Neck Mobility Research Articles

Impacto da dor cervical, da mobilidade e do índice de massa corporal no controle postural de professores

ABSTRACT Purpose: to analyze the impact of neck pain, neck mobility, and body mass index on teachers’ postural control. Methods: a cross-sectional study with 54 state public school teachers, 68.5% (n = 37) being females, with a mean age of 46.5 ± 9.3 years. Data were collected with the following instruments: Craniocervical Dysfunction Index (Brazilian version), force platform in bipedal and semi-tandem stance, visual analog scale, cervical mobility index, and body mass index. Data were analyzed with nonparametric statistics and multiple linear regression; the significance level was set at p<0.05, with 95% confidence intervals. Results: teachers with neck pain and severely impaired neck mobility had greater postural control changes in the semi-tandem stance. In the bipedal stance, those with mild mobility changes and neck pain had a smaller total displacement. Obese teachers had a smaller movement amplitude in the anteroposterior and mediolateral directions. Conclusion: teachers presented with neck pain and severely impaired neck mobility had a worse postural control. Obese teachers had a smaller total amplitude in both movement directions.

Impact of cervical pain, neck mobility, and body mass index on teachers’ postural control

RESUMO Objetivo: analisar o impacto da cervicalgia, mobilidade cervical e índice de massa corporal no controle postural de professores. Métodos: estudo transversal com 54 professores da rede estadual de ensino, com média de idade de 46,5 ± 9,3 anos, dos quais: 68,5% (n = 37) eram do sexo feminino. A coleta de dados teve como base os seguintes instrumentos: Craniocervical Dysfunction Index (versão brasileira), plataforma de força na posição bipodal e semitandem, escala visual analógica, índice de mobilidade cervical e índice de massa corporal. Para análise dos dados, foi utilizada estatística não paramétrica e análise de regressão linear múltipla, com nível de significância p<0,05 e intervalo de confiança de 95%. Resultados: os professores com cervicalgia e comprometimento severo da mobilidade cervical tiveram maior alteração do controle postural na posição semitandem. Na posição bipodal, aqueles com leve alteração da mobilidade e dor cervical apresentaram menor deslocamento total, assim como professores obesos demostraram menor amplitude de movimento nas direções anteroposterior e médio-lateral. Conclusão: os professores com cervicalgia e comprometimento severo da mobilidade cervical tiveram pior controle postural. Já os obesos apresentaram menor amplitude total em ambas as direções do movimento.

Dor cervical e distúrbio do sistema visual: qual a relação?

Continuous use of digital devices without rest periods makes individuals more vulnerable to oculomotor disorders. These dysfunctions can lead to adaptive cervical postural changes. It was proposed here to evaluate the correlation between convergence insufficiency, visual attention and neck pain. Fourteen college students with neck pain and 14 without neck pain were evaluated in terms of convergence insufficiency, visual attention and neck mobility. There was difference between the groups in the Royal Air Force (p=0.03), in the Convergence Insufficiency Symptom Survey (p=0.01) and in the flexion (p=0.016) and right and left neck tilt movements (p= 0 .14) and (p=0.28). There was no difference in time and performance of the bell cancellation test (p=0.17). The group with neck pain showed signs of convergence insufficiency with a point close to convergence above the normal value of 10 centimeters and a high score in the Convergence Insufficiency Symptom Survey. The group without neck pain performed within normal limits. Although the sample was of convenience and the individuals only performed clinical evaluations, the results are promising in demonstrating the presence of convergence insufficiency in the group with neck pain.

CHALLENGES OF 'RIGID AIRWAY' IN ANKYLOSING SPONDYLITIS: A CASE SERIES

Ankylosing spondylitis is the complex, multisystemic disorder primarily involving the axial skeleton. Uniform progressive brous ossication of articular and para-articular tissue results in bony ankylosis, loses exibility of spine, ultimately leading to structural and functional impairment. Temporomandibular joint ankylosis with limited neck mobility due to fused cervical spine makes airway management challenging for anesthesiologist. Axial skeletal changes pose neuraxial anesthesia technically demanding and difculty in positioning. These patients may require surgery for hip or spine deformity. We report a series of three ankylosing spondylitis cases with difculties faced in securing airway and how we managed it successfully. Thorough knowledge of the disease process, familiarity with established airway techniques and choosing the most appropriate airway equipment at the right time is crucial.

The reliability and validity of the Turkish version of the self-administered neck mobility assessment tool (s-rom-neck) in patients with chronic neck pain.

The self-administered neck mobility assessment tool (S-ROM-Neck) is the subjective cervical region range of motion (S-ROM) assessment scale. The study aimed to demonstrate the reliability and validity of the Turkish version of the S-ROM-Neck in patients with chronic neck pain. : A cross-sectional study was conducted with a total of 60 chronic neck pain patients in the Physical Therapy and Rehabilitation Clinic of Pamukkale University Hospital between January and August 2021. The mean age of the individuals was 34.1 ± 9.9 years. Patients were assessed with S-ROM-Neck twice to prove the test-retest reliability. In addition, Visual Analogue Scale (VAS), Neck Disability Index (NDI) and bubble inclinometer measurement were used to analyze the construct validity of S-ROM-Neck. The intraclass correlation coefficients of the S-ROM-Neck were higher than 0.80 (ICC > 80, CI: 0.90-98). The internal consistency of the S-ROM-Neck total score was within the acceptable limits (α = 0.754). Construct validity was high regarding the correlation analysis (r > 0.05, p < 0.01). Turkish S-ROM-Neck is a valid and reliable tool to assess the S-ROM of individuals with chronic neck pain.

The relationship between urethral mobility and clinical outcomes after midurethral sling surgery

Objective:To explore the relationship between urethral mobility and clinical outcomes after midurethral sling (MUS) surgery. Methods:This was a retrospective analysis of the patients who had MUS surgery and clinic follow-up with ultrasound exams between 2017 and 2022. The sling location, sling-pubic gap (SPG), bladder neck mobility, and segmental urethral mobility were measured and compared between women with cured SUI, recurrent SUI, de novo VD, and continent women without MUS. The correlations between ultrasound findings and clinical outcomes were tested. Results:Of 198 women with MUS, 176 had a telephone follow-up, and 151 (151/176, 85.8%) were subjectively satisfied. Affected by the epidemic, only 107 patients had clinic follow-up, 92 valid data of 32 cured SUI (Group 1), 37 recurrent SUI (Group 2), and 23 de novo VD (Group 3) were compared with 102 women without MUS. Groups 1 and 2 had significant lower midurethral mobility. In Group 3, the mid and lower urethra was tightly near the symphysis on Valsalva, and the mobility was excessively decreased. SPG was significantly wider in Group 2 than in Group 1 (13.8 ± 3.6 mm vs 11.2 ± 2.7 mm, p = 0.001). SPG was strongly related to midurethral mobility (r=0.32, p=0.002) and clinical outcomes (r=0.45, p<0.001). Multivariable regression showed SPG positively correlated to recurrent SUI [OR: 1.439 (95% CI:1.191–1.738) p<0.001]. Conclusion:Midurethral sling reduced midurethral mobility. A wider SPG indicated a higher midurethral mobility and a higher risk of recurrent SUI.

Mobilization Of First Rib Impairment Caused By Bone Thronged In Larynx (A Case Study)

Case Description:A 47-year-old female patient was presented in the Department of Physical Therapy, Shahida Islam teaching hospital, Lodhran with the chief complaint of severe headache, vertigo, and decreased neck mobility with severe pain. A detailed history revealed that the patient has bone struck in the throat which was removed in an OPD setting under the procedure of video laryngeal rigid telescopic by the specialist. After the procedure, she was prescribed medicine for headaches and vertigo. She used medicine for 5 days but there was no relief. In Follow up visit after 5 days she complained about the same symptoms of headache, vertigo, and pain which made her sleepless for the last 5 days therefore was referred to the physical therapy department by the physician. In the physiotherapy department she was administered Maitland mobilization, cervical traction, and cervical muscle stretching for first rib mobilization and to increase joint range of motion.Outcomes: The patient was discharged from therapy after 4 physiotherapy sessions weekly, having fully achieved all of her functional goals and resolved her primary complaints of pain and dizziness

Creating a re-expanded prefabricated island flap constructed with an anastomosed vascular pedicle for burned ear reconstruction: a case report

The combined use of various flap techniques has rapidly improved the reconstruction quality of auricle defects that are complicated by a scarcity of periauricular skin after severe burns. Nevertheless, there is still no preferable method when the optimal alternative skin to cover the auricular framework is unavailable and the periauricular vascular network is devastated. Copious scars were observed in the periauricular region, neck, forearm, and supraclavicular region of a 19-year-old man. He had been burned by high-voltage electricity and exhibited a right auricular defect. We innovatively created a prefabricated expanded island flap constructed with an anastomosed vascular pedicle buried in the anterior thoracic chest, followed by flap transfer, tissue re-expansion, and sculpted autologous costal cartilage implantation. The remnant ear was successfully reconstructed in a three-stage surgical procedure. All the flaps survived well without any complications. The reconstructed right ear had a natural shape and a clear structure without apparent displacement and deformation during follow-up. The patient was satisfied with the final appearance, and his neck mobility markedly improved. Advantages and disadvantages were discussed. This procedure explored a novel solution to construct an auricular framework covering for patients who do not have high-quality donor skin and lack anastomotic vessels in the recipient area.

Correlation between sensitization and range of motion in children and adolescents with migraine

IntroductionMigraine affects 7.7% of children and adolescents and presents with short duration, bilateral and generally frontotemporal localization, however, the relationship of pain and sensitivity symptoms and their correlations with physical tests as well as range of motion are not well understood in these groups. ObjectiveCorrelate sensitization including allodynia and pressure pain threshold (PPT) of cervical muscles with neck mobility in children and adolescents with migraine. MethodsFifty children (CH) and adolescents (AD) diagnosed with migraine by ICHD-III were screened, of both sexes, aged between 6 and 17 years at the tertiary headache outpatient clinic. Allodynia was assessed by the adapted allodynia questionnaire based on the ICHD-III and the sensitivity of the cervical muscles sternocleidomastoid, elevator, suboccipital, trapezius and scalene by the pressure pain threshold (PPT) using a digital algometer DDK-20 Kratos®. The active mobility of the cervical spine (ROM) was evaluated in the movements of flexion, extension, lateral flexion, and rotation by the Flexion Rotation Test (FRT), using the CROM®. ResultsThe mean age of patients was 11.7 years (SD=3.0), most of them female (n=31/62%), adolescents (n= 28/56%) with a diagnosis of episodic migraine (n=32/64%), of low intensity (2.4; SD=0.6), pulsatile quality, duration in hours (18.0; SD=22.7) and more than half of the sample had no aura (n=32/64%). More than 70% of the sample had some comorbidity associated with the diagnosis of migraine, and neurological diseases, such as epilepsy, were more prevalent in both children (25.2%) and adolescents (26.3%), followed by respiratory diseases in children (20.1%) and psychological conditions in adolescents (19.8%). (To see the complete abstract, please, check out the PDF).

Cranial ecomorphology of turtles and neck retraction as a possible trigger of ecological diversification.

Turtles have a highly modified body plan, including a rigid shell that constrains postcranial anatomy. Skull morphology and neck mobility may therefore be key to ecological specialization in turtles. However, the ecological signal of turtle skull morphologies has not been rigorously evaluated, leaving uncertainties about the roles of ecological adaptation and convergence. We evaluate turtle cranial ecomorphology using three-dimensional geometric morphometrics and phylogenetic comparative methods. Skull shape correlates with allometry, neck retraction capability, and different aquatic feeding ecologies. We find that ecological variables influence skull shape only, whereas a key functional variable (the capacity for neck retraction) influences both shape and size. Ecology and functional predictions from three-dimensional shape are validated by high success rates for extant species, outperforming previous two-dimensional approaches. We use this to infer ecological and functional traits of extinct species. Neck retraction evolved among crownward stem-turtles by the Late Jurassic, signaling functional decoupling of the skull and neck from the shell, possibly linked to a major episode of ecomorphological diversification. We also find strong evidence for convergent ecological adaptations among marine groups. This includes parallel loss of neck retraction, evidence for active hunting, possible grazing, and suction feeding in extinct marine groups. Our large-scale assessment of dietary and functional adaptation throughout turtle evolution reveals the timing and origin of their distinct ecomorphologies, and highlights the potential for ecology and function to have distinct effects on skull form.

Rapid Improvement in Neck Disability, Mobility, and Sleep Quality with Chronic Neck Pain Treated by Fu's Subcutaneous Needling: A Randomized Control Study.

Background Chronic neck pain is a common musculoskeletal disorder caused by overuse of neck and upper back muscles or poor posture, and it is commonly combined with a limited range of motion in the neck and shoulders. Most cases will recover within a few days; however, the symptoms often recur easily. Fu's subcutaneous needling (FSN) is a new therapeutic approach used to treat patients with chronic neck pain. However, there is no solid evidence to support the effectiveness of FSN on chronic neck pain and disability. Methods Participants (n = 60) with chronic neck pain for more than 2 months with pain intensity scored by visual analog scale (VAS) more than five were enrolled in this trial. Participants were equally randomized into the FSN or transcutaneous electrical nerve stimulation (TENS) group who received interventions once a day on day 1, day 2, and day 4. They were assessed by outcome measurements during pre- and post-treatment and followed up for 15 days. Results The VAS was immediately reduced in the FSN and TENS groups and sustained for 15 days of follow-up (all P < 0.001). The immediate effects were also observed as the pressure pain threshold increased in the FSN group on day 2 (P=0.006) and day 4 (P=0.023) after treatment, and tissue hardness decreased by FSN on day 1 and day 2 after treatment (both P < 0.001). FSN and TENS treatment improved neck disability and mobility; moreover, FSN promoted participants to receive better sleep quality, as determined by PSQI assessment (P=0.030). TENS had no benefit on sleep quality. Conclusion FSN was able to relieve pain and relax muscle tightness. Notably, FSN significantly improved neck disability and mobility and enhanced sleep quality. These findings demonstrated that FSN could be an effective alternative treatment option for patients with chronic neck pain. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03605576, registered on July 30, 2018.

The Use of the Shikani Video-Assisted Intubating Stylet Technique in Patients with Restricted Neck Mobility.

Among all the proposed predictors of difficult intubation defined by the intubation difficulty scale, head and neck movement (motility) stands out and plays as a crucial factor in determining the success rate and the degree of ease on endotracheal intubation. Aside from other airway tools (e.g., supraglottic airway devices), optical devices have been developed and applied for more than two decades and have shown their superiority to conventional direct laryngoscopes in many clinical scenarios and settings. Although awake/asleep flexible fiberoptic bronchoscopy is still the gold standard in patients with unstable cervical spines immobilized with a rigid cervical collar or a halo neck brace, videolaryngoscopy has been repeatedly demonstrated to be advantageous. In this brief report, for the first time, we present our clinical experience on the routine use of the Shikani video-assisted intubating stylet technique in patients with traumatic cervical spine injuries immobilized with a cervical stabilizer and in a patient with a stereotactic headframe for neurosurgery. Some trouble-shooting strategies for this technique are discussed. This paper demonstrates that the video-assisted intubating stylet technique is an acceptable alternative airway management method in patients with restricted or confined neck motility.

Does Transcervical Styloidectomy for Eagle Syndrome Improve Quality of Life?

Eagle syndrome is an uncommon disorder that significantly impacts the quality of life (QoL) of patients. No formal QoL study has been carried out on a population of Eagle syndrome patients treated via transcervical approach. We aim to evaluate and analyze the outcomes of the patients with Eagle syndrome treated with transcervical styloidectomy via our modified QoL survey. A retrospective cohort study was utilized for patients with Eagle syndrome who underwent transcervical styloidectomy at our institution from January 2008 until December 2018. Two QoL surveys were sent to subjects. Patients were asked preoperatively and postoperatively about the presence and intensity of pain, alteration of speech, diet or chewing, limitations of daily activity, mobility or recreation, and the presence of anxiety or mood disturbances related to the disease. The styloid length on preoperative computed tomography scans and the length of the surgical specimen were obtained, and correlations with the Numeric Pain Rating Scale (NPRS) were analyzed. Spearman's rank correlation coefficient was used to determine numerical correlation. Data are expressed as mean±standard deviation, and P value less than .05 was considered statistically significant. The study sample comprised 10 patients with Eagle syndrome who underwent transcervical styloidectomy. Eight patients underwent unilateral styloidectomy, and 2 patients were bilateral. Most patients were female (80%) with a mean age of 46.0. Preoperative NPRS score averaged 5.5±2.7 (range 1 to 10) and postoperative NPRS was 2.1±1.4 (range 0 to 4) (P= .008). No correlation was found between preoperative or postoperative NRPS score and preoperative styloid length and length of styloid resected. QoL survey showed a significant improvement in neck mobility and the anxiety felt by the patients. The survey showed that all patients would recommend surgery to a friend or family member with similar symptoms. Seven patients (70%) would recommend the operation as primary treatment, and the rest would recommend it after conservative options fail. Transcervical styloidectomy was associated with a statistically significant decrease in NPRS and positive QoL changes for patients operated for Eagle syndrome at our institution.

The Clinical Effects of Pixel CO2 Laser on Bladder Neck and Stress Urinary Incontinence.

Background: Our study aims to assess Pixel CO2 laser efficacy for female stress urinary incontinence (SUI). Methods: In the study, 25 women with SUI were included and scheduled for vaginal Pixel CO2 Laser (FemiLift™, Alma Lasers, Israel) treatment. All subjects had a baseline and 6-month post-treatment assessment that included three-dimensional perineal ultrasound and validated questionnaires. Results: Data showed that monthly three-session vaginal Pixel CO2 Laser treatment significantly improved SUI symptoms, as evidenced by validated questionnaires, including UDI-6, IIQ-7, ICIQ, and vaginal laxity questionnaire (p < 0.05). The Pixel CO2 Laser efficacy in vaginal treatment was 20/25 (80%), and the perineal sonography showed that laser treatment significantly decreased bladder neck mobility and middle urethral area (during resting and straining). Permanent adverse events were not found. Conclusions: The results of our study suggested that for the treatment of mild to moderate SUI symptoms, Pixel CO2 Laser is effective and safe; however, more studies and a longer follow-up should be conducted to confirm its efficacy and durability.

Clinical comparison of superior thyroid artery perforator flap and sternocleidomastoid myocutaneous flap for intraoral reconstruction

The aim was to evaluate the techniques and outcomes of superior thyroid artery perforator flaps (STAPF) for intraoral reconstruction and to compare them with those of the sternocleidomastoid myocutaneous flap (SCMMF). The cases of 43 patients who underwent reconstruction with either a SCMMF or STAPF for the repair of a medium-sized intraoral defect, between January 2013 and December 2020, were reviewed retrospectively. Although both flaps are based on the superior thyroid artery, their specific harvesting techniques largely differ. All SCMMF (n = 23) were superiorly-based rotational flaps with myocutaneous designs. The STAPF cases (n = 20) included 18 septocutaneous flaps and two chimeric flaps. The flap size was larger in the STAPF group (P = 0.008), while incomplete level IIB dissection (oncological safety) was more frequent in the SCMMF group (P = 0.002). The flap necrosis rate was lower in the STAPF group (STAPF 15% vs SCMMF 34.8%, though this was not statistically significant). Cox multivariate analysis showed that the postoperative flap outcome (total flap necrosis vs flap survival; hazard ratio 27, 95% confidence interval 2.149–336.05; P = 0.001) and complications (excluding fistula) (hazard ratio 14, 95% confidence interval 1.314–142.767; P = 0.029) were associated with overall patient survival. Both speech (P < 0.001) and neck mobility (P < 0.001) functions were superior with STAPF reconstruction. Compared with the traditional SCMMF, the STAPF was found to have a lower necrosis rate with uncompromised oncological safety during harvesting. The STAPF is a good alternative for the repair of medium-sized head and neck defects.

Alterations in kinematics of temporomandibular joint associated with chronic neck pain.

Temporomandibular disorder (TMD) is an umbrella term for pain and dysfunction of the temporomandibular joint (TMJ) and its associated structures. Patients with TMD show changes in TMJ kinematics and masticatory muscle activation. TMD is commonly comorbid with non-specific chronic neck pain (NCNP), which may be one of the risk factors for TMD. This study aimed to investigate whether patients with NCNP have altered TMJ kinematics and masticatory muscle activity. This was a cross-sectional exploratory study including 19 healthy participants and 20 patients with NCNP but without TMD symptoms. TMJ kinematics was measured during mouth opening and closing, jaw protrusion and jaw lateral deviation. Surface electromyography was used to record the muscle activity of the anterior temporalis, masseter, sternocleidomastoid and upper trapezius while clenching. Furthermore, cervical posture, cervical range of motion (ROM) and pressure-pain threshold of the neck and masticatory muscles were measured. Compared with the healthy group, the NCNP group showed significantly reduced upper cervical rotation ROM (p=.041) and increased condylar path length (p=.02), condylar translation (opening p=.034, closing p=.011) and mechanical pain sensitivity of the upper trapezius (p=.018). Increased condylar translation was significantly correlated with reduced upper cervical mobility and poor cervical posture (r=-0.322 to -0.397; p=.012-.046). Increased condylar translation and path length in patients with NCNP may indicate poor control of TMJ articular movement, which may result from neck pain or may be a compensation for limited neck mobility. Evaluation of excessive TMJ translation may be considered in patients with NCNP.

Posttraumatic Stress Symptoms and Pain Sensitization After Whiplash Injury: A Longitudinal Cohort Study With Quantitative Sensory Testing.

Posttraumatic stress symptoms (PTSS) are common after whiplash injury and are associated with poor recovery. The acute stress response may lead to pain sensitization and widespread pain, thereby compromising recovery. To our knowledge, no longitudinal study has assessed the associations between early PTSS and pain sensitization over time using quantitative sensory testing (QST). The aim of this study was to compare participants with different levels of PTSS, as measured by the impact of event scale (IES; subclinical 0–8, mild 9–25, and clinical ≥ 26) at baseline (<10-day post-injury) and at a follow-up of 1, 3, 6, and 12-month post-injury on pain sensitivity, neck mobility, pain distribution, and pain intensity. In total, 740 participants were recruited from emergency units or general practitioners with acute neck pain after a whiplash injury. The clinical PTSS group showed increased pain sensitivity on all QSTs at all time points compared to the subclinical PTSS group. Also, the clinical PTSS group showed significantly lower neck mobility at all time points except for a 3-month follow-up compared to the subclinical PTSS group. Moreover, the clinical PTSS group showed more widespread pain and self-reported headache and neck pain intensity at all time points compared to the subclinical PTSS group. This study emphasizes that participants with clinical levels of PTSS constitute a high-risk group that is sensitized to pain early after the injury. Hence, screening for PTSS within the 1st week after whiplash injury for those who experience high levels of pain intensity and distress may be an important clinical procedure in the assessment and treatment of whiplash-associated disorders (WAD).

Difficult Laryngoscopy Prediction Score for Intubation in Emergency Departments: A Retrospective Cohort Study.

ObjectiveDifficult laryngoscopy is associated with difficult intubation, an increasing number of endotracheal intubation attempts, and adverse events. Clinical prediction of difficult airways in an emergency setting was limited in sensitivity and specificity. This study developed a new model for predicting difficult laryngoscopy in the emergency department.MethodsThis retrospective cohort study was conducted using an exploratory model at the Emergency Medicine of Ramathibodi Hospital. The study was conducted from June 2018 to July 2020. The eligibility criteria were an age of ≥15 years who undergo intubation in the emergency department. Difficult laryngoscopy was defined as a Cormack–Lehane grade 3 and above. The predictive model and score were developed by multivariable logistic regression analysis.ResultsA total of 617 patients met the eligibility criteria; 83 (13.45%) had difficult laryngoscopy. Five independent factors were predictive of difficult laryngoscopy. Significant factors were M: limited mouth opening, O: presence of obstructed airway, N: poor neck mobility, T: large tongue, and H: short hypo-mental distance. The difficult laryngoscopy score had an accuracy of 89%. A score of >4 increased the likelihood ratio of difficult laryngoscopy by 7.62 times.ConclusionThe MONTH Difficult Laryngoscopy Score of >4 was associated with difficult laryngoscopy.

A Prospective Study to Correlate Difficult Intubation with Difficult Laryngeal Exposure for Microlaryngeal Surgery using Various Grading Scales of Difficult Intubation.

Adequate visualization of the vocal folds is essential for optimal phonosurgery. Pre-operative knowledge of a difficult laryngeal exposure (DLE) can alert the surgeon regarding the need for alternative measures. Our study is based on the hypothesis that a patient who has difficult intubation (DI) is likely to have DLE, thus scales anticipating DI should also anticipate DLE. Our aims were to correlate patients of actual DI on table with patients who had DLE, secondly to assess the ability of grading scales of DI to predict DLE and finally to obtain a cut-off value of neck circumference and length for predicting DLE. This is a prospective, observational study wherein four grading scales; Modified Mallampati Classification (MMC), 3-3-2, Upper lip bite test (ULBT) and Neck Mobility (NM) were used for anticipating DI and correlated with DLE during MLS. Occurrence of actual DI and DLE was correlated. Neck circumference and neck length was correlated with incidence of DLE. Out of 42 patients, 22 were anticipated to have DI (52.38%). Actual incidence of DI was 6 (14.28%) and DLE was 10 (23.80%). Correlation between actual DI and DLE was statistically significant. Of the 4 grading scales, ULBT was significant in predicting DLE. Neck circumference more than 37.5cm and neck length less than 15.3cm was significant in anticipating DLE. There is a significant correlation between DI and DLE. A positive ULBT, neck circumference more than 37.5 cms and neck length less than 15.3 cms are independently suggestive of a DLE.

Is Cervical Stabilization Exercise Immediately Effective in Patients with Chronic Neck Pain and Upper Cervical Spine Dysfunction? Randomized Controlled Trial.

Purpose: To compare the effectiveness of a single exercise session with manual therapy techniques in the segments of the upper cervical spine (C0–1, C1–2 and C2–3), against a single exercise session in patients with chronic neck pain and mobility deficits in the upper cervical spine. Methods: A single-blind randomized controlled trial was performed. Fifty-eight patients were recruited (29 for the manual therapy and exercise group and 29 for the exercise group) who presented chronic neck pain and upper cervical spine dysfunction. The exercise focused on the deep muscles. The manual therapy combined manipulations and mobilizations with these exercises. Cervical range of motion, flexion-rotation test, pressure pain threshold and pain intensity were measured by a blind evaluator before and after the intervention. Results: Compared to pre-intervention, after intervention, the exercise group was significantly lower in terms of the range of motion, flexion-rotation test, and pressure pain threshold (p < 0.05). The manual therapy and exercise group improved in upper cervical flexion, the flexion-rotation test and intensity of pain (p < 0.05). Conclusions: It may be necessary to normalize the mobility of the upper cervical spine before cervical stabilization training, in patients with chronic neck pain and mobility deficits in the upper cervical spine.