Patient Presentation:
35 year old female secretary to a law firm, whose job involves prolong periods of computer work (up to 3 hours without break, twice daily), answering phones and working as receptionist. She presents with low cervical and bilateral supraspinous fossa pain as her initial complaint, with headaches that come when this first pain is worse. Once the headaches are there, she finds it very difficult to ease them off without lying down with medication.
Aggravates: Working at computer, particularly as the day goes on, so that by mid-day, she almost always has a headache, making completing the day’s work very difficult. Driving long distances will provoke the neck and supraspinous pain. Sitting watching her children play sport will bring on the neck and supraspinous pain. The headaches are associated with work and the computer mostly.
Eases: Headache – lying down with medication (panadeine x 2) will lead to a reduction in the headache after about 30 minutes, so that she can continue with her home duties. Headache only completely eases with a good night’s sleep. Neck and supraspinous pain – also is reduced by lying down with the panadeine. Also eased by heat and massage.
No significant precautionary question information.
No significant psychosocial history or situation.
History: She took her present job 7 years ago when her children went to school. Gradually over the time, her workload on the computer has increased from 1-2 hours to her present load. She is always under deadline pressures with what she types and finds having to answer the phone and work on the desk distracting, putting more pressure on the deadlines. She works from a dictaphone most of the time, but one of the lawyers writes notes rather than using the d...
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... 'Movement coordination and differential kinematics of the cervical and thoracic spines in people with chronic neck pain', Clinical Biomechanics, vol. 28, no. 6, 7//, pp. 610-617.
van Eijsden-Besseling, MD, van den Bergh, KA, Staal, JB, de Bie, RA & van den Heuvel, WJ 2010, 'The Course of Nonspecific Work-Related Upper Limb Disorders and the Influence of Demographic Factors, Psychologic Factors, and Physical Fitness on Clinical Status and Disability', Archives of Physical Medicine and Rehabilitation, vol. 91, no. 6, 6//, pp. 862-867.
Wærsted, M 2000, 'Human muscle activity related to non-biomechanical factors in the workplace', European Journal of Applied Physiology, vol. 83, no. 2-3, 2000/10/01, pp. 151-158.
Westgaard, R 1999, 'Muscle Activity as a Releasing Factor for Pain in the Shoulder and Neck', Cephalalgia, vol. 19, no. 25 suppl, December 1, 1999, pp. 1-8.
The borders between the different forms are very fluid and the specific conditions are often misdiagnosed as a strong migraine, causing the patients to suffer significant pain before treatment is started. Which directly links to another problem: The treatment. Oxygen treatment seems promising, yet it is not readily available to the patients. Orally administered triptans are usually too weak and nasally administered triptans (e.g. ZOMIG) cannot be used in a sufficient frequency to relieve the pain during the whole day, especially in the case of Paroxysmal Hemicrania where attacks are generally of shorter duration yet of higher intensity. Therefore, patients still need to resort to taking a significant amount of painkillers which is medically problematic since an attack period can last up to several months or even years in the case of chronic conditions which 10-15% of cluster headache patients suffer from.
Based on the initial pain medicine evaluation report dated 06/22/15, the patient complains of constant neck pain which radiates down to the bilateral upper extremity, fingers and hands. Pain is accompanied by intermittent tingling and numbness in the bilateral upper extremities to the level of the fingers and muscle weakness. The neck pain is associated with occipital, temporal and frontal headaches and muscle spasms in the neck area. The patient describes the pain as aching, burning, pins and needles, sharp, and stabbing. The pain is aggravated by activity, flexion/extension, prolonged sitting, pulling, pushing, repetitive head motions and standing. She also reports severe difficulty in sleep.
Oatis C. (2009) Kinesiology: The Mechanics & Pathomechanics of Human Movement (Second ed.). Glenside, Pennsylvania: Lippincott Williams & Wilkins.
The delivery of dental care requires excellent endurance of the motor skills for prolonged periods of time. These muscles seem to get tired quickly and start to w...
Muscle activity, including generating force and moving limbs through lengthening and shortening, is an important influence on beneficial tissue stress. Muscles adapt quickly to periods of lower or higher stress and demonstrate obvious visual and functional changes. At a tissue level, the Physical Stress Theory (PST) states that muscle adaptations are consistent with other high and low strain tissue adaptation models. Low stress/activity associated with immobilization results in decreases in contractile protein, fiber diameter, peak tension and power. Evidence supports the idea that tissues within the musculoskeletal system atrophy and become less tolerant of physical stress if stress on the tissue diminishes below a baseline level.3 In addition,
through the Eyes of a Participant Observer." Chiropractic & Manual Therapies. Vol. 20, No. 1, 19 Jan. 2012, p. 1. EBSCOhost. 2017 October 25.
The software setting is set as described in the lab manual. The stimulus intensity is initially set to 1 amps and gradually increased until a slight response is observed and recorded. The intensity is now increased by 0.2 amps with an interval of 2-3 seconds until the stair stepping response reaches saturation. Refer to the Muscle lab manual for the correct procedure to record data (*-*-*). Part 2 involved measurement and observation of the shape and strength of single muscle contractions such as latent period, contraction and relaxation. The Amp to 75% of max muscle contraction, 10 stimuli were recorded and 6 were selected to be observed and calculated (*-*-*-). Part 3 was used to measure the effects of frequency of stimulation and motor unit recruitment on the muscle contraction force. The Amp to 15% of the muscle contraction, constant stimulus recordings were taken increasing the frequency initially set to 1, then 2, and then in increments of 2 until maximum plateaued contraction was achieved. The interval of 5 seconds was required for each frequency. Part 4 measured the differences in relaxation rates of a fatigued and non-fatigued
Repetitive arm use can cause fatigue of shoulder muscles and this has been a potential link to the development of shoulder pain. A reduction in force generation of shoulder muscles might lead to a reduction in control or stabilization for joint motions, such as the GH joint. The infraspinatus has been seen to play a significant role in the alteration of GH kinematics when fatigued while other shoulder musculature, such as the anterior/posterior deltoid and serratus anterior, did not alter GH kinematics while fatigued. Altered scapular kinematics have been found after fatiguing external rotators such as the infraspinatus. decreased scapular posterior tilt, upward rotation, and external rotation during arm elevation after the external rotators were fatigued. confirmed a decrease in scapular posterior tilt from external rotator fatigue, but also noted an increase in scapular upward rotation at 60° of arm elevation. also stated an increase in scapular upward rotation with arm elevation following fatigue.
After many years of battling migraine headaches, she had decided to try something new. The doctors tell her everything is okay with her. MRI shows no abnormality but the
In reviewing the medical care provided ,it seems that the patient’s previous medical history clouded her doctor’s decisions. Because of this, none of her doctors opted to dig deeper into other possible reasons for her daily headaches. Many factors that should have been...
At the time of the study, a tri-axial accelerometer (ADXL 327, Analog Devices, Norwood, Massachusetts) was taped to the participants neck at the level of the cricoid cartilage such that the sensitive axes of the accelerometer were aligned to the anatomical anterior-posterior (A-P), superior-inferior (S-I) and medial-lateral (M-L) axes. Signals from A-P,S-I, and M-I were bandpass filtered from 0.1 to 3000 Hz with ten times amplification (model P55, Grass Technologies, Warwick, Rhode Island) prior to storage on a research computer. The voltage signals for each axis of the accelerometer were fed into a National Instruments 6210 DAQ and recorded at 20 kHz by the LabView program Signal Express (National Instruments, Austin, Texas). Concurrent with the accelerometer, bolus
Voci’s physician assistant for a lengthy appointment. The recent EMG of the upper extremities showed mild carpal tunnel to the right hand, there was no radiculopathy from the cervical spine, the EMG of the lower extremities was normal with any radiculopathy of the lower extremities. The VNG for vertigo was negative. A recent MRI of the lumbar spine showed bulges at L3/L4, narrowing, bulges at L4/5, L5/Si. Ms. Tocco again expressed how helpless she feels with her pain, balance, migraines, and jaw pain. It has affected her whole life. She has a lot of anxiety related to her current continued symptoms. She said Dr. Morelli wants her to have some epidural injection, but also told her she would need to have another cervical spine surgery to repair the damage from the original repair not healing. In the meantime, medications are being changed to try and get the migraines under control, Cambia and Maxalt will be tried. She can take a Norco at twice a day and will continue with the Cyclobenzaprine. We talked about the recommendation by the physical therapist to try therapeutic massage. We obtained a
One of the most common symptoms related to these untreated injuries include headaches. To effectively treat a headache, the chiropractor needs to have the skills necessary to diagnose the type of headache a patient is experiencing. One headache that our chiropractors frequently treat is caused by tension and stress in the cervical spine. These headaches are very responsive to chiropractic care and other forms of physical medicine.
Musculoskeletal pain generally arises due to an injury, infection or overuse/exertion. This is generally marked by muscle tenderness, weakness, limited range, stiffness and decreased nerve conduction velocity.²Here, we wanted to analyse the musculoskeletal pain among school and university female teachers. They have various works ranging from giving lectures, checking assignments to tedious computer work. These all are the reasons for the increase neck, shoulder and back pain. Teachers in colleges have to give long hours of lectures in standing whereas teachers in high school have more stress and work load as they have to cover large syllabuses including competitive exams. Awoman has to manage the whole house taking care of elderly as well as her children. And being a teacher definitely increases the wholesome workload. Whereas men on the other hand, are not at all active in the household chores, which thereby proves the difference in the workload among the two genders.Also women, undergoes various hormonal changes in the body and many a times musculoskeletal pain is one the symptoms.
Jackson, M.A. & Simpson, K. H. (2006). Chronic Back Pain. Continuing Education in Anaethesia, Critical Care and Pain, 6(4), 152-155. http://dx.doi: 10.1093/bjaceaccp/mkl029