Neck Complaints Research Articles

Terapi Akupunktur Dan Pola Hidup Sehat Untuk Menurunkan Tekanan Darah Pada Penderita Hipertensi

Background: Hypertension is a disease that is a public health problem found in both developed and developing countries. It takes obedience and discipline and money to be able to control high blood pressure. Acupuncture can be applied to help control blood pressure by stimulating acupuncture points to deliver and smooth the Qi in an effort to balance Yin Yang which medically can improve the physiology of blood pressure. More than 20% of the Bibis Luhur RW XXI Nusukan Banjarsari Surakarta community complained of frequent dizziness and experiencing high blood pressure. Methods: Examination of blood pressure checks, counseling on healthy lifestyles and prevention of hypertension, as well as acupuncture therapy services located at Griya Sehat Prima Hati. The activity was carried out 12 times with a frequency of once a week with local health cadres. Blood pressure was checked at each visit and blood pressure comparisons were made from the first and last therapy. Results: There was an average decrease of 19 mmHg for systolic pressure and 10 mmHg for diastolic pressure. Patients, families and health cadres experienced an increase in knowledge about hypertension management and a healthy lifestyle by 80%. Acupuncture reduces comorbidities for people with hypertension such as dizziness, insomnia, stiff neck, and other complaints. Conclusion: With counseling, health care, and acupuncture therapy to help people understand and improve their daily life patterns, reduce complaints, and lower blood pressure.

Effect of Congenital C4–5 Synostosis on Adjacent Mobile Segments: Radiographic Assessment

Study DesignProspective case series.PurposeTo assess the corporal morphology of the fused body and adjacent segment conditions.Overview of LiteratureIt is known that two fused vertebral bodies take the similar shape of the single body with inwaisting, with or without caudal flaring of the fused body, and that the fused body can cause the fusion disease at the adjacent segment that can be a risk factor for potential neurological compromise.MethodsRadiograms of the 11 study subjects (six men and five women), aged 22–90 years who visited the outpatients’ clinic for various neck complaints without trauma history were examined. C4–5 synostosis was an incidental finding in all the subjects.ResultsAll the fused bodies were inwaisted and had anterior caudal breaking but no interior corporal flaring. Adjacent segment disease was not found in eight patients aged <40 years. Disk degeneration was found at C3–4 and C5–6 in three patients each and at C6–7 in two patients. Disk degeneration was limited to the adjacent segments.ConclusionsDegenerative disk changes are associated with the natural aging process, and the corporal morphology of the fused vertebral becomes inwaisted similar to that in the single vertebrae.

COMORBIDITY CHARACTERISTICS OF ADULT PATIENTS WITH REPORTED NECK AND LOW BACK COMPLAINTS - AN OUTPATIENT CLINICAL POPULATION-BASED COHORT STUDY

In clinical practice, a comprehensive history and examination often includes questionnaires covering all systems. Physical examination is augmented by functional assessment using subjective (neck and lumbar disability indexes, NDI and LBDI respectively) and objective measures (computerized dynamic posturography, CDP). In this retrospective chart review of patients with complaints of postural instability and neck or low back pain, the presence and number of comorbidities and their classification were analyzed by age, gender, and severity of the disability. In general subjects showed higher disability in the NDI than in the LBDI (with more significant impact of the proximal vs. distal pain, joint and receptor dysfunction); they had a wide range of CDP results (the more difficult the test, the higher the number of subjects that were not able to complete it and the lower the number that had healthy balance); and on average 3.84 comorbid conditions were present, with 21 subjects presenting with 5 or more, 3 with 10 or more, and one reporting 15 comorbidities. No statistically significant differences were found for age, BMI and LBDI; sex and NDI affected metabolic comorbidities; certain tests of the CDP affected the Musculoskeletal and Other type of comorbidities. It was difficult to detect strong correlation trends that could be easily explained. Complex subjects cases complicate the possibility of doing practice based clinical research, but more importantly they create a challenge for the clinician in deciding the best course of action for treating the patient. New algorithmic assessments and integrated approaches are needed.

Erosion of Superior Vena Caval Stent into Trachea, An Unusual Cause of Hemoptysis.

Erosion of Superior Vena Caval Stent into Trachea, An Unusual Cause of Hemoptysis.

Head- and neck-related symptoms post-motor vehicle collision (MVC): Separate entities or two-sides of the same coin?

Although post-motor vehicle collision (MVC) pain and symptoms are largely convergent among those with mild traumatic brain injury (mTBI) and whiplash associated disorder (WAD), and patients oftentimes report initial neck and head complaints, the clinical picture of mTBI and WAD has been primarily studied as separate conditions which may result in an incomplete clinical picture. As such, this study was conducted to explore the role of pain and post-traumatic psychological features in explaining both head and neck-related symptom variability in a cohort of post-collision patients. This is with the goal of disentangling if contributory factors are uniquely related to each diagnosis, or are shared between the two. Patients recruited in the very early acute phase (<72h) returned for clinical and psychological assessment at 6 months post-accident. In order to determine which factors were unique and which ones were overlapping the same potential contributors: mean head pain, mean neck pain, female gender, number of post-collision painful body areas, PTSD, and depression were included in the regression models for both neck disability index (NDI) and Rivermead post-concussion symptoms questionnaire (RPQ). Of 223 recruited participants, 70 returned for a follow-up visit (age range 18-64, mean(SD) 37.6 (11.9), 29F). This cohort primarily met the criteria for mTBI, but also fulfilled the criteria for whiplash, reinforcing the duality of injury presentation. Correlations existed between the NDI and RPQ scores (Spearman's ρ=0.66, p<0.001), however overlap was only partial. Regression analysis showed that after the removal of area-of-injury pain neck related disability (r=0.80, p <0.001) was explained solely by number of painful body areas (ß=0.52, p <0.001). In contrast, post-concussion syndrome symptoms (r=0.86, p<0.001) are influenced by clinical pain, painful body areas (ß=0.31, p=0.0026), female gender (ß=0.19, p=0.0053), and psychological factors of depression (ß=0.31, p=0.0028) and PTSD symptoms (ß=0.36, p=0.0013). It seems that while mechanisms of neck- and head-related symptoms in post-collision patients do share a common explanatory feature, of residual body pain, they are not entirely overlapping. In that psychological factors influence post-concussion syndrome symptoms, but not post-whiplash neck disability.

Stratified care integrated with eHealth versus usual primary care physiotherapy in patients with neck and/or shoulder complaints: protocol for a cluster randomized controlled trial

BackgroundNeck and shoulder complaints are common in primary care physiotherapy. These patients experience pain and disability, resulting in high societal costs due to, for example, healthcare use and work absence. Content and intensity of physiotherapy care can be matched to a patient’s risk of persistent disabling pain. Mode of care delivery can be matched to the patient’s suitability for blended care (integrating eHealth with physiotherapy sessions). It is hypothesized that combining these two approaches to stratified care (referred to from this point as Stratified Blended Approach) will improve the effectiveness and cost-effectiveness of physiotherapy for patients with neck and/or shoulder complaints compared to usual physiotherapy.MethodsThis paper presents the protocol of a multicenter, pragmatic, two-arm, parallel-group, cluster randomized controlled trial. A total of 92 physiotherapists will be recruited from Dutch primary care physiotherapy practices. Physiotherapy practices will be randomized to the Stratified Blended Approach arm or usual physiotherapy arm by a computer-generated random sequence table using SPSS (1:1 allocation). Number of physiotherapists (1 or > 1) will be used as a stratification variable. A total of 238 adults consulting with neck and/or shoulder complaints will be recruited to the trial by the physiotherapy practices. In the Stratified Blended Approach arm, physiotherapists will match I) the content and intensity of physiotherapy care to the patient’s risk of persistent disabling pain, categorized as low, medium or high (using the Keele STarT MSK Tool) and II) the mode of care delivery to the patient’s suitability and willingness to receive blended care. The control arm will receive physiotherapy as usual. Neither physiotherapists nor patients in the control arm will be informed about the Stratified Blended Approach arm. The primary outcome is region-specific pain and disability (combined score of Shoulder Pain and Disability Index & Neck Pain and Disability Scale) over 9 months. Effectiveness will be compared using linear mixed models. An economic evaluation will be performed from the societal and healthcare perspective.DiscussionThe trial will be the first to provide evidence on the effectiveness and cost-effectiveness of the Stratified Blended Approach compared with usual physiotherapy in patients with neck and/or shoulder complaints.Trial registrationNetherlands Trial Register: NL8249. Officially registered since 27 December 2019. Date of first enrollment: 30 September 2020. Study status: ongoing, data collection.

Neck complaints before and after uncomplicated thyroidectomy: prevalence, postoperative outcome and relationships with thyroid weight and reflux like symptoms

PurposeThe surgical thyroid disease includes upper aerodigestive complaints with not homogenous prevalence and specific features. The purpose was to analyze before and after total thyroidectomy (TT) the prevalence and severity of voice, swallowing, respiratory, and reflux airway symptoms in relation with thyroid weight.MethodsA total of 98 consenting patients undergoing TT were enrolled. Preoperatively, 1 and 3 months after TT, patients underwent videolaryngoscopy, subjective evaluation of voice (VIS), swallowing (SIS and EAT-10), respiratory (mMRC), and reflux symptoms (RSI, Gerd-Q). The scores were analyzed based on thyroid weight (<25 gr, 26–50 gr, 51–75 gr, >75 gr) and post-operative score gain was calculated from the score before TT and the follow-up examination.ResultsIn total, 40/98 selected cases of uncomplicated TT completed the postoperative evaluation. Endoscopic signs suggestive of reflux disease were observed in 1/40 (2.5%) and 0/19 cases before and after TT respectively. The prevalence of cases with abnormal reflux symptom index decreased significantly after surgery (8/40 vs 1/40) (p < 0.05), similarly occurred for the Gerd-Q (4/40 vs 1/40) (p < 0.05). Three months after TT the voice, swallowing and respiratory scores were significantly lower than the preoperative ones (p < 0.05). The SIS correlated positively with EAT-10 and RSI. After 3 months the postoperative score gain of voice, swallowing, respiratory, and reflux symptoms (Gerd-Q) was statistically higher (p < 0.05) in the cases with heaviest gland.ConclusionsThe surgical thyroid disease is associated to mild aerodigestive preoperative compressive symptoms, that include respiratory abnormalities and reflux like symptoms, regardless of the gland weight. In absence of endoscopic signs of airway reflux the presence of reflux symptoms suggests an overlapping with thyroid neck complaints. The patients undergoing uncomplicated TT had improvement in compressive symptoms and the greatest improvement is seen in larger goiters.

Association of Complaints of Arm, Neck, and Shoulders with Physical and Psychosocial Risks Factors among Computer Users of Nigerian Bank Employees

Background: Complaints of arm, neck, and shoulders (CANS) affects millions of computer users and are thought to be associated with physical and psychosocial risk factors. Assessing the risk factors of these complaints are imperatives for preventive measures in enhancing the effectiveness of clinical interventions, hence this study. Materials and Methods: A cross-sectional survey was conducted among 260 bankers whose major work task involved the use of desktop computers in Surulere Local Government Area, Lagos, Nigeria. Maastricht Upper Extremity Questionnaire (MUEQ) was used to collect the data. The MUEQ contains 95-item in seven main domains assessing physical and psychosocial risk factors with regards to work stations, posture during work, quality of break time, job demands, job control, and social supports. It also asked questions about the quality of the work environments and the occurrence of CANS. Data were summarized using descriptive statistics of frequencies and percentages, while Chi-square statistic tested the association of CANS with physical and psychosocial risk factors at a significance level of P ≤ 0.05. Results: A 70% 1 year prevalence rate of CANS was obtained. Poor body posture was significantly associated with the complaints of shoulder, arm, and elbow (P < 0.05). High job demand was significantly associated with the complaints of the shoulder and lower arm (P < 0.05), while poor work environment was significantly associated with the occurrence of CANS (P < 0.05). Conclusion: Physical and psychosocial risk factors of body posture, job demand, and work environment are associated with the prevalence of CANS among Nigerian bank employees.

Neurosurgical and neuro-immunological management of IgG4-related hypertrophic sclerosing pachymeningitis. A literature survey and discussion of a unique index case

BackgroundDural thickening is observed in lymphoma, dural carcinomatosis, meningioma, tuberculosis, and autoimmune diseases. We encountered a patient with dural thickening and complaints of neck and back pain, numbness and loss of strength in the hands. The patient also suffered from polychondritis and had previously received steroid and methotrexate treatment for this indication. The patients’ serum was also positive for ANA, yet she did not have any other findings suggesting lupus. Our radiological and pathological analysis revealed IHSP (IgG4-related hypertrophic sclerosing pachymeningitis). In this review study, we provided a detailed literature survey to increase the awareness about IHSP in the neurosurgical community. MethodsMRI (magnetic resonance imaging)-based radiological analyses revealed a posterior extramedullary spinal mass extending from C2 to T2-T3 level. The dural mass was surgically excised and a broad panel of immunohistochemical markers including S100, EMA, CD246/ALK-1, CD45, CD20, CD79a, CD138, CD68, CD1a and CD34 was studied. Immunoglobulin heavy chain/kappa chain gene rearrangement analysis was performed which ruled out a lymphoproliferative disorder. ResultsMRI and pathological findings suggested IHSP. As the disease relapsed with a new anterior extramedullary multilobulated lesion extending from C5 to T1 level, the patient is now closely monitored for further medical and surgical treatment. ConclusionsIHSP is a relatively novel entity of hypertrophic pachymeningitis and should be included in the differential diagnosis of dural thickening. The fibrosis accompanying IHSP may not respond to medical treatment, which includes steroids and immunosuppressive agents. Additionally, neurological deficits, seizures, spinal decompression, hydrocephalus, or brainstem compression necessitate early surgical intervention. A continued vigilance is also necessary as the disease may relapse long-term following surgical treatment.

Epidemiology and Clinical Presentations of Head and Neck Lymphomas

Background: Head and neck cancer is the sixth most common malignancy worldwide. Neoplastic lymphoma is a malignant origin of colonization of B cell, T cell and NK cell. It is the third most common malignancy in the head and neck area after squamous cell carcinoma and salivary gland tumors. Lymphoma is divided into Non Hodgkin's lymphoma (NHL) and Hodgkin lymphoma (HL) groups. They have two peak ages of 20-30 and 70-60 years. The first symptom of lymphoma in patients is usually a painless, enlarging lymph node. Then we can mention weight loss, night sweats, fever. Diagnosis is based on clinical findings and biopsy.The aim of this study was to determine the frequency and histopathologic subtypes of the head and neck lymphomas and to evaluate the clinical symptoms and diagnostic processes in patients with lymphoma diagnosed in ENT department of East Azerbaijan University of Medical Sciences. Methods: The study population has 40 samples. There were 602 seropositive biopsies and 59 patients with diagnosed lymphoma, 19 of which were excluded due to lack of records and exclusion criteria.Patients' records were reviewed for age, sex, clinical presentation, laboratory tests, Paraclinic and pathologic outcome. Results: The Hodgkin's lymphoma was 62.5% more common than non Hodgkin's lymphoma. Most patients were in the age range of 10-20 years. Mean age of patients was 35.6 ±24 24.72. 82.5% of patients referred to the hospital with complaints of neck swelling.The most prevalent subtype of Hodgkin's lymphoma was nodular sclerosis (44%) and the most prevalent subtype of non Hodgkin's was diffuse large B cell 36%. Conclusion: lymphoma should be considered as one of the differential diagnoses of cervical swelling in the diagnostic and therapeutic studies of patients. Also, males and age groups of 10-20 years and 60-70 years should be considered important.

A Simple Test for the Most Common Cause or Aggravating Factor of the Neck, Shoulder, or Upper Extremity Pain

Background: Shoulder pain and neck pain affect respectively 25% and 43% of the population. The aim of this clinical study is to assess the proportion, correct diagnosis, and treatment of hypertension (HTN) in patients with pain in the neck, shoulder, and upper extremity. Methods: 300 patients with complaints of neck, shoulder, or upper extremity pain without trauma or infection were studied from January 2015 to December 2017. After taking the history and examination, the blood pressure of these patients was recorded. Laboratory tests, x-ray, and magnetic resonance imaging (MRI) of the neck and affected shoulder joint were requested. Antihypertensive and symptomatic treatments were prescribed for patients with HTN. In the next visits, new history and examination, including the range of motion (ROM) of neck, shoulder, and upper extremity, blood pressure, and the results of laboratory tests, and images were checked. The final data were analyzed using chi-square test in SPSS software. Results: The Prevalence of HTN in patients in the age groups of 20-30, 31-60, and above 60 years were 21%, 44%, and 56 %, respectively. Neck, shoulder, and upper extremity pain and motion improved significantly after antihypertensive and symptomatic treatment in patients with HTN. Conclusion: HTN is the most common cause of neck, shoulder, and upper extremity pain in the adults and older patients referring to a physician. Thus, checking blood pressure by a physician or specialist is recommended for adults or older patients with neck, shoulder, or upper extremity pain. Antihypertensive and symptomatic treatments must be prescribed for nonsteroidal antiinflammatory drugs (NSAIDs), and acetaminophen-codeine and corticosteroids should be prohibited for the patients with HTN.

Headaches in hypermobility syndromes: A pain in the neck?

Headache and neck pain (cervicalgia) are frequently reported among patients with joint hypermobility but the prevalence and scope of these symptoms has not been studied in the era of contemporary Ehlers-Danlos and hypermobility disorder nosology. We performed a single-center retrospective study on the incidence of head and neck symptoms in 140 patients with hypermobility disorders over a 2-year period. Overall, 93 patients (66%) reported either headache or neck pain with 49 of those (53%) reporting both. Migraine (83%) was the most common headache type among those with headache disorders and cervical spondylosis (61%) the most common pathology among those with neck symptoms. Fifty-nine percent of spondylosis patients who underwent cervical facet procedures reported significant improvement in neck and head symptoms. Of patients with both head and neck complaints, 82% had both migraine and spondylosis, which, when combined with the high response rate to injections raises the possibility of cervicogenic headache. In this large multidisciplinary retrospective study of patients with hypermobility disorders, head and neck symptoms were highly prevalent, with migraine and cervical spondylosis common, often coexisting, and frequently responsive to targeted therapy for the cervical spine suggesting that degenerative spinal pathology may cause or contribute to headache symptoms in some patients with hypermobility disorders.

Kawasaki Disease with Rare Presentation Masquerading as Severe Infection in Children: A 10-year Retrospective Review in a Tertiary Hospital in Hong Kong SAR

Kawasaki disease (KD) with uncommon presentations can lead to diagnostic confusion mimicking severe infections: particularly KD shock syndrome (KDSS) mimicking toxic shock syndrome; and retropharyngeal edema (RPE) mimicking retropharyngeal neck abscess according to our local experience. High vigilance is needed for early diagnosis and timely treatment to minimize unnecessary operations and development of complications. A 10-year (2007-2016) retrospective review was performed for KD presented with features of KDSS/RPE. 120 KD cases were recruited. M:F was 1.2: 1, age 3.5 months to 12 years old. Sixteen had RPE mimicking neck abscess (13.3%) presenting as fever with neck complaints: swelling, pain or refusal to rotation/extension. None of them fulfilled sufficient diagnostic criteria for KD initially, some even with absent KD signs. They responded poorly to administration of antibiotics. Neck X-ray showed thickened retropharyngeal space suspicious of abscess. Computed tomography (CT) showed retropharyngeal fluid collection with no definite rim-enhancement. One case in doubt of early abscess underwent fine needle aspiration yielding 1.5ml necrotic material, sterile for bacterial culture. Signs of KD emerged as clinical course progressed, and all patients responded well to treatment with immunoglobulin (IVIG) and aspirin. Four presented as KDSS mimicking toxic shock (3.3%) with systolic hypotension requiring inotropic support and had ventricular dysfunction, mitral regurgitation on echocardiogram. Three had coronary ectasia on presentation. All were IVIG resistant and had severe hypoalbuminemia, probably contributing to shock. Two required pulse methylprednisolone and two responded to second dose IVIG.

Eagle's syndrome, elongated styloid process and new evidence for pre-manipulative precautions for potential cervical arterial dysfunction

IntroductionSafety with upper cervical interventions is a frequently discussed and updated concern for physical therapists, chiropractors and osteopaths. IFOMPT developed the framework for safety assessment of the cervical spine, and this topic has been discussed in-depth with past masterclasses characterizing carotid artery dissection and cervical arterial dysfunction. Our masterclass will expand on this information with knowledge of specific anatomical anomalies found to produce Eagle's syndrome, and cause carotid artery dissection, stroke and even death.Eagle's syndrome is an underdiagnosed, multi-mechanism symptom assortment produced by provocation of the sensitive carotid space structures by styloid process anomalies. As the styloid traverses between the internal and external carotid arteries, provocation of the vessels and periarterial sympathetic nerve fibers can lead to various neural, vascular and autonomic symptoms. Eagle's syndrome commonly presents as neck, facial and jaw pain, headache and arm paresthesias; problems physical therapists frequently evaluate and treat. PurposeThis masterclass aims to outline the safety concerns, assessment and management of patients with Eagle's syndrome and styloid anomalies. By providing evidence of this common anomaly found in almost one-third of the population, hypothesis generation and clinical reasoning with patients presenting with head and neck symptoms can improve. ImplicationsIncluding styloid anomalies as potential hypotheses for patients with head and neck complaints can assist therapists in safe practice and expedite referral. The authors recommend updating the IFOMPT framework to incorporate Eagle's syndrome, a comprehensive autonomic assessment, and palpation of the stylohyoid complex to avoid potentially serious complications from conceivably hazardous interventions.

The 3 Sagittal Morphotypes That Define the Normal Cervical Spine: A Systematic Review of the Literature and an Analysis of Asymptomatic Volunteers.

Cervical alignment is vital for maintaining horizontal gaze and sagittal balance. The aims of this study were to summarize previously published descriptions of normative cervical alignment and to analyze a cohort of asymptomatic volunteers in order to identify natural clusters of normal radiographic parameters. We performed a systematic review of the literature on radiographic measurements of asymptomatic volunteers through a search of MEDLINE and ScienceDirect databases. We then performed an analysis of demographic and radiographic parameters of volunteers without back or neck complaints. Only subjects with a chin-brow vertical angle (CBVA) within previously published normal limits were retained for analysis. A 2-step cluster analysis was used to find natural groups of cervical alignment. Differences among groups were investigated with a post hoc analysis of variance (ANOVA). We included 37 articles in our analysis. There was a broad spectrum of both C2-C7 lordosis-kyphosis and T1 slope across ages and sexes. Of the 119 asymptomatic volunteers who were available for analysis, 84 (with a mean age [and standard deviation] of 49.0 ± 17.1 years) had a CBVA ranging from -4.7° to 17.7°. The cluster analysis identified 3 alignment groups based on cervical lordosis-kyphosis and T1 slope (silhouette measure of cohesion, >0.6). Twenty-seven volunteers (32.1%) were identified as the "kyphotic curve cohort" (KCC) (mean C2-C7 Cobb angle, -8.6° ± 7.3°; mean T1 slope, 17.4° ± 6.6°), 43 volunteers (51.2%) were identified as the "medium lordosis cohort" (MLC) (mean C2-C7 Cobb angle, 8.7° ± 7.2°; mean T1 slope, 26.6° ± 4.0°), and 14 volunteers (16.7%) were identified as the "large lordosis cohort" (LLC) (mean C2-C7 Cobb angle, 21.2° ± 7.2°, mean T1 slope, 39.5° ± 6.4°) (p < 0.001 for both). Moving from KCC to LLC, there was a significant decrease in C0-C2 lordosis (p = 0.016). Examination of the cervical vertebral orientation demonstrated that C4 had a constant orientation relative to the horizontal (p = 0.665). Correlation analysis between C2-C7 and vertebral orientations again demonstrated that C4 orientation was independent of C2-C7 alignment. We have identified 3 morphotypes of the cervical spine based on C2-C7 alignment and T1 slope. These findings demonstrate the broad definition of normal cervical alignment and the range of cervical lordosis-kyphosis that is acceptable.

Prevalence of Musculoskeletal Symptoms in Interventional Radiologists

PurposeTo investigate the prevalence of musculoskeletal symptoms, defined as aches, pains, discomfort, or numbness, by using a validated assessment tool among interventional radiologists. Materials and MethodsA Web-based survey using the Nordic Musculoskeletal Questionnaire was disseminated to interventional radiologist members by email in November 2015. Musculoskeletal symptoms were evaluated in 9 body areas. Information regarding participant demographics, practice details, use of radio-protective equipment, and exercise routines was also gathered. Univariate and multivariate analyses were performed to determine risk factors associated with more severe symptoms. ResultsOf 4,096 SIR members at the time of the survey, 640 completed the questionnaire in its entirety (16% response rate). Respondents consisted of 69 females (11%) and 571 males (89%), with a mean age of 47.5 ± 10.2 years old, a mean body mass index of 25.5 ± 3.9 kg/m2, and a mean practice length of 17.1 ± 9.8 years. Prevalence of musculoskeletal symptoms was 88% in the 12 months preceding the survey. For those reporting musculoskeletal issues, 58% attributed the symptoms to work-related activities. Lower back (61%), neck (56%), and shoulder complaints (46%) were the most common. Symptoms prevented 21.2% of respondents from being able to work over the same time period. Multivariate analysis identified female gender, above-normal body mass index, and a practice length of 10 years or more as factors associated with a higher risk of moderate-to-severe symptoms. ConclusionsMusculoskeletal symptoms are prevalent among interventional radiologists, the majority of which are attributed to work-related causes.

Primary Thyroid Lymphoma

Primary thyroid lymphoma (PTL) is a rare condition and accounts for 5% of all thyroid malignancies. They constitute less than 2 % of all lymphomas. Most PTL’s are non-Hodgkin's lymphomas. It is clinically essential to discriminate between primary or secondary lymphoma of the thyroid as the treatment and prognosis varies. It commonly occurs in women in their sixth and seventh decade. Primary thyroid lymphoma is quite curable without the need for extensive surgery if diagnosed early. We present such a case of a 60- year old female patient presenting with complaints of neck swelling with loss of appetite and dysphagia. Histopathological diagnosis confirmed Primary thyroid lymphoma of B cell origin which was confirmed by immunohistochemistry.

Ten must know pseudolesions of the head and neck.

Patients may present in the emergency setting for a variety of head and neck complaints such as fever, trouble swallowing, or a newly palpable mass. When reviewing radiologic head and neck exams for etiology of complaints, it is important to be familiar with the multiple pseudolesions that may mimic pathology. These may be normal variant anatomy, normal anatomy located in an atypical location, as well as iatrogenic or self-introduced foreign bodies. This review article discusses ten common pseudolesions encountered in the head and neck and their typical imaging appearance so that one does not mistake them for ominous pathology, thus preventing unnecessary follow-up, biopsy, or continued concern for the patient.

Clinical Response to Thyroidectomy in Three Cases of Refractory Hashimoto’s Encephalopathy—a Potential Therapy

Hashimoto’s thyroiditis is a common endocrine disorder. Clinical presentation in Hashimoto’s thyroiditis is predominantly due to associated hypothyroidism with or without goiter-related neck complaints. Rarely, HT can be associated with recurrent encephalopathy characterized by seizures, amnesia, and comatose episodes. The treatment for this enigmatic disease is symptomatic and supportive with no curative option. There are meager, anecdotal reports on the role of thyroidectomy as a treatment option. In this context, we report our experience on impact of total thyroidectomy on Hashimoto’s encephalopathy, refractory to anti-epileptic medications and steroids. This is a retrospective study conducted in an endocrine surgery department of a tertiary care hospital. Three patients with Hashimoto’s encephalopathy are included in this study. All the clinico-investigative and operative data are scrutinized and analyzed. All of them underwent uneventful total thyroidectomy. Written informed consent was obtained in all cases. Mean follow-up after surgery was 1.6 SD 0.8 years (1.2–2.8). Mean age was 46 ± 6.4 years (39–52). None of the patients had associated hypertension, migraine, diabetes, or any other neurological illnesses. The mean preoperative serum anti-thyroperoxidase antibody level was 445 SD 106.2 IU/L (370–700), which was above the upper reference limit of 60 IU/L and post-operative level was 62.75 SD 34 IU/L (32–104). There was complete remission of seizure attacks in all the cases till the last follow-up period. Total thyroidectomy appears to be a viable curative option for refractory Hashimoto’s encephalopathy. Anti-thyroperoxidase antibody-related autoimmunity appears to play a role in Hashimoto’s encephalopathy etiologic cascade. Long-term impact and multi-institutional results are required to validate the curative role of surgery in this condition.

Work-Related Musculoskeletal Symptoms in Otorhinolaryngology-Head and Neck Surgery Residents

ObjectivesWork-related musculoskeletal disorders in Saudi Arabia are not often reported in the literature. This study aimed to identify musculoskeletal symptoms among otorhinolaryngology residents in Saudi Arabia.MethodsThis cross-sectional survey-based study was conducted in May 2018 and included residents registered in the Saudi Otorhinolaryngology-Head and Neck Surgery Board Training programme, Riyadh, Saudi Arabia. The Nordic Musculoskeletal Questionnaire was used to assess musculoskeletal symptoms in addition to demographic and occupational factors, including operating position and the average number of operating hours.ResultsA total of 45 residents (response rate: 68.2%) completed the survey, including 33 males (73.3%) and 12 females (26.7%). Most residents (91.1%) reported at least one musculoskeletal symptom. The most commonly reported musculoskeletal over the previous 12 months were shoulder complaints (64.4%) followed by neck complaints (60%). In the short term (i.e. within seven days preceding the survey), neck complaints were more common than shoulder complaints (28.9% versus 20%). Lower back complaints were the most common cause of activity limitation (24.4%) followed by shoulder complaints (13.3%), while those with neck complaints reported it as a cause for visiting a physician (8.9%). Hip and thigh complaints were significantly more frequent among residents with operation times of eight hours or more compared to those who operating for less than eight hours (42.9% versus 5.9%; P = 0.021).ConclusionA high incidence of shoulder, neck and lower back complaints was found in this study. Residency is an ideal time in an otorhinolaryngologist’s career to implement programmes in ergonomic best practices before bad habits are developed.