Unilateral Neck Pain Research Articles

Vertebral Artery Dissection with Cerebellar Infarction Due to Sudden Head Turning: Case Report

Abstract A 27-year-old man upon quickly turning his head experienced sudden dizziness, unilateral limb weakness, neck pain, and paralysis. He was transported to the emergency department by ambulance. Computed tomography (CT), computed tomography angiography (CTA), and magnetic resonance imaging (MRI) of the brain identified a left vertebral artery dissection with cerebellar infarction without subarachnoid hemorrhage (SAH). The patient’s blood pressure was controlled, and he was placed on bed rest, but no surgical intervention was undertaken. A cerebral angiography performed two months after the dissection found the previously stenosed site fully patent with no further stenosis. Our case suggests that for extracranial vertebral dissection, the patient must be first checked for intracranial SAH, and in its absence, conservative treatment can be considered. Many studies have examined surgical intervention to address vertebral artery dissection; however, our case report presents a literature review regarding suitability for surgery in these patients.

Cervical Multifidus Stiffness Assessment in Individuals with and without Unilateral Chronic Neck Pain: An Inter-Examiner Reliability Study.

This study aimed to evaluate the inter-examiner reliability of shear wave elastography (SWE) for measuring cervical multifidus (CM) muscle stiffness in asymptomatic controls and patients with chronic neck pain. A longitudinal observational study was conducted to assess the diagnostic accuracy of a procedure. SWE images, following a detailed procedure previously tested, were acquired by two examiners (one novice and one experienced) to calculate the shear wave speed (SWS) and Young's modulus. The painful side was examined for the experimental cases while the side examined in the control group was selected randomly. Data analyses calculated the intra-class correlation coefficients (ICCs), absolute errors between examiners, standard errors of measurement, and minimal detectable changes. A total of 125 participants were analyzed (n = 54 controls and n = 71 cases). The Young's modulus and SWS measurements obtained by both examiners were comparable within the asymptomatic group (both, p > 0.05) and the chronic neck pain group (both, p > 0.05). Nonetheless, a notable distinction was observed in the absolute error between examiners for shear wave speed measurements among patients with neck pain, where a significant difference was registered (p = 0.045), pointing to a sensitivity in measurement consistency affected by the presence of chronic neck pain. ICCs demonstrated moderate-to-good reliability across both groups, with ICC values for asymptomatic individuals reported as >0.8. Among the chronic neck pain patients, ICC values were slightly lower (>0.780). The study revealed moderate-to-good consistency, highlighting the practicality and generalizability of SWE.

Transient idiopathic perivascular inflammation of the carotid artery syndrome (TIPIC syndrome) is a rare variant of non-atherosclerotic arteriopathy

Syndrome of transient idiopathic perivascular inflammation of the carotid artery (TIPIC syndrome) refers to a benign variant of non-atherosclerotic arteriopathy. TIPIC is characterized by regression of symptoms and pathological changes without specific therapy. The main manifestation of carotidynia is ipsilateral neck pain, which, due to low awareness of this disease, is often mistakenly regarded as dissection or atherosclerosis of the carotid artery and leads to additional unjustified diagnosis and treatment. This article presents a clinical case of a patient with idiopathic carotidynia with a discussion of the diagnostic algorithm and management of patients with unilateral neck pain and suspected TIPIC syndrome.

Carotidynia: Overview of an uncommon identification for unilateral neck pain.

Carotidynia, also known as Fay Syndrome, manifests as an atypical facial neuralgia characterized by an unusual neck pain extending towards the head and associated with carotid artery tenderness. Diagnostic criteria include neck tenderness, elevated carotid pulse without anatomical abnormalities, and neck distension. It was initially classified as a vascular headache but later re-evaluated and reclassified as a nonentity-a general condition caused by nonvascular factors. The etiology has not been extensively elucidated. We present two cases characterized by dysphagia, intermittent discomfort, and numbness in the throat and cervical region. Although the neurological examinations yielded no abnormalities, the diagnosis of carotidynia was ultimately established among the differential diagnoses upon the identification of wall thickening and inflammatory alterations through neuroimaging. Carotidynia is consistent with idiopathic vasculitis near the distal common carotid artery. Inflammatory processes trigger sympathetic plexus stimulation, causing discomfort in the head and neck. Neuroimaging resolves ambiguities in idiopathic unilateral neck pain, detecting soft tissue growth near the carotid artery. "Carotidynia" now refers to a diagnostic symptom and clinical entity encompassing a variety of disorders; therefore, approach to definition remains controversial. This report aims to raise healthcare awareness by highlighting two different cases of carotidynia.

The Use of Osteopathic Manipulative Treatment for a Case of Cervical Radiculopathy

Abstract Cervical radiculopathy is a clinical condition related to dysfunction of the cervical spinal nerve roots. Signs and symptoms include unilateral neck, shoulder, or arm pain; paresthesias of the arm, forearm or hand; diminished muscle tendon reflexes, sensory disturbances; and/or muscle weakness. Cervical radiculopathy is primarily a clinical diagnosis with patients reporting a varying degree of pain and/or neurologic dysfunction along a nerve root distribution. In addition to a thorough history, a detailed physical exam including muscle strength testing, deep tendon reflex testing and sensory testing should be performed to determine the nerve root involved and to further help determine a course of action for the patient. The current case report demonstrates the impact of a somatic dysfunction component on underlying pathology of cervical spondylosis, likely driving the symptomatic component of cervical radiculopathy. By eliminating the somatic dysfunction components with the use of osteopathic manipulative treatment, the patient's system was able to function maximally within existing structural limitations and the symptoms resolved.

Dissecting the mystery: A case report of a parapharyngeal ganglioneuroma

Introduction: Ganglioneuromas, slow-growing non-neoplastic tumors from neural crest cells, are typically asymptomatic but may manifest clinically when reaching a significant size. While rare in the parapharynx, imaging assists in preoperative planning and assessing features of more sinister pathologies. Case Report: A 45-year-old woman presented with persistent unilateral neck pain and sore throat, computed tomography (CT) imaging parapharyngeal space, ultimately diagnosed as a parapharyngeal ganglioneuroma on tissue biopsy. Surgical excision was performed with an uneventful postoperative course. Conclusion: Parapharyngeal ganglioneuromas pose diagnostic challenges due to their rarity and diverse presentations. This case underscores the diagnostic challenges posed by rare parapharyngeal lesions and highlights the successful management of ganglioneuromas through appropriate imaging and surgical intervention.

Impact of Class IV LASER Therapy and Conventional Exercise on Young Adults with Cervicogenic Headache: A Randomised Clinical Trial Protocol

Introduction: A Cervicogenic Headache (CGH) is characterised by unilateral neck pain that originates in the bony or soft tissues of the neck and refers to the head. Light Amplification by Stimulated Emission of Radiation (LASER) therapy is frequently employed in clinical settings to treat musculoskeletal diseases. Need for the study: Authors anticipate cervicogenic headache (CGH) treatment with Class IV LASER therapy will lead to statistically significant reduction in both neck pain and headache compared to baseline measurement. Adverse events related to Class IV LASER on CGH is minimal. The anticipated result of the present protocol will provide valuable insight into the efficacy and safety of Class IV LASER in the management of headache and neck pain. Aim: To determine the efficacy of Class IV LASER therapy in young adults with CGH. Materials and Methods: A randomised clinical trial protocol will be conducted on a total of 44 patients having age range between 20- 39 years with cervicogenic headache were recruited by convenience sampling method. Recruited individuals with cervicogenic headache will be randomly divided into two groups: Treatment Group A (Class IV LASER therapy with conventional exercises) and Treatment Group B (Conventional exercises). Treatment time for group A will be calculated by dividing the total energy delivered by the average total output. Each patient received six sessions in total alternative days. Group B also received same session as group A. The visual analogue scale, neck disability index, algometer, and headache impact test are outcome measures that will be recorded as a baseline and of the two-week post-intervention period.

Examination of Myofascial Stiffness and Elasticity in the Upper Trapezius Region in Patients with Unilateral Neck Pain: A Cross-Sectional Study.

(1) Background: Globally, neck pain is prevalent, affecting around thirty percent of the population annually. To better understand the influence of pain on the myofascial layers, the present study investigated these on the upper trapezius muscle in unilateral, more severe neck pain. (2) Methods: This study was a cross-sectional study. Forty patients (42.2 ± 14.7) with a confirmed diagnosis of unilateral neck pain were examined using durometry and indentometry. This study evaluated the stiffness, elasticity, and pressure pain threshold of both sides of the neck (symptomatic side: SS; healthy side: HS). Furthermore, the range of motion of the cervical spine (lateral flexion, rotation) was quantified using a digital goniometer. (3) Results: A significant lateral discrepancy was observed in stiffness between groups (durometry: SS-33.76 ± 7.78, HS-29.75 ± 7.45, p < 0.001; indentometry: SS-59.73 ± 33.93, HS-4.18 ± 12.69, p = 0.024). In contrast, no differences were found between the comparison sides of the upper trapezius for the parameter's elasticity (SS-0.101 ± 1.09, HS--0.006 ± 0.29, p = 0.416), cervical spine mobility (lateral flexion: SS-37.08 ± 8.15, HS-37.73 ± 7.61, p = 0.559; rotation: SS-73.55 ± 12.37, HS-72.85 ± 11.10, p = 0.660), and algometry (SS-36.41 ± 17.53, HS-37.22 ± 17.00, p = 0.657). (4) Conclusion: Overall, it can be concluded that more severe neck pain unilaterally shows differences in stiffness on the same side. Future research is needed to investigate the links.

Transient perivascular inflammation of the carotid artery: Ultrasonography and magnetic resonance imaging findings

AbstractTransient perivascular inflammation of the carotid artery (TIPIC) syndrome is a rare cause of atypical neck pain. The etiology of TIPIC is not fully known and is characterized by transient inflammation around the carotid artery. Ultrasonography (US) and especially magnetic resonance imaging (MRI) are the most important evaluation methods in the diagnosis and follow‐up of the disease. In this article, we report a 25‐year‐old male patient who presented with unilateral neck pain and was diagnosed with TIPIC in the light of his clinical and radiological findings.

Unilateral Primary Carotiditis: A Case Report

We report the first case of isolated unilateral carotid arteritis, following an upper respiratory tract infection in a patient without other medical conditions. We collected clinical information during the patient’s hospitalization and follow-up. Through a Pubmed search, we identified articles discussing TIPIC syndrome, carotid pain, or inflammation. After reviewing the articles and the corresponding images, none of these reported clinical and radiological findings similar to ours. A 55-year-old man consulted for unilateral neck pain, without relevant clinical history apart from an upper respiratory tract infection, nor other signs or symptoms. An MRI before admission showed signs of focal adventitial inflammation of the left internal carotid artery. Ultrasound identified a mixed plaque with hypoechoic and isoechoic components at the beginning of the left internal carotid. In particular, there was no halo sign suggestive of giant cell arteritis. Extensive laboratory exams only found increased plasma IL-1 receptor antagonist. After three days of corticosteroid and acetylsalicylic acid treatment., cervicalgia completely regressed, and prednisone was stopped. The patient was discharged on day 7 on daily acetylsalicylic acid. At three months, he remained asymptomatic, carotid ultrasound was comparable to the first one, and treatment was stopped. We suggest that a purely vascular inflammation of the carotid could appropriately be defined “carotiditis”, considering the focal, isolated involvement of the carotid wall, and that such a unilateral presentation has never been reported before. Speculatively, we propose an association between carotidis and the upper respiratory tract infection in this patient.

Transient Perivascular Inflammation of the Carotid Artery (TIPIC) Syndrome as a rare cause of unilateral neck pain.

Transient Perivascular Inflammation of the Carotid Artery (TIPIC) Syndrome as a rare cause of unilateral neck pain.

Is the Proof in the Pain? Association between Head and Neck Pain and Vessel Pathology at Follow-Up in Cervical Artery Dissection: A Retrospective Data Analysis

Unilateral head and neck pain is a hallmark of cervical artery dissection (CAD). While pain is conceived as an alarming sign for patients and often leads to discovery of the dissection, it is not known if persistence of pain is associated with the course of CAD. Potentially, pain could indicate persisting vessel pathology and thus guide treatment decisions aimed at reducing risk of ischemic stroke in CAD. We performed a retrospective analysis of data from patients with CAD treated at the University Hospital Zurich (USZ). Only patients with information about the presence of pain, independence after CAD according to the modified Rankin scale (mRS), and imaging-based information on vessel status were included. Patients were grouped according to presence/absence of head and/or neck pain on admission and at a three-month follow-up. We used descriptive statistics and logistic regression to reveal a potential association between pain on admission and pain at follow-up with status of the dissected vessel at follow-up (open vs. stenosed or occluded). We screened 139 patients with CAD between 2014 and 2019 and included 68. Fifty-nine patients (86.8%) had pain on admission, which was resolved in 46 (68%) at follow-up. Our post hoc analysis revealed that more patients with headache or neck pain on admission had a migraine diagnosis in medical history (n = 7 (10.4%) vs. n = 0 (0%), p = 0.029) and that NIHSS on admission was higher in patients with no pain at presentation (group B NIHSS = 3, IQR 8 vs. group A NIHSS = 2, IQR 5, group C NIHSS = 0, IQR 2, p = 0.041). There were no other differences between the three patient groups in the descriptive analysis. Logistic regression analysis for vessel status at follow-up did not show an association with pain on admission or at follow-up. In our cohort of patients with CAD, headache was a common initial clinical presentation, which rarely persisted for three months. Headache on admission or at follow-up did not predict persisting vessel pathology in patients with CAD.

Efeito imediato da técnica de rotação cervical grau II na sensação de posição articular em indivíduos com e sem dor não específica

Introduction: Passive joint mobilisation in individuals with neck pain has recognised effectiveness in relieving pain and increasing joint range. However, there are few studies on its influence on proprioceptive capacity. Objective(s): To study the immediate effect of grade II cervical rotation technique on joint position sense in young adults with and without unilateral neck pain of non-specific origin. Methods: A double-blind quasi-experimental study was conducted in a convenience sample of 37 subjects (18-24, both sexes), divided into 2 groups: 22 pain-free and 15 with neck pain. The Cervical Range of Motion device was used to evaluate the active cervical joint position sense at 30⁰ of right and left rotation, before and immediately after the performance of Maitland’s joint cervical rotation grade II mobilisation technique (four mobilisations of 30 seconds each). The test was repeated six times for each side. The absolute and variable errors were calculated using the t-test for comparison between groups and moments, with a significance level of 5%. Results: Significant differences were observed only between groups in the variable error in left rotation after performing the technique, and between moments in the left and right rotation in the pain-free group. However, error magnitudes were equal to or less than 1⁰ on average. Conclusion: The grade II cervical rotation technique does not seem to produce clinically relevant immediate effects on repositioning accuracy and consistency, evaluated at 30⁰ of rotation.

Thyroid Abscess: A Case Series and Literature Review.

In this retrospective case series, we chronicle six patients presenting with acute suppurative thyroiditis (AST) with progression to thyroid abscess in a single institution. Patients ranged in age from 16 to 74years of age. The most common presenting symptoms were progressive unilateral neck pain, swelling, and odynophagia. Other symptoms included hoarseness and systemic signs of infection. Diagnosis of thyroid abscess was made with a CT scan of the neck, fine needle aspiration, and/or incision and drainage (I&D). Management included antibiotic therapy, I&D, and thyroidectomy. All patients were successfully treated except for one who developed mediastinitis and died. A complete literature review was performed to determine etiologies, common findings, and management of similar cases.

RF35 | PSAT257 The Severity of Subacute Thyroiditis Depends on Its Causative Agent

Abstract We retrospectively evaluated 402 patients referred to of the University Hospital of Pisa because of a SAT from January 2011 to December 2020. Neck pain was present in all patients; in 92 patients it was bilateral. A previous symptomatic involvement of the upper airways was reported by 97 patients. 32 patients did not receive pharmacological treatments, 16 were treated with non-steroidal anti-inflammatory drugs (NSAIDs) and 354 with glucocorticoids; the most common initial dose of prednisone was 25 mg (in 286 patients); the majority (n. 277 patients) were treated for 90 days. 88 patients experienced permanent hypothyroidism. Free thyroxine (FT4) values ​​correlated with those of the C reactive protein (CRP), erythrocyte sedimentation rate (ESR) and thyroglobulin (Tg) ​​(p &amp;lt;0.001 for all). Tg values ​​correlated with the severity of thyrotoxicosis and the levels of inflammatory markers. Values ​​of FT4, Tg, ESR and CRP in patients experiencing hypothyroidism were higher compared to those observed in patients who remained euthyroid after SAT. Values ​​of FT4, Tg, and CRP and incidence of hypothyroidism were higher in patients with bilateral neck pain compared to those experiencing unilateral neck pain. Similar differences were observed comparing patients who had respiratory symptoms prior to SAT to those who did not. Glucocorticoid treatment was associated with a shorter duration of neck pain (14 days) compared to those treated with NSAIDs (28 days) and those left untreated (28 days) (p &amp;lt;0.001). The initial dose of 25 mg (lower than that recommended by the recent guidelines of the American Thyroid Association - 40 mg/day) was sufficient to control the pain. The annual incidence of SAT was similar throughout the entire period of observation. The third quarter of the year was characterized by the highest number of cases compared to the other quarters in all years except 2012 and 2015, when there was a higher incidence in the first quarter, and in 2020, when most of the SAT cases occurred in the second and fourth quarters. In these peculiar periods thyrotoxicosis and inflammatory markers were higher and permanent hypothyroidism more common. The clusters of SAT in 2020 occurred within a month of the Covid-19 waves, while in the winter seasons 2011-12 and 2014-15 in Italy there was a higher incidence of the influenza virus A.H3N2. In conclusion, the severity of SAT depends upon the causative virus. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Monday, June 13, 2022 1:06 p.m. - 1:11 p.m.

INCIDENTAL PULMONARY CAVITARY LESIONS AS AN UNCOMMON PRESENTATION OF LEMIERRE SYNDROME

INCIDENTAL PULMONARY CAVITARY LESIONS AS AN UNCOMMON PRESENTATION OF LEMIERRE SYNDROME

Pain-side related difference in cross-sectional area of the longus colli muscle and its relationship with standing balance in persons with non-specific neck pain

BackgroundLongus colli muscle has a significant role in postural control. A reduction of longus colli cross-sectional area (CSA) has been demonstrated in neck pain patients. However, pain-side related difference and its relationship with clinical features and standing balance remain unclear. ObjectiveTo investigate side-to-side difference in the longus colli CSA and to determine the relationships of the CSA with clinical characteristics and standing balance in neck pain patients. Study designCross-sectional study. Materials and methodsFifty participants with chronic non-specific neck pain (20 unilateral and 30 bilateral) were recruited. CSA of the longus colli muscle was measured using ultrasound imaging. Balance was measured using a force platform during a narrow stance with eyes open, eyes closed, and neck torsion (left and right). Balance outcomes were sway area and displacement in anterior-posterior (AP) and medial-lateral (ML) directions. Clinical characteristics were neck pain intensity, disability, and duration. ResultsThe longus colli CSA was reduced on the painful side in patients with unilateral neck pain (p < 0.01). There was a trend towards reduced CSA on the more painful side in those with bilateral neck pain (p = 0.08). The reduced CSA was mostly correlated with the greater AP sway displacement and sway area (r ranged from −0.27 to −0.54, p < 0.05). The longus colli CSA was not correlated with pain intensity, disability, and duration (p > 0.05). ConclusionThe longus colli CSA was reduced on the painful side of neck pain. The reduced CSA was correlated with impaired standing balance, but not with clinical characteristics of neck pain.

Subacute Thyroiditis Post-COVID-19 Infection: A Case Report

Background: Subacute thyroiditis (SAT) or granulomatous thyroiditis is usually a self-limiting inflammatory condition. The clinical presentation varies from person to person, but is usually associated with pain and systemic symptoms. Case Report: Herein, a case of a previously healthy 40 years old male who presented with unilateral right neck pain of gradual onset and progressive course has been described. The patient had recovered from a symptomatic Covid-19 infection 5 months back. The clinical examination, imaging and histopathological examination were consistent with the clinical diagnosis of subacute thyroiditis. The patient received medication in the form of pain killer, Celebrex and paracetamol, without corticosteroids, and completely recovered. Conclusion: The possibility of subacute thyroiditis post-COVID-19 infection should be considered.

Factors Associated with Treatment Success After Interlaminar Epidural Steroid Injection for Cervical Radicular Pain.

To investigate the demographic, clinical and radiological findings associated with treatment success after interlaminar epidural steroid injection (ILESI) in radicular pain induced by cervical disc herniation. In this retrospective study, the data of patients who received cervical ILESI between January 2017 and June 2021 were screened. Of 223 patients, 92 with unilateral radicular neck pain due to cervical disc herniation were included. Demographic data, symptom duration, and numerical rating scale scores at baseline, at three weeks, three months, and six months after treatment were collected from the medical records of the patients. Disc herniation level, cervical axis, disc height, presence and degree of spinal canal and neural foraminal stenosis, vertebral endplate signal change, and definitive presence of uncovertebral and facet osteoarthritis were evaluated using cervical spine magnetic resonance imaging. Treatment success was determined as ?50% reduction in pain scores at six months compared to baseline. Data of 92 patients (27 men, 65 women) were included. The mean age was 50.82 ± 10.22 years, and the median symptom duration was 12 (4.25 to 20) months. At six months after ILESI, treatment was successful in 58 (58.7%) patients and unsuccessful in 34 (41.3%) patients. Multivariable logistic regression analysis was performed to identify the factors associated with treatment success at six months post-injection. In the final model, neural foraminal stenosis (non-severe vs. severe) and spinal canal stenosis (non-severe vs. severe) were significantly associated with the treatment success (OR=3.02, 95% CI=1.40?10.95, p=0.009; OR=5.31, 95% CI=1.77?15.85, p=0.003). Treatment success of cervical ILESI at six months is favorable. However, the presence of severe neural foraminal and spinal canal stenosis is associated with a reduced likelihood of treatment success.

Local Triamcinolone Injection and Oral Steroid in the Patients with Thyrohyoid Syndrome

Background and Objectives Thyrohyoid syndrome is rare disease characterized by unilateral chronic neck pain on hyoid bone area. Currently, local triamcinolone injection was widely used, but oral steroid treatment was rarely tried. We compared the oral steroid and triamcinolone injection for the thyrohyoid syndrome. Subjects and Method Patients who had unilateral pain and tenderness at thyrohyoid membrane were enrolled while excluding those with other diseases, such as gastroesophageal reflux, by physical exam and history taking. Patients were treated with oral steroid (n=15) and local triamcinolone injection (n=11); pain scores based on the pretreatment and post-treatment numeric rating scale (NRS)-11 were compared between the groups.Results Patients with thyrohyoid syndrome were comorbid with globus (42.3%), sore throat (19.2%), and radiating pain (15.4%). In the oral steroid group, posttreatment pain scores (4.0± 2.2) significantly improved (p=0.001) more than pretreatment pain scores (7.7±1.2). In the triamcinolone injection group, posttreatment pain scores (2.3±1.7) also significantly improved (p=0.003) more than pretreatment scores (7.5±1.4). None of the patients revealed treatment related complications. Pretreatment scores were not significantly different, but post-treatment scores wre significantly better in the triamcinolone injection group than in the oral steroid group (p=0.047).Conclusion Oral steroid treatment could be easily performed and have significant effects for patients with thyrohyoid syndrome. Local triamcinolone injection was more effective than oral steroid treatment.