison to presurgical scoliosis models. IDP: At the fused level, spinal fusion surgery produced a much lower IDP in all of the loading conditions (p = .001). FJF: At the adjacent level, spinal fusion surgery produced a considerably larger left lateral rotation FJF (p = .001) in comparison to presurgical scoliosis models. At the fused level, spinal fusion surgery produced considerably lower FJF in all the loading conditions (p = .001) in comparison to presurgical scoliosis models. ConclusionsThis study was the first to investigate the effect of adjacent load transfer before and after fusion surgery using in vivo CT scans of 10 scoliotic spines. A posterior fusion has only a minor effect on mechanical behavior and a large effect on pressure and forces at the adjacent level. As expected, a large effect in the kinematics and kinetics was found at the fused level. Level of EvidenceLevel 3.

Reoccurring Neck Injury in a College Football Player

HISTORY: A 20-year-old male community college football defensive end developed left shoulder paresthesia during a game. He was tackling an opponent and his head was forced into a left lateral rotation. After this, he developed immediate paresthesia in the left upper trapezius and upper deltoid. He was evaluated on the side line by medical staff and removed from the remainder of game. Symptoms resolved within the next two days, and he returned to competition. Two weeks later, he again had his head forced into a left lateral rotation during a tackle. Paresthesia immediately returned in the left upper trapezius and upper deltoid. However, this time pain was increased and had onset of a burning sensation. After sideline evaluation, he was removed from competition. Following the game, he continued to have severe burning pain. He was sent to a local emergency department and ultimately released home. Paresthesia resolved over the next five days, but he was not cleared to return to competition. PHYSICAL EXAMINATION: There was no deformity to the neck or upper extremity. No cervical or left shoulder tenderness to palpation. His range of motion in the left glenohumeral joint was full. Strength was full throughout the entire left upper extremity. Sensation to light touch was diminished in the left upper trapezius and upper deltoid, but normal throughout the remainder of the upper extremity. Deep tendon reflexes were 2+ in bilateral biceps, brachioradialis, and triceps. Spurling’s test was positive on the left. DIFFERENTIAL DIAGNOSIS: 1.Upper trunk brachial plexopathy 2.Cervical radiculopathy 3.Cervical stenosis TEST AND RESULTS: 1.Cervical spine anterior-posterior, lateral and flexion-extension radiographs: No fracture or destructive change, disc spaces preserved, no pathologic movement 2. Cervical Magnetic Resonance Imaging: Left paramedian/foraminal disc protrusion at C3-4 resulting in moderate left foraminal stenosis and displacement of left C4 nerve root. No spinal canal stenosis or ligamentous injury. FINAL WORKING DIAGNOSIS: Left C4 radiculopathy TREATMENT AND OUTCOMES: 1. Orthopaedic spine referral determined to treat with non-operative management 2. Physical therapy for cervical strengthening, flexibility, and traction 3. Currently being withheld from competition with undetermined return to play date

Avaliação da qualidade de vida e do tratamento fisioterapêutico em pacientes com cervicalgia crônica

INTRODUÇÃO: Para analisar a efetividade do tratamento fisioterapêutico no paciente com dor crônica cervical, este trabalho teve como objetivo avaliar antes e após o tratamento fisioterapêutico: a qualidade de vida com o instrumento WHOQOL-100 e a melhora na amplitude de movimento usando um goniômetro. MATERIAIS E MÉTODOS: Participaram deste estudo 15 pacientes (10 mulheres e 5 homens). O nível de significância adotado foi de p &lt; 0,05. RESULTADOS: Foi verificada melhora significativa após o tratamento fisioterapêutico no domínio I - físico (p = 0,0117); domínio II - psicológico (p = 0,004); domínio III - nível de independência (p = 0,0006); domínio IV - relações sociais (p &lt; 0,0001); e no domínio V - ambiente (p = 0,0019); e também na amplitude articular dos movimentos de flexão cervical (p &lt; 0,0001), extensão cervical (p = 0,0004), inclinação lateral á direita (p &lt; 0,0001) inclinação lateral à esquerda (p &lt; 0,0001), rotação lateral à direita (p &lt; 0,0001) e rotação lateral à esquerda (p &lt; 0,0001). DISCUSSÃO: Andersen et al. (17) relataram que exercícios de alongamento melhoram de forma significativa a amplitude de movimento articular em mulheres com cervicalgia crônica. Chiu et al. (20) observaram melhora na dor crônica cervical e na limitação articular após seis semanas de tratamento com TENS e exercícios. CONCLUSÃO: O presente estudo conclui que a intervenção fisioterapêutica composta de exercícios de alongamento, técnicas de relaxamento, massagens e eletroterapia foram benéficos para melhorar a qualidade de vida e a flexibilidade nos pacientes com cervicalgia crônica.

Study of basilar artery hemodynamic changes in cervical rotation and flexion by color Doppler ultrasound

Objective To evaluate the basilar artery hemodynamical changes in cervical rotation and ventral flexion by color Doppler flow imaging(CDFI). Methods Basilar artery blood flow were detected during cervical With cervical right lateral,left lateral rotation and ventral flexion, the detection ratio of basilar artery by ultrasound were 89% ,84% ,81% respectively. There were no difference in statistics between the detction ratio of three kinds during cervical flexion,peak systolic velocity(PSV) and end-diastolic velocity(EDV) decreased apparently during left lateral rotation,which did not change during right lateral rotation. No changing was found with resistant index between the three kinds of cervical position. Conclusions The hemodynamic changing of basilar artery during cervical rotation and flexion could be detected by CDFI accurately,which might be useful in clinical study. Key words: Ultrasonography; Doppler; color; Basilar artery; Hemodynamic phenomena

Structure and geodynamic evolution of the Central Bransfield Basin (NW Antarctica) from seismic reflection data

The Bransfield Basin is a young active rift basin located between the northern margin of the Antarctic Peninsula and the South Shetland Islands margin. Deception and Bridgeman islands divide the Bransfield Basin in three subbasins, the western, central and eastern. Specific morpho-tectonic features and sediment fill differentiate each subbasin. The structure and geodynamic evolution of the Central Bransfield Basin, which is in a stage of incipient seafloor spreading, have been investigated in detail from a dense grid of single-channel seismic reflection data. The Central Bransfield Basin is dominated by two families of normal faults which are oriented northeast and northwest. The NE-trending faults define three graben systems that are roughly parallel to the basin axis. In an across-basin direction, the mean trend of this family of faults ranges from N71 (the graben system nearest to the Antarctic Peninsula) over N64 (the intermediate graben system), to N53 (the graben system nearest to the South Shetland Islands). The NW-trending family of faults is responsible for the deepening of the basin from southwest to northeast. Both families of faults define the overall Central Bransfield Basin structure, resulting in a complex division of the basin floor. Additionally, tens of volcanic edifices are located on the basin floor, the larger ones being associated to the NW-trending faults. Interaction of tectonics and sedimentation give place to the differentiation of three tectonostratigraphic units, TU1, TU2 and TU3 (from oldest to youngest). TU1 occupies the southernmost graben system, and it is affected by the NE-trending bounding normal faults. TU2 extends further northwestwards than TU1 and essentially fills the intermediate graben system. TU3 represents a further extension of the sediment infill over most of the Central Bransfield Basin, and marks the initiation of the infill of the northernmost graben system. Faults bounding this graben also determine the straight and abrupt morphology of the South Shetland Islands margin. The observed arrangement of the graben systems and the filling tectonostratigraphic units reveal a migration of extensional tectonics and associated depocentres from the Antarctic Peninsula margin to the South Shetland Island margin. The left-lateral rotation from N71 to N53 in the mean trend of the three successive graben systems could have been produced by the oblique subduction of the Phoenix plate and the effect of the sinistral strike-slip movement of the South Scotia Ridge, 200 km northeastwards of the Central Bransfield Basin.

Calcified Plaque in the Cervical Spine With Pain and Paresthesia

History A 52-year-old diabetic woman was seen in the clinic for pain in her shoulder and left arm. She also complained of paresthesias in her left upper extremity for the previous 13 years. Past history showed head trauma at age 2 years following a 4-m fall. Physical examination of the neck showed normal flexion, extension to 60°, right lateral rotation to 60°, and left lateral rotation to 45°. No sensory deficit was detected in her left arm. Figure 1 shows the lateral film from the cervical spine series. Diagnosis Ossification of the posterior longitudinal ligament of the cervical spine (Japanese disease). Comment The initial roentgenograms (Fig 1) demonstrated a bony plaque along the posterior aspect of vertebral bodies C-2 to C-4. Osteoarthritic changes were noted at the C-5 to C-6 level. Additionally, an os odontoideum was seen at C-1 Anteroposterior and lateral tomograms (Fig 2 and 3) showed the ossified