Neck and Arm Pain (Pain Series)

180 Pages·1981·14.87 MB·English

by  Rene Cailliet

NECK AND
ARPMA IN
NECAKN D
ARMP AIN
Edition 2
RENE CAILlIET, M.D.
Professor and Chairman
Department of Rehabilitative Medicine
University of Southern California
School of Medicine
Los Angeles, California
Illustrations by R.C ailliet, M.D.
'F.
A.D AVISC OMPANY .
Phil.d"ph,.
Alsob yR ene CailHet:
FOOT AND ANKLE PAIN
HAND PAINA ND IMPAIRMENT
KNEE PAINA ND DISABILITY
LOW BACK PAIN
SCOLIOSIS
SHOULDERP AIN
SOFTT ISSUEP AINA ND DISABILITY
THE SHOULDERI NH EMAPLEGIA
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Library of Congress Cataloging in Publication
Data
CailliReetn,e .
Necka nda rmp ain.
Inculdesb ibliographriecfaelr encaensd
index.
I.N eckp ain.2. BrachialgIi.a T.i tle.
[DNLM: I. Arm. 2. Neck. 3. Pain.
4. Shoulder.W E805 C134nl
RC936.C26 1981 617' .53 80-17352
ISB N0 -8036-1609-0
Preface to Second Edition
Over the years since the first edition of Neck and Arm Pain there
have been numerous additions and changes in diagnostic procedures
and in treatment concepts of these syndromes. The second edition is
presented in an attempt to update these newer concepts.
Cervical myelopathy was omitted from the previous edition and
neglected a very important consideration of painful, disabling aspects
of cervical spine disease. The frequency of cervical spondylosis caus­
ing myelopathy yet being unrecognized encouraged me to add this
important chapter to the second edition.
Numerous concepts of treatment, both surgical and nonsurgical, al­
ways benefit from careful review and revision. Numerous theories of
local pain and referred pain are always being reviewed clinically and in
research laboratories and their pertinence to clinical application needs
to be reviewed for the busy clinician who has too little time to assimi­
late and make applicable these many factions of a common clinical
syndrome.
The medical-legal aspect of painful and disabling conditions is con­
tinually mandating better medical evaluation and patient care. A better
educated patient population also expects better infomled medical care
delivery as well as explanation of a painful, disabling condition.
The following statement by a legal specialist in a medical journal
well summarizes these thoughts:
Cervictarla umiaso neo ft hosaer eaosfp hysicianij uwrhyi clhi khee ada nd
bacikn jurioeftse,nr esulitnss u bjective cotmhpalatar ieen xttsr emely dif­
ficuflottr h ec ourtisn,d ustcroimamli ssionienrssu,r anccaer riaenrdsa ttor­
neytso p roperleyv aluate. Lneeaudrionsgu rgaincda lo rthopsepdeicci alists
telulst hatth eriess timlulc ht haitsu nknowanb outth ep atholoofgc ye rvical
traumtah,a mta nyt imetsh edyo n otk nowe xactwlhya tt ol oofko irn i njuries
v
tot hiasr eaa,n dt hatth euys ualclayn nodte ny subjeccotmipvlea iinnvt ise w
ofl acokf p reciisnef omlation.·
This revision has been prepared in an attempt to add to this knowl­
edge. It is always with the idea that specialists will also benefit but,
more importantly, that students, interns, residents of all specialties, and
practitioners of every field of medicine will acquire a sufficient knowl­
edgeable basis for evaluation and treatment of the patient suffering
from cervical spine pathology. This is the purpose of the second edition
of Neck and Arm Pa;n.
RENE CAILLlET, M.D .
• AllenW,. S.: Mediclll·alsepegcatlos f cervictamlu l1lCal.i nN.e urosur2:g 1.06 -13,
1954.
vi
Preface to First Edition
Of all the musculo-skeletal and neuromuscular conditions causing
pain and disability in man. pain and dysfunction originating in the
neck. shoulders. and upper extremities is exceeded only by low back
pain.
The early manifestations of neck pain and the significance oflimited
motion are frequently overlooked because of ignorance of normal
functions and abnormal deviation.s In later life. neck pain and its
sequelae are attributed toaging or to the weartlIld tear of life. SuITerers
from these effects would have benefitted from earlier recognition and a
more physiological approach to treatmen.t
The musculo-skeletal system must be fully understood in its static
anatomical sense and in its kinetic function before abnormality and the
mechanism of pain production and dysfunction can be recognized and
understood. Pathological changes can be prevented; and when a com­
plete reversal of abnormal changes is impossible. at least the symptoms
and disability caused by these changes can be ameliorated.
The neck in this monograph is discussed in a didactic. positive
manner principally from the author's viewpoin.t The bibliography is
small and selective regarding the more controversial aspects. but the
text is based on voluminous literature as well as personal observation
and opinion.
The stick-man drawings and the simplified sketches have been ef­
fective in similar monographs and as teaching aids in the classroom.
They are used here to aid the busy practitioner. the burdened medical
student or intern. and the practicing physical therapist; and they should
be helpful as well in informing the patient during office practice.
l owe my publishers a debt of gratitude for oITering this text in an
inexpensive paperback volume. This manner of presenting medical
texts brings medical information in a practical. low-cost form to the
physician who is staggered by the annual deluge of medical texts.
vii
I am sincerely grateful to the physicians of the Gaylord Seminar
under the direction of Sidney Licht, M.D., who reviewed the manu­
script and made invaluabJe constructive criticism.s
RENE CAILLlET, M.D.
viii
Contents
Illustrations xi
Introduction xv
Chapter 1. Functional Anatomy 1
. . . . . . . . . . . ..•........... . . .
Anterior Portion of the Functional Unit 1
..............•...
Posterior Portion of the Functional Unit 7
. . . . . . . . . . . . . ...•.
Static Spine 8
................................. . . . . . . . . . . .
Posture 9
................................................
Kinetic Spine II
...................•.•..........•.... . .....
Ligamentous Support 18
. . . . . . . . . . . .................. . . . . . .
Musculature of the Neck 21
. . . . . . . . . .. . . . ...•.•.. . . . . . . . . . .
Tissue Sites of Pain Production 23
. . ....•...... . .•.• .•... . . .
The Cervical Nerves 27
....................................
The Sympathetic Nervous System 34
.......................
Upper Cervical Segments 38
. . . . . . . . . . . . . . . . . . . . . . . . .......
Chapter 2. Neck Pain Originating in the Soft Tissues 42
. . . . . . . .
Chapter 3. Diagnosis of Neck Pain 50
. . . . . . . . . . . . . . . . . . • . . . . . .
Physical Examination 51
. . . . . . . . . . . ..•..........•. . . . . . ....
X-Ray Examination 52
. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .....
Chapter 4. Cervical Disk Disease as a Factor in Pain and
Disability 56
..................................................
Nature and Mechanism of Radicular Pain 56
. . . . .. . . . . . . . . . .
Cervical Disk 62
.................... . . .. . . . . . . . . ..........
Localization of Root Level by Clinical Examination 64
. . . . . . .
Chapter 5. Subluxations of the Cervical Spine Including the
"Whiplash" Syndrome 73
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ix