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Sun Y, Wu X, Lou H, Jiang J, Li Z, Xu J, Sun Y, Cong D. Cervical vertigo due to rotational fixation of atlantoaxial joint combined with benign paroxysmal positional vertigo: A case report and literature review. Medicine (Baltimore) 2024; 103:e39192. [PMID: 39093787 PMCID: PMC11296434 DOI: 10.1097/md.0000000000039192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Vertigo is the most common clinical complaint, misdiagnosed patients are not rare, so it is very important to exclude and identify vertigo. For vertigo caused by multiple causes, including cervical vertigo with atlantoaxial rotation fixation combined with benign paroxysmal positional vertigo (BPPV), tuina can correct joint misalignment. The reduction technique will return the fallen otolith to the correct position. The use of massage and reduction can improve clinical symptoms and improve quality of life and may be a simple, safe, and effective treatment strategy for this disease. PATIENT CONCERNS We report on a patient with both cervical vertigo due to atlantoaxial rotational fixation and BPPV, including his imaging examination, clinical manifestations, and treatment methods. DIAGNOSIS Cervical vertigo (atlantoaxial rotatory fixation) and BPPV. INTERVENTION Tuina combined with atlantoaxial directional inverted reduction technique and reduction manipulation. OUTCOMES The patient's vertigo symptoms improved significantly, nystagmus disappeared, cervical occipital pain, nausea, head distension, and other symptoms disappeared, and cervical motion rotation reached 60°. CONCLUSION This study proved the effectiveness of massage combined with a reduction in the treatment of cervical vertigo and BPPV, as well as the importance of vertigo diagnosis and differential diagnosis, and provided a new treatment idea for the future diagnosis and treatment of vertigo caused by a variety of causes.
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Affiliation(s)
- Yahui Sun
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Xingquan Wu
- Department of Tuina, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Huijuan Lou
- Department of Tuina, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Jinglei Jiang
- Department of Tuina, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Zhongxu Li
- Department of Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Jing Xu
- Department of Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Yiping Sun
- Department of Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Deyu Cong
- Department of Tuina, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
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Streicher NS, Popovich M, Almeida A, Alsalaheen B, Ichesco IK, Freeman J, Lorincz M, Eckner JT. Understanding Abnormal Examination Findings During Concussion Recovery: A Retrospective Chart Review. Neurol Clin Pract 2024; 14:e200284. [PMID: 38699600 PMCID: PMC11065325 DOI: 10.1212/cpj.0000000000200284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/22/2024] [Indexed: 05/05/2024]
Abstract
Background and Objective Physical examination findings in athletes with sport-related concussion (SRC) are not well described in the literature. The objective of this study was to describe physical examination findings during the first month following concussion in athletes, with a focus on the effect of sex, age, and time since injury. Methods This was a retrospective electronic medical record (EMR) review of physical examination findings in 500 patients aged 6-24 who were initially seen within 15 days of SRC at a multidisciplinary outpatient academic concussion clinic between 2017 and 2019. A standardized concussion examination built in the EMR recorded mental status, cranial nerve, vestibulo-ocular motor screen, and balance findings for all patients. The primary outcome was the frequency of abnormal examination findings during the first 30 days postinjury, which was further analyzed by sex, age, and time since injury using mixed logistic regression models. Results The most common abnormal examination findings overall were eyes-closed single-leg stance, vestibular-ocular reflex, visual motion sensitivity, the neck examination, and eyes-closed tandem stance. Abnormal findings were more frequent in female athletes for vestibular ocular reflex and visual motion sensitivity. The frequency of abnormal findings increased with age for vestibulo-ocular reflex, visual motion sensitivity, the neck examination, convergence testing, and eyes-open single-leg stance, whereas abnormalities decreased in frequency with age for eyes-open tandem stance and tandem gait. The frequency of abnormal findings generally decreased with time over the first 4 weeks following injury. Discussion A comprehensive physical examination is pivotal for evaluation of athletes with concussion. These findings highlight high-yield components of the concussion examination and support use of these examination components as injury markers. Future work should investigate associations between physical examination findings and postconcussion symptoms and recovery outcomes. Classification of Evidence This retrospective cohort study provides Class IV evidence that neurologic examination with specifically designed clinical tests are helpful for diagnosis of traumatic brain injury in young athletes at age 6-24.
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Affiliation(s)
- Nicholas S Streicher
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - Michael Popovich
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - Andrea Almeida
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - Bara Alsalaheen
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - Ingrid K Ichesco
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - Jeremiah Freeman
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - Matt Lorincz
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - James T Eckner
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
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3
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Pyykkö I, Vinay, Vetkas A, Zou J, Manchaiah V. Association of Head Injury, Neck Injury or Acoustic Trauma on Phenotype of Ménière's Disease. Audiol Res 2024; 14:204-216. [PMID: 38391776 PMCID: PMC10885978 DOI: 10.3390/audiolres14010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
The aim of the present study was to investigate adverse effects of head injury, neck trauma, and chronic noise exposure on the complaint profile in people with Ménière's disease (MD). The study used a retrospective design. Register data of 912 patients with MD from the Finnish Ménière Federation database were studied. The data comprised case histories of traumatic brain injury (TBI), neck trauma and occupational noise exposure, MD specific complaints, impact related questions, and the E-Qol health-related quality of life instrument. TBI was classified based on mild, moderate, and severe categories of transient loss of consciousness (TLoC). The mean age of the participants was 60.2 years, the mean duration of the disease was 12.6 years, and 78.7% were females. Logistic regression analysis, linear correlation, and pairwise comparisons were used in evaluating the associations. 19.2% of the participants with MD had a history of TBI. The phenotype of participants with TBI was associated with frequent vestibular drop attacks (VDA), presyncope, headache-associated vertigo, and a reduction in the E-QoL. Logistic regression analysis explained the variability of mild TBI in 6.8%. A history of neck trauma was present in 10.8% of the participants. Neck trauma associated with vertigo (NTwV) was seen in 47 and not associated with vertigo in 52 participants. The phenotype of NTwV was associated with balance problems, VDA, physical strain-induced vertigo, and hyperacusia. Logistic regression analysis explained 8.7% of the variability of the complaint profile. Occupational noise exposure was recorded in 25.4% of the participants and correlated with the greater impact of tinnitus, hyperacusis, and hearing loss. Neither the frequency, duration, or severity of vertigo or nausea were significantly different between the baseline group and the TBI, NTwV, or noise-exposure groups. The results indicate that TBI and NTwV are common among MD patients and may cause a confounder effect.
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Affiliation(s)
- Ilmari Pyykkö
- Hearing and Balance Research Unit, Field of Otolaryngology, Tampere University, 33100 Tampere, Finland
| | - Vinay
- Department of Neuromedicine and Movement Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Artur Vetkas
- Faculty of Medicine, University of Tartu, 50090 Tartu, Estonia
| | - Jing Zou
- Hearing and Balance Research Unit, Field of Otolaryngology, Tampere University, 33100 Tampere, Finland
- Department of Otolaryngology-Head and Neck Surgery, Center for Otolaryngology-Head & Neck Surgery of the Chinese PLA, Changhai Hospital, Second Military Medical University, Shanghai 201823, China
| | - Vinaya Manchaiah
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO 80045, USA
- UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, CO 80045, USA
- Virtual Hearing Lab., Collaborative Initiative between University of Colorado School of Medicine and University of Pretoria, Aurora, CO 80045, USA
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria 0001, South Africa
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal 576104, Karnataka, India
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Garcia CB, Alves NGP, Bittar RSM. A new treatment for cervical dizziness. Braz J Otorhinolaryngol 2023; 89:101321. [PMID: 37716098 PMCID: PMC10509662 DOI: 10.1016/j.bjorl.2023.101321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/18/2023] Open
Abstract
OBJECTIVES To verify the rates of heat effectiveness generated by Carbon Nanotubes (CNT) in the resolution of dizziness in individuals diagnosed with Cervical Dizziness (CD). METHODS Randomized clinical trial was performed and samples from volunteers diagnosed with CD, divided into a Study Group (SG) and Control Group (CG). Patches containing CNT with thermotherapeutic effect were used in SG and inert patches in the CG. Treatment was performed over 30 days and measures of pain, dizziness and asymmetry of cervical muscle tension were evaluated over 60 days. RESULTS Pain, dizziness and asymmetry of cervical muscle tension were reduced in the SG. The variables analyzed in this study did not change in the CG. CONCLUSION Our results show that the therapeutic effect of heat was effective in the treatment of patients diagnosed with CD. We could also observe a clear interrelationship between pain and dizziness symptoms with the asymmetry of cervical muscle tension. LEVEL OF EVIDENCE 1B.
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Affiliation(s)
- Cesar Bertoldo Garcia
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Pós-Graduação em Medicina, São Paulo, SP, Brazil.
| | - Nedison Gomes Paim Alves
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Pós-Graduação em Ciências, São Paulo, SP, Brazil
| | - Roseli Saraiva Moreira Bittar
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), Departamento de Otorrinolaringologia, Setor de Otoneurologia, São Paulo, SP, Brazil
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5
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Gill-Lussier J, Saliba I, Barthélemy D. Proprioceptive Cervicogenic Dizziness Care Trajectories in Patient Subpopulations: A Scoping Review. J Clin Med 2023; 12:jcm12051884. [PMID: 36902670 PMCID: PMC10003866 DOI: 10.3390/jcm12051884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/12/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Proprioceptive cervicogenic dizziness (PCGD) is the most prevalent subcategory of cervicogenic dizziness. There is considerable confusion regarding this clinical syndrome's differential diagnosis, evaluation, and treatment strategy. Our objectives were to conduct a systematic search to map out characteristics of the literature and of potential subpopulations of PCGD, and to classify accordingly the knowledge contained in the literature regarding interventions, outcomes and diagnosis. A Joanna Briggs Institute methodology-informed scoping review of the French, English, Spanish, Portuguese and Italian literature from January 2000 to June 2021 was undertaken on PsycInfo, Medline (Ovid), Embase (Ovid), All EBM Reviews (Ovid), CINAHL (Ebsco), Web of Science and Scopus databases. All pertinent randomized control trials, case studies, literature reviews, meta-analyses, and observational studies were retrieved. Evidence-charting methods were executed by two independent researchers at each stage of the scoping review. The search yielded 156 articles. Based on the potential etiology of the clinical syndrome, the analysis identified four main subpopulations of PCGD: chronic cervicalgia, traumatic, degenerative cervical disease, and occupational. The three most commonly occurring differential diagnosis categories are central causes, benign paroxysmal positional vertigo and otologic pathologies. The four most cited measures of change were the dizziness handicap inventory, visual analog scale for neck pain, cervical range of motion, and posturography. Across subpopulations, exercise therapy and manual therapy are the most commonly encountered interventions in the literature. PCGD patients have heterogeneous etiologies which can impact their care trajectory. Adapted care trajectories should be used for the different subpopulations by optimizing differential diagnosis, treatment, and evaluation of outcomes.
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Affiliation(s)
- Joseph Gill-Lussier
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC H3N 1X7, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (IURDPM), CRIR, CIUSSS South-Center, Montreal, QC H3S 1M9, Canada
- Collège d’Études Ostéopathique de Montréal (CEOM), Montréal, QC H3G 1W7, Canada
| | - Issam Saliba
- Division of Otolaryngology, Head and Neck Surgery—Otology and Neurotology, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, QC H2X 3E4, Canada
- Correspondence:
| | - Dorothy Barthélemy
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC H3N 1X7, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (IURDPM), CRIR, CIUSSS South-Center, Montreal, QC H3S 1M9, Canada
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He Q, Huang H, Liang H, Chou LW, Fu Z. Subcutaneous stretching enlarges adjacent vertebral artery instantly in patients with cervicogenic dizziness: Two case reports. Medicine (Baltimore) 2023; 102:e32643. [PMID: 36749247 PMCID: PMC9901990 DOI: 10.1097/md.0000000000032643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
RATIONALE Fu's subcutaneous needling (FSN) is effective for cervicogenic dizziness (CGD), which is often a result of vascular problems. Here, we attribute the positive treatment effect of FSN for CGD to improvements in vascular problems. PATIENT CONCERN Two patients were experiencing low quality of life due to reproducible dizziness. DIAGNOSIS Two patients with cervical spine disorder, presented with neck pain and reproducible dizziness. Other causes of dizziness were excluded. INTERVENTIONS Case 1 received 1 session of FSN treatment, while case 2 received 3 sessions of FSN treatment in a month. OUTCOMES The dizziness and neck pain experienced by both patients instantly improved significantly after FSN treatment, and the luminal diameter of the vertebral artery (VA) measured by carotid and VA ultrasound enlarged simultaneously up to 1.29-fold and 1.09-fold for both cases. According to the Hagen-Poiseuille equation, the blood flow volume increased 2.77-fold and 1.43-fold, respectively. Case 2 recovered from CGD with 1.19-fold VA luminal diameter increment and about 2.01-fold increase of blood flow volume in a month. LESSONS Subcutaneous stretching provides a safe, convenient and immediate solution to CGD, and supports the diagnosis and treatment of CGD under carotid and VA ultrasound. This study suggests that stretching subcutaneously can influence adjacent VA, which may also help improve some cerebrovascular diseases.
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Affiliation(s)
- Qingtao He
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, Guangdong, China
| | - Huiyi Huang
- Clinical Medical College of Acupuncture & Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hongyu Liang
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, Guangdong, China
| | - Li-Wei Chou
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan, China
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan, China
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan, China
| | - Zhonghua Fu
- Clinical Medical College of Acupuncture & Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- The Institute of Fu’s Subcutaneous Needling, Beijing University of Chinese Medicine, Beijing, China
- * Correspondence: Zhonghua Fu, Clinical Medical College of Acupuncture & Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China (e-mail: )
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Alvarez G, Lucas S, Roura S. Osteopathic manipulative techniques in the treatment of vestibular dizziness not related to the cervical spine. J Osteopath Med 2023; 123:273-276. [PMID: 36732063 DOI: 10.1515/jom-2022-0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/21/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Gerard Alvarez
- Spain National Center, Foundation Come Collaboration, Barcelona, Spain.,Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau, IIB Sant Pau, C. Sant Atoni Maria Claret 167, Pavelló 18, Planta 0, 08025 Barcelona, Catalunya, Spain
| | - Sergi Lucas
- Institute for Vestibular Rehabilitation and Balance, Barcelona, Spain
| | - Sònia Roura
- Spain National Center, Foundation Come Collaboration, Barcelona, Spain.,PhD program on Biomedical Research Methodology and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
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Sung YH. Classification of cervicogenic dizziness. HEARING, BALANCE AND COMMUNICATION 2023. [DOI: 10.1080/21695717.2023.2168415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Yun-Hee Sung
- Department of Physical Therapy, College of Health Sciences, Kyungnam University, Changwon, Republic of Korea
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9
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Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121791. [PMID: 36556992 PMCID: PMC9786116 DOI: 10.3390/medicina58121791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/08/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Dizziness or vertigo can be caused by dysfunction of the vestibular or non-vestibular systems. The diagnosis, treatment, and mechanism of dizziness or vertigo caused by vestibular dysfunction have been described in detail. However, dizziness by the non-vestibular system, especially cervicogenic dizziness, is not well known. This paper explained the cervicogenic dizziness caused by abnormal sensory input with references to several studies. Among head and neck muscles, suboccipital muscles act as stabilizers and controllers of the head. Structural and functional changes of the suboccipital muscles can induce dizziness. Especially, myodural bridges and activation of trigger point stimulated by abnormal head posture may be associated with cervicogenic dizziness.
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Hamidi Nahrani M, Akbari M, Mansour Sohani S, Mazaher Yazdi M, Maarefvand M. Vestibular Evoked Myogenic Potentials in Cervical Myofascial Pain Syndrome. Indian J Otolaryngol Head Neck Surg 2022; 74:3993-3997. [PMID: 36742763 PMCID: PMC9895190 DOI: 10.1007/s12070-021-02772-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/18/2021] [Indexed: 02/07/2023] Open
Abstract
Cervical myofascial pain syndrome with dizziness (CMPS-D) has always faced the challenges of evaluation, diagnosis, and etiology. Vestibular-evoked myogenic potentials (VEMPs) are applicable to evaluate the functions of the vestibular system, especially the saccule. The Sound evoked triceps myogenic potentials (SETMPs) have different anatomical efferent connections from Sternocleidomastoid (SCM)-VEMPs. The present study aimed to evaluate the SETMPs and SCMVEMPs in CMPS-D group and compare the results with the control group. We tested 15 participants with CMPS-D with 15 participants in the control group using SCMVEMP and SETMP tests. All participants had normal hearing and vestibular functions. The SCMVEMP response was absent in 4 of 15 patients with CMPS-D, and the mean response CMPS-D group was significantly lower than the control group. There were the SETMP and SCMVEMP responses in all participants in the control group. In CMPS-D subjects with false absent SCMVEMP response, SETMP tests are suitable alternatives for the saccule evaluation, and diminished SCMVEMP in the CMPS-D subjects may not necessarily mean the saccular injury. Furthermore, the involvement of spinal cord pathways is not a cause of dizziness in CMPS-D patients.
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Affiliation(s)
- Morteza Hamidi Nahrani
- Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madad karan St., Madar Sq., Mirdamad Blv, 15459-13187 Tehran, Iran
| | - Mehdi Akbari
- Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madad karan St., Madar Sq., Mirdamad Blv, 15459-13187 Tehran, Iran
| | - Soheil Mansour Sohani
- Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Malihah Mazaher Yazdi
- Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madad karan St., Madar Sq., Mirdamad Blv, 15459-13187 Tehran, Iran
| | - Mohammad Maarefvand
- Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madad karan St., Madar Sq., Mirdamad Blv, 15459-13187 Tehran, Iran
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Bernhoff G, Huhmar HM, Rasmussen-Barr E, Bunketorp Käll L. The Significance of Pain Drawing as a Screening Tool for Cervicogenic Headache and Associated Symptoms in Chronic Fatigue. J Pain Res 2022; 15:2547-2556. [PMID: 36061488 PMCID: PMC9432569 DOI: 10.2147/jpr.s369470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) present with a broad spectrum of symptoms, including headache. A simple, yet powerful tool – the pain drawing identifies essential aspects such as pain distribution. The aim with this study was to 1) evaluate the significance of pain drawing as a screening tool for cervicogenic headache using a predefined C2 pain pattern, 2) assess whether there was an association between dizziness/imbalance and a C2 pain pattern, and 3) compare subgroups according to the pain drawing with respect to pain characteristics and quality of life. Patients and Methods Pain drawings and clinical data from 275 patients investigated for ME/CFS were stratified into: 1) cervicogenic headache as determined by a C2 pain pattern, 2) headache with no C2 pain pattern, and 3) no headache. For inference logistic regression presented with odds ratios (OR) and 95% confidence intervals (95% CI) and Kruskal–Wallis test were applied. Results One hundred sixteen participants (42%) were stratified to the group for which the pain drawing corresponded to the C2 pain pattern, thus indicating putative cervicogenic origin of the headache. Dizziness/imbalance was strongly associated with a C2 pain pattern; OR 6.50 ([95% CI 2.42–17.40] p ˂ 0.00), whereas this association was non-significant for patients with headache and no C2 pain pattern. Those demonstrating a C2 pain pattern reported significantly higher pain intensity (p = 0.00) and greater pain extent (p = 0.00) than the other groups, and lower health-related quality of life (p = 0.00) than the group with no headache. Conclusion For patients with chronic fatigue who present with a C2 pain pattern (interpreted as cervicogenic headache) the pain drawing seems applicable as a screening tool for signs associated with neuropathic and more severe pain, dizziness and reduced quality of life as detection of these symptoms is essential for targeted treatment.
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Affiliation(s)
- Gabriella Bernhoff
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Stockholm, Sweden
- ME-Centre, Bragée Clinics, Stockholm, Sweden
- Correspondence: Gabriella Bernhoff, Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Alfred Nobels allé 23 D2, 141 83 Huddinge, Stockholm, Sweden, Tel +46 720 71 33 29, Email
| | | | - Eva Rasmussen-Barr
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
| | - Lina Bunketorp Käll
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden
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12
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Özel Aslıyüce Y, Demirel A, Ülger Ö. Investigation of Joint Position Sense and Balance in Individuals With Chronic Idiopathic Neck Pain: A Cross-Sectional Study. J Manipulative Physiol Ther 2022; 45:188-195. [PMID: 35906105 DOI: 10.1016/j.jmpt.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/26/2022] [Accepted: 06/09/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the relationship between joint position sense and static and dynamic balance in female patients with chronic neck pain compared with healthy controls. METHODS The study sample comprised 25 female patients with chronic neck pain and 25 healthy (asymptomatic) female controls. Pain severity with the visual analog scale, joint position sense with the laser pointer method, static balance with the Single-Leg Balance Test, and dynamic balance with the Y Balance Test were assessed. RESULTS The deviation in cervical joint position sense was greater in extension (P < .001), right rotation (P < .001), and left lateral rotation (P < .05) in the patients with chronic neck pain compared with the healthy controls. The results of the patients with chronic neck pain were worse than the healthy controls in the Single-Leg Balance Test with both eyes open (P < .05) and eyes closed (P < .05). The patients with chronic neck pain had worse dynamic balance only in the anterior direction reach of the left leg (P < .05). CONCLUSION Cervical joint position sense and static balance were worse in female patients with chronic idiopathic neck pain when compared with asymptomatic controls. Dynamic balance in all other directions except for the anterior direction was not negatively affected in individuals with chronic idiopathic neck pain.
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Affiliation(s)
- Yasemin Özel Aslıyüce
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Aynur Demirel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Özlem Ülger
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
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Combination of Two Manipulative Techniques for the Treatment of Cervicogenic Dizziness: A Randomized Controlled Trial. Life (Basel) 2022; 12:life12071023. [PMID: 35888111 PMCID: PMC9318906 DOI: 10.3390/life12071023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 12/23/2022] Open
Abstract
Cervicogenic dizziness is clinically associated with upper cervical spine dysfunctions. It seems that manual therapy decreases the intensity of dizziness in these subjects, but what happens to pain measured by pressure pain threshold (PPT) has not been studied. Purpose: analyze the short-term effects of combination two manipulation techniques protocol in worst dizziness intensity (wVAS), dizziness and cervical disability, upper cervical spine mobility and mechanosensivity of cervical tissue. Methods: Assessor-blinded randomized controlled trial was developed. A total of 40 patients with cervicogenic dizziness were randomly divided into two groups. The experimental group received three treatments consisting of a functional massage and a manipulation technique, and compared with a control group. The wVAS, dizziness handicap inventory (DHI), neck disability index (NDI), UCS mobility, and PPTs were measured. Measurements were made at the baseline, first follow-up 48 h after intervention and second follow-up 1 month after the intervention. Results: at second follow-up wVAS (p < 0.001), NDI (p < 0.001), DHI (p < 0.001), and upper right trapezius (p < 0.022) and right suboccipital (p < 0.043) PPTs showed a difference between groups in favor of the experimental group. Conclusions: apparently, the proposed intervention protocol decreases the intensity of dizziness and the mechanosensitivity of the cervical tissue and improves the feeling of disability due to neck pain and dizziness.
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14
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Chinese Herbal Medicine for Cervicogenic Dizziness: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2425851. [PMID: 35586689 PMCID: PMC9110151 DOI: 10.1155/2022/2425851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 01/18/2023]
Abstract
Background Chinese herbal medicines (CHMs) have been widely used in the treatment of cervicogenic dizziness (CGD) based on their empirical effectiveness and safety. Herein, we reviewed and evaluated the clinical evidence of the efficacy and safety of CHMs for CGD. Methods Among the relevant studies published in 11 electronic databases up to December 2021, only randomised controlled trials were included. Methodological quality was assessed using the revised Cochrane risk-of-bias tool for randomised trials, and the strength of evidence for the main outcomes was evaluated using the grading of recommendations assessment, development, and evaluation system. Results All 35 included randomised controlled trials with 3,862 participants were conducted with six types of modified CHM and four types of active controls. More than half of the included studies were of low quality because of the high risk of bias due to deviations from intended interventions. CHM plus active control was more effective in the treatment of CGD than active control alone. CHM plus anti-vertigo drugs, CHM plus manual therapy, CHM plus acupuncture therapy, and CHM plus manual and acupuncture therapy were all effective in treating CGD, with CHM plus manual and acupuncture therapy showing the most reliable effect. All CHMs were effective for specific patterns of CGD when administered with active controls, with Dingxuan Tang and Yiqi Congming Tang demonstrating the most reliable effects. No serious adverse events were reported in any of the included studies. Conclusion The current evidence suggests that CHM may enhance the treatment of CGD when combined with other treatments without serious adverse events. Further high-quality evidence is needed to draw definitive conclusions.
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Knapstad MK, Ask T, Skouen JS, Goplen FK, Nordahl SHG. Prevalence and consequences of concurrent dizziness on disability and quality of life in patients with long-lasting neck pain. Physiother Theory Pract 2022; 39:1266-1273. [DOI: 10.1080/09593985.2022.2034077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mari K. Knapstad
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tove Ask
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Physical Therapy, Haukeland University Hospital, Bergen, Norway
| | - Jan S. Skouen
- Department of Physical Medicine and Rehabilitation, Outpatient Spine Clinic, Haukeland University Hospital, Rådal, Norway
| | - Frederik K. Goplen
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Stein Helge G. Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Yuan H, Ye F, Zhou Q, Feng X, Zheng L, You T, Cao R, Feng D. The Relationship between Atypical Symptoms of Degenerative Cervical Myelopathy and the Segments of Spinal Cord Compression: A Retrospective Observational Study. World Neurosurg 2022; 161:e154-e161. [PMID: 35092814 DOI: 10.1016/j.wneu.2022.01.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with degenerative cervical myelopathy(DCM) often present with atypical symptoms such as vertigo, headache, palpitations, tinnitus, blurred vision, memory loss and abdominal discomfort. This study aims to investigate the relationship between atypical symptoms of DCM and the segments of spinal cord compression. METHODS 166 DCM patients with atypical symptoms admitted to our institution from 2019 to 2020 were divided into vertigo, headache, blurred vision, tinnitus and palpitations groups according to their atypical symptoms; while the typical group was 214 DCM patients with typical symptoms only. Differences in segments of compression were compared between each group. And the results of over one-year follow-up were further summarized for non-surgical and surgical treatment of DCM patients with atypical symptoms. RESULT The incidence of vertigo, headache, blurred vision, tinnitus and palpitations of all DCM patients was 37%, 18%, 15%, 11% and 11% respectively. Compared to the typical group, patients in the blurred vision and tinnitus group were older (P < 0.05) and the incidence of spinal cord compression at C3-5 in the vertigo group, C4-5 in the headache group and C6-7 in the palpitation group was higher (P < 0.05). The scores of vertigo, headache and palpitations decreased after surgical decompression (P < 0.05), whereas only vertigo and headache scores decreased after non-surgical treatment (P < 0.05). CONCLUSION Atypical symptoms were common in patients with DCM and the segments of spinal cord compression might be associated with specific atypical symptoms. Surgical treatment is effective in relieving some of the atypical symptoms.
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Affiliation(s)
- Hao Yuan
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China
| | - Fei Ye
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China
| | - Qinzhong Zhou
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China
| | - Xiaolan Feng
- Department of Imaging, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan province, China
| | - Lipeng Zheng
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China
| | - Ting You
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China
| | - Renping Cao
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China
| | - Daxiong Feng
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China.
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Eğilmez O, Beyaz S, Yilmaz M, Demir G, Kocayiğit H. Effectiveness of ozone-oxygen mixture by ultrasonography-guided facet medial branch block in the treatment of cervicogenic dizziness. INDIAN JOURNAL OF OTOLOGY 2022. [DOI: 10.4103/indianjotol.indianjotol_179_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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18
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Tardov M, Boldin A, Razumov A. Cervicogenic vertigo. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:50-56. [DOI: 10.17116/jnevro202212212150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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He LL, Lai RJ, Leff J, Yuan R, Yue JN, Ni JX, Yang LQ. Cervicogenic dizziness alleviation after coblation discoplasty: a retrospective study. Ann Med 2021; 53:639-646. [PMID: 33855907 PMCID: PMC8057077 DOI: 10.1080/07853890.2021.1910336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Little is known about the therapeutic relationship between coblation discoplasty and cervicogenic dizziness (CGD). CGD can be caused by abnormal proprioceptive inputs from compressed nerve roots, intradiscal mechanoreceptors and nociceptors to the vestibulospinal nucleus in the degenerative cervical disc. The aim was to analyze the efficacy of coblation discoplasty in CGD through intradiscal nerve ablation and disc decompression in a 12-month follow-up retrospective study. METHODS From 2015 to 2019, 42 CGD patients who received coblation discolplasty were recruited as the surgery group, and 22 CGD patients who rejected surgery were recruited as the conservative group. Using intent-to-treat (ITT) analysis, we retrospectively analyzed the CGD visual analogue scale (VAS), neck pain VAS, CGD frequency score, and the CGD alleviation rating throughout a 12-month follow-up period. RESULTS Compared with conservative intervention, coblation discoplasty revealed a better recovery trend with effect sizes of 1.76, 2.15, 0.92, 0.78 and 0.81 in CGD VAS, and effect sizes of 1.32, 1.54, 0.93, 0.86 and 0.76in neck pain VAS at post-operative 1 week, and 1, 3, 6, 12 months, respectively. The lower CGD frequency score indicated fewer attacks of dizziness until postoperative 3 months (p < 0.01). At post-operative 12 months, the coblation procedure showed increased satisfactory outcomes of CGD alleviation rating (p < .001, -1.00 of effect size). CONCLUSIONS Coblation discoplasty significantly improves the severity and frequency of CGD, which is important inbridging unresponsive conservative intervention and open surgery.Key messagesThere is a correlation between the degenerative cervical disc and cervicogenic dizziness (CGD).CGD can be caused by abnormal proprioceptive inputs from a compressed nerve root and intradiscal mechanoreceptors and nociceptors to the vestibulospinal nucleus in the degenerative cervical disc.Cervical coblation discoplasty can alleviate CGD through ablating intradiscal nerve endings and decompressing the nerve root.
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Affiliation(s)
- Liang-liang He
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ru-jing Lai
- Department of Anesthesiology, Longyan First Hospital, Affiliated to Fujian Medical University, Longyan City, Fujian, China
| | | | - Rong Yuan
- Ultrasonic Diagnosis Department, North District of Peking University Third Hospital, Beijing, China
| | - Jian-ning Yue
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jia-xiang Ni
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li-qiang Yang
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China
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Harman SC, Zheng Z, Kendall JC, Vindigni D, Polus BI. Does My Neck Make Me Clumsy? A Systematic Review of Clinical and Neurophysiological Studies in Humans. FRONTIERS IN PAIN RESEARCH 2021; 2:756771. [PMID: 35295476 PMCID: PMC8915649 DOI: 10.3389/fpain.2021.756771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction: Clumsiness has been described as a symptom associated with neck pain and injury. However, the actuality of this symptom in clinical practice is unclear. The aim of this investigation was to collect definitions and frequency of reports of clumsiness in clinical studies of neck pain/injury, identify objective measures of clumsiness and investigate the association between the neck and objective measures of clumsiness. Methods: Six electronic databases were systematically searched, records identified and assessed including a risk of bias. Heterogeneity in designs of studies prevented pooling of data, so qualitative analysis was undertaken. Results: Eighteen studies were retrieved and assessed; the overall quality of evidence was moderate to high. Eight were prospective cross-sectional studies comparing upper limb sensorimotor task performance and ten were case series involving a healthy cohort only. Clumsiness was defined as a deficit in coordination or impairment of upper limb kinesthesia. All but one of 18 studies found a deterioration in performing upper limb kinesthetic tasks including a healthy cohort where participants were exposed to a natural neck intervention that required the neck to function toward extreme limits. Conclusion: Alterations in neck sensory input occurring as a result of requiring the neck to operate near the end of its functional range in healthy people and in patients with neck pain/injury are associated with reductions in acuity of upper limb kinesthetic sense and deterioration in sensorimotor performance. Understanding the association between the neck and decreased accuracy of upper limb kinesthetic tasks provide pathways for treatment and rehabilitation strategies in managing clumsiness.
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Affiliation(s)
- Samantha C. Harman
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, Melbourne, VIC, Australia
| | - Zhen Zheng
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, Melbourne, VIC, Australia
| | - Julie C. Kendall
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, Melbourne, VIC, Australia
| | - Dein Vindigni
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, Melbourne, VIC, Australia
| | - Barbara I. Polus
- School of Engineering, Royal Melbourne Institute of Technology University, Melbourne, VIC, Australia
- *Correspondence: Barbara I. Polus
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Liu P, Ma S, Du G, Sun S, Zhang X, Tang P, Hou C, Liu Y, Zhao J, Zhang X, Chen L, Gu C, Zhang L, Chong L, Yang X, Li R. Changing Paradigm for Vertigo/Dizziness Patients: a Retrospective Before-After Study from Tertiary Hospitals in Northwestern China. J Gen Intern Med 2021; 36:3064-3070. [PMID: 33501533 PMCID: PMC8481407 DOI: 10.1007/s11606-020-06475-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Single disciplinary management of patients with vertigo and dizziness is an important challenge for most physicians in China. OBJECTIVE To assess the impact of a new paradigm of practice (Clinic for Vertigo and Dizziness, CVD) performed by a multidisciplinary team (MDT) on diagnostic spectrum, medical costs, and patient satisfaction. DESIGN Retrospective before-after study. PARTICIPANTS Sample of 29,793 patients with vertigo/dizziness as primary complaint. MEASURES Changes in diagnostic spectrum, medical costs, and patient satisfaction before and after the establishment of a CVD based on a 4-year database in three tertiary hospitals in northwestern China. KEY RESULTS The most common diagnoses of patients with vertigo and dizziness were Meniere's disease (25.77%), cervical disease (25.00%), cerebral vascular disease (13.96%), vestibular syndrome (10.57%), and other etiologies (6.34%) before the CVD establishment. In contrast, after the CVD establishment, the most common diagnoses were BPPV (23.92%), vestibular migraine (15.83%), Meniere's disease (14.22%), CSD/PPPD (11.61%), and cerebral vascular diseases (4.45%). Extended implementation of a structured questionnaire for vertigo/dizziness and vestibular-oriented examinations (nystagmus, positional tests, HINTS) at the CVD resulted in a remarkable decline in the utility of CT/MRI and X-ray examination (p < 0.001). Meanwhile, medical costs in patients with vertigo/dizziness dropped by 11.5% (p < 0.001), with a significant improvement in patient satisfaction after the establishment of CVD (p < 0.001). CONCLUSIONS AND RELEVANCE Our study suggested that the MDT paradigm of CVD practice may facilitate the medical management of patients with vertigo/dizziness and improve patient satisfaction.
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Affiliation(s)
- Peng Liu
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Shaolin Ma
- Clinic for Vertigo and Dizziness, Xinyuan Hospital of Yulin, Yulin, 719000 Shaanxi People’s Republic of China
| | - Guixiang Du
- Clinic for Vertigo and Dizziness, The First Municipal Hospital of Weinan, Weinan, 714000 Shaanxi People’s Republic of China
| | - Shengde Sun
- Otorhinolaryngology Head and Neck Surgery, Wuwei People’s Hospital, Wuwei, 733000 Gansu People’s Republic of China
| | - Xin Zhang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Peng Tang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Chen Hou
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Yue Liu
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Jiaxing Zhao
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Xiaohui Zhang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Li Chen
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Chaochao Gu
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Lina Zhang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Li Chong
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Aerospace Clinical Medical College of Peking University, Beijing, 100049 People’s Republic of China
| | - Rui Li
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
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22
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Liu TH, Liu YQ, Peng BG. Cervical intervertebral disc degeneration and dizziness. World J Clin Cases 2021; 9:2146-2152. [PMID: 33850933 PMCID: PMC8017505 DOI: 10.12998/wjcc.v9.i9.2146] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
Clinical studies have found that patients withcervical degenerative disease are usually accompanied by dizziness. Anterior cervical surgery can eliminate not only chronic neck pain, cervical radiculopathy or myelopathy, but also dizziness. Immunohistochemical studies show that a large number of mechanoreceptors, especially Ruffini corpuscles, are present in degenerated cervical discs. The available evidence suggests a key role of Ruffini corpuscles in the pathogenesis of dizziness caused by cervical degenerative disease (i.e. cervical discogenic dizziness). Disc degeneration is characterized by an elevation of inflammatory cytokines, which stimulates the mechanoreceptors in degenerated discs and results in peripheral sensitization. Abnormal cervical proprioceptive inputs from the mechanoreceptors are transmitted to the central nervous system, resulting in sensory mismatches with vestibular and visual information and leads to dizziness. In addition, neck pain caused by cervical disc degeneration can play a key role in cervical discogenic dizziness by increasing the sensitivity of muscle spindles. Like cervical discogenic pain, the diagnosis of cervical discogenic dizziness can be challenging and can be made only after other potential causes of dizziness have been ruled out. Conservative treatment is effective for the majority of patients. Existing basic and clinical studies have shown that cervical intervertebral disc degeneration can lead to dizziness.
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Affiliation(s)
- Tang-Hua Liu
- Department of Algology, The Third People's Hospital of Yibin, Yibin 644000, Sichuan Province, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Bao-Gan Peng
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
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Carrasco-Uribarren A, Rodriguez-Sanz J, López-de-Celis C, Pérez-Guillen S, Tricás-Moreno JM, Cabanillas-Barea S. Short-term effects of the traction-manipulation protocol in dizziness intensity and disability in cervicogenic dizziness: a randomized controlled trial. Disabil Rehabil 2021; 44:3601-3609. [PMID: 33470861 DOI: 10.1080/09638288.2021.1872719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Analyse the short-term effects of traction-manipulation protocol in dizziness and pain intensity and disability, cervical mobility and postural instability. MATERIALS AND METHODS Randomized controlled assessor-blind clinical trial. The traction-manipulation protocol was carried out in the intervention group and compared with a control group where the subjects were kept supine. The intervention protocol follows the IFOMPT safety recommendations. Dizziness and pain intensity, Dizziness Handicap Inventory (DHI), cervical mobility and balance were measured after 48 h and a one-month follow-up. RESULTS Forty subjects with cervicogenic dizziness were randomly assigned to an intervention or control group. Significant differences were found in favour of the intervention protocol group in: dizziness intensity (p < 0.001; d = 1.31), DHI (p < 0.001; d = 0.76) pain intensity (p < 0.007; d = 0.92), upper cervical flexion (p < 0.032; d = 0.30) and extension (p < 0.012; d = 0.80) at 48 h follow up. At one-month follow up there were significant differences in favour of the intervention group in: dizziness intensity (p < 0.001; d = 0.95), DHI (p < 0.001; d = 0.0.92) pain intensity (p < 0.001; d = 1.38) and upper cervical extension (p < 0.005; d = 0.92). Postural instability improved in mediolateral displacement static with eyes closed (p < 0.032; d = 0.79) and in dynamic with eyes open (p = 0.003; d = 0.55) at one-month follow-up in the intervention group. CONCLUSION The traction-manipulation protocol reduces the dizziness and pain intensity, ameliorates disability and improves upper cervical mobility and postural instability.IMPLICATIONS FOR REHABILITATIONThe intervention protocol reduces the dizziness and pain intensity, and improves self-perceived disability in patients with cervicogenic dizziness.Manual therapy improves the cervical range of motion and the postural instability in the cervicogenic dizziness.The intervention protocol follows the safety recommendations of the International Federation of Orthopaedic Manipulative Physical Therapists.
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Affiliation(s)
| | - Jacobo Rodriguez-Sanz
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
| | - Carles López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain.,Fundació Institut Universitari per a La Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Silvia Pérez-Guillen
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
| | | | - Sara Cabanillas-Barea
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
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Peng B, Yang L, Li Y, Liu T, Liu Y. Cervical Proprioception Impairment in Neck Pain-Pathophysiology, Clinical Evaluation, and Management: A Narrative Review. Pain Ther 2021; 10:143-164. [PMID: 33464539 PMCID: PMC8119582 DOI: 10.1007/s40122-020-00230-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/16/2020] [Indexed: 12/16/2022] Open
Abstract
Neck pain is very common, but most of the causes are unknown, making diagnosis and treatment extremely challenging. Current studies have found that one of the main problems in patients with neck pain is the impairment of cervical proprioception, which subsequently leads to cervical sensorimotor control disturbances. Cervical spine has a very delicate proprioceptive system that plays a crucial role in controlling posture and balance. Cervical proprioceptive impairment in neck pain occurs through a variety of mechanisms. Experimental neck muscle pain induced by injection of hypertonic saline results in inhibition of the activation of painful muscle; chronic neck pain causes structural and functional impairment of cervical muscles; excessive activation of mechanoreceptors in degenerative cervical discs and facet joints produces a large number of erroneous sensory signals. Clinical examinations to assess the link between structural pathology and neck pain have been unsuccessful, opening the way for the development of function-based tests. To date, eight neck sensorimotor control tests have been reported to evaluate patients with chronic neck pain. Although some tests may involve different subsystems (such as oculomotor system and vestibular system), all tests measure sensorimotor control in the neck, and the most commonly used is cervical joint position error (JPE) test. Current studies support the effectiveness of exercises targeting different aspects of sensorimotor function, in particular retraining aimed at improving cervical proprioception and muscle coordination. Based on the available evidence, it is recommended that patients with neck pain should be assessed and managed for cervical proprioceptive impairment and sensorimotor control disturbances.
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Affiliation(s)
- Baogan Peng
- Department of Spinal Surgery, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing, China.
| | - Liang Yang
- Department of Spinal Surgery, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Yongchao Li
- Department of Spinal Surgery, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Tanghua Liu
- Department of Algology, Lizhuang Tongji Hospital, Yibin, Sichuan, China
| | - Yanqing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Oh H, Shin S, Lee E. Herbal medicine for cervicogenic dizziness: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23852. [PMID: 33371169 PMCID: PMC7748346 DOI: 10.1097/md.0000000000023852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Herbal medicines are empirically used to treat cervicogenic dizziness. However, till date there have been no systematic review to evaluate the efficacy and safety of these medicines. Therefore, this study protocol describes the methods for evaluating the efficacy and safety of herbal medicine for cervicogenic dizziness. METHODS AND ANALYSIS The following electronic academic databases will be searched up to December 2019 without language or publication status restrictions: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), and the Cochrane Central Register of Controlled Trials (CENTRAL), together with Korean, Chinese, and Japanese databases. Any randomized controlled trials related to herbal medicine for cervicogenic dizziness will be included. The functional outcomes and the vertebrobasilar artery hemodynamic states will be evaluated as primary outcomes. The total effective rate, hematological conditions, and adverse events will be assessed as secondary outcomes. Study selection, data extraction, quality assessment of studies, and qualitative evaluation of clinical evidence will be performed by 2 independent reviewers. The methodological quality of the included studies will be evaluated using a revised Cochrane risk-of-bias tool for randomized trials. The strength of evidence from the included data will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Data synthesis will be performed as either a fixed-effects or a random-effects model using Review Manager software version 5.3. The results will be reported as a risk ratio for dichotomous outcomes and as a mean difference or standardized mean difference for continuous outcomes. ETHICS AND DISSEMINATION No ethical approval is required since the individual clinical information of the patient is not used. The findings of this systematic review will be disseminated through the peer-reviewed publications or conference presentations. REVIEW REGISTRY UNIQUE IDENTIFYING NUMBER reviewregistry1036.
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Affiliation(s)
- Hyunjoo Oh
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Seungwon Shin
- National Agency for Development of Innovative Technologies in Korean Medicine, National Development Institute of Korean Medicine, Seoul, Republic of Korea, Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Euiju Lee
- Department of Sasang Constitutional Medicine, College of Korean Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
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26
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Yang TH, Xirasagar S, Cheng YF, Kuo NW, Lin HC. Association of Cervical Spondylosis With Peripheral Vertigo: A Case-Control Study. Laryngoscope 2020; 131:E625-E630. [PMID: 32396217 DOI: 10.1002/lary.28715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to assess the association of prior cervical spondylosis (CS) with peripheral vertigo. STUDY DESIGN Case-control study. METHODS Data were retrieved from the Taiwan Longitudinal Health Insurance Database. A total of 2,570 patients who were newly diagnosed with peripheral vertigo were identified. We compared them with a 3:1 ratio of propensity score-matched patients, 7,710 comparison patients from the same dataset. We performed multivariate logistic regressions to estimate the odds ratio for prior CS occurrence among peripheral vertigo patients versus controls. RESULTS Of 10,280 sample patients, 1,739 (16.92%) patients had CS prior to the index date. A significant difference in prior CS between peripheral vertigo patients and controls (19.49% vs. 16.06%, P < .001) was observed. Logistic regression analysis shows that the odds of prior CS was 1.285 for peripheral vertigo patients versus controls (95% confidence interval [CI]: 1.143-1.446) after adjusting for age, sex, urbanization level, monthly income, geographic region, hyperlipidemia, diabetes, coronary heart disease, hypertension, and asthma. Prior CS with myelopathy was not associated with peripheral vertigo. Stratified analysis by age showed that the odds of CS were highest among patients with peripheral vertigo in the 45- to 64-year-old age group (1.442, 95% CI: 1.215-1.712). CONCLUSIONS CS is associated with subsequent peripheral vertigo in the Taiwan population, with higher risk among those aged 45 to 64 years. LEVEL OF EVIDENCE 2b Laryngoscope, 131:E625-E630, 2021.
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Affiliation(s)
- Tzong-Hann Yang
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan.,Department of Speech, Language, and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan.,Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, U.S.A
| | - Yen-Fu Cheng
- Department of Speech, Language, and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan.,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nai-Wen Kuo
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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27
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Hoppes CW, Romanello AJ, Gaudette KE, Herron WK, McCarthy AE, McHale CJ, Bares J, Turner R, Whitney SL. Physical therapy interventions for cervicogenic dizziness in a military-aged population: protocol for a systematic review. Syst Rev 2020; 9:62. [PMID: 32293544 PMCID: PMC7087372 DOI: 10.1186/s13643-020-01335-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic cervicogenic dizziness is dizziness that is temporally associated with neck pain and injury after other causes of dizziness have been excluded. It can lead to activity limitations and participation restrictions that may include lost duty or work days. The objective of this systematic review is to determine which interventions are most effective in decreasing dizziness or vertigo and neck pain in military-aged adults with traumatic cervicogenic dizziness. METHODS The literature will be systematically searched using the following online databases: MEDLINE, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, CENTRAL, Cochrane Methodology Register), CINAHL, SCOPUS, Web of Science, and J-STAGE. The review will include randomized controlled trials (RCTs), including cluster RCTs and controlled (non-randomized) clinical trials or cluster trials, and observational studies (including prospective and retrospective comparative cohort and case-control or nested case-control studies) and determine the effectiveness of physical therapy interventions for the treatment of traumatic cervicogenic dizziness in military-aged adults. Assessment of methodological quality will be performed by two independent, blinded reviewers using the PEDro scale. The level of evidence will be determined using the GRADE scale. The primary outcome measures will be change in dizziness and neck pain and disability from baseline to the last available follow-up, measured using the Dizziness Handicap Inventory and Neck Disability Index. Other relevant outcome measures will include self-reported change in symptoms, time to return to duty or work, and quality of life. DISCUSSION This systematic review will identify, evaluate, and integrate the evidence on the effectiveness of physical therapy interventions for cervicogenic dizziness in a military-aged population. We anticipate our findings may inform individual treatment and future research. Clinical recommendations generated from this systematic review may inform military physical therapy treatment of individuals with cervicogenic dizziness. SYSTEMATIC REVIEW REGISTRATION In accordance with the guidelines, our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 21 January 2020 (registration number CRD42020150853). In the event of protocol amendments, the date of each amendment will be accompanied by a description of the change and the rationale.
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Affiliation(s)
- Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX, 78234, USA.
| | - Anthony J Romanello
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX, 78234, USA
| | - Kathryn E Gaudette
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX, 78234, USA
| | - William K Herron
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX, 78234, USA
| | - Anne E McCarthy
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX, 78234, USA
| | - Catherine J McHale
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX, 78234, USA
| | - Joan Bares
- Stimson Library, U.S. Army Medical Center of Excellence, Joint Base San Antonio-Fort Sam Houston, TX, USA
| | - Rose Turner
- Falk Library, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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Yi YY, Xu HW, Zhang SB, Hu T, Wang SJ, Wu DS. Does the C3/4 disc play a role in cervical spondylosis with dizziness? A retrospective study. INTERNATIONAL ORTHOPAEDICS 2020; 44:1159-1168. [PMID: 32193610 DOI: 10.1007/s00264-020-04531-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/04/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate the effect of C3/4 disc degeneration on cervical spondylosis with dizziness (CSD) and to assess the curative effect of anterior cervical decompression and fusion (ACDF) in patients with CSD. METHOD Four hundred nineteen patients who underwent ACDF for treatment of myelopathy or radiculopathy were divided into dizziness and non-dizziness group. The visual analog scale (VAS) score and Japanese Orthopaedic Association (JOA) score were used to determine the intensity of dizziness and neurological symptoms, respectively. Cervical disc degeneration was evaluated using Miyazaki's classification system. Some parameters were measured using cervical radiographs. The surgical effects on CSD were compared between surgery with and without C3/4 level. Multivariate logistic regression analysis was used to determine the risk factors for CSD. RESULTS The pre-operative incidence of CSD was 33.9%. Women were more likely to develop dizziness than men (p < 0.05), CSD was significantly associated with C3/4 disc degeneration (69.7%, p < 0.001), and smokers were more subject to dizziness (p < 0.05). Regression analysis showed that female (OR = 1.611, p = 0.031), smoking (OR = 1.719, p = 0.032), Miyazaki grade of C3/4 ≥ IV (OR = 2.648, p < 0.001), and instability on C3/4 (OR = 1.672, p = 0.024) were risk factors for CSD. Treatment of CSD by ACDF involving C3/4 was more effective than not involving C3/4 (efficacy rate, 73.2% vs 51.7%, p < 0.05). CONCLUSION The CSD is a common clinical manifestation in elderly patients, especially patients with cervical spondylosis at the C3/4 level. Female, smoking, instability on C3/4, and C3/4 Miyazaki grade ≥ IV could be considered significant risk factors for CSD. CSD is more likely to be alleviated by ACDF involving C3/4.
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Affiliation(s)
- Yu-Yang Yi
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hao-Wei Xu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shu-Bao Zhang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Hu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shan-Jin Wang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - De-Sheng Wu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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29
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Chu ECP, Chin WL, Bhaumik A. Cervicogenic dizziness. Oxf Med Case Reports 2019; 2019:476-478. [PMID: 31844531 DOI: 10.1093/omcr/omz115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/23/2019] [Accepted: 10/06/2019] [Indexed: 12/20/2022] Open
Abstract
Cervical muscles have numerous connections with vestibular, visual and higher centres, and their interactions can produce effective proprioceptive input. Dysfunction of the cervical proprioception because of various neck problems can alter orientation in space and cause a sensation of disequilibrium. Cervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain in patients with cervical pathology. Here, we report a 24-year-old female, who was diagnosed with CGD based on the correlating episodes of neck pain and dizziness. Both symptoms improved with targeted chiropractic adjustment and ultrasound therapy. CGD is a seemingly simple complaint for patients, but tends to be a controversial diagnosis because there are no specific tests to confirm its causality. For CGD to be considered, an appropriate management for the neck pain should not be denied any patient.
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Affiliation(s)
- Eric Chun Pu Chu
- New York Chiropractic & Physiotherapy Center, New York Medical Group, Hong Kong, China
| | - Wui Ling Chin
- New York Chiropractic & Physiotherapy Center, New York Medical Group, Hong Kong, China
| | - Amiya Bhaumik
- Department of Health Science, Lincoln University College, Selangor Darul Ehsan, Malaysia
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30
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Knapstad MK, Nordahl SHG, Skouen JS, Ask T, Goplen FK. Neck pain associated with clinical symptoms in dizzy patients-A cross-sectional study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1815. [PMID: 31814286 DOI: 10.1002/pri.1815] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/08/2019] [Accepted: 10/03/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Many patients suffer from concurrent neck pain and dizziness. The aim of this study was to describe the clinical symptoms and physical findings in patients with concurrent neck pain and dizziness and to examine whether they differ from patients with dizziness alone. METHODS Consecutive patients with dizziness and neck pain were recruited from an ear-nose-throat department and a spine clinic. They were divided into three groups: patients with dizziness only (n = 100), patients with dizziness as their primary complaint and additional neck pain (n = 138) and finally, patients with neck pain as their primary complaint accompanied by additional dizziness (n = 55). The patients filled in questionnaires regarding their symptom quality, time-course, triggers of dizziness and the Vertigo Symptom Scale Short Form. The physical examination included Cervical Range of Motion, American College of Rheumatology (ACR) Tender Points, Cervical Pressure Pain Thresholds and Global Physiotherapy Examination 52-Flexibility. RESULTS Both neck pain groups were more likely to have a gradual onset of dizziness symptoms, more light-headedness, visual disturbances, autonomic/anxiety symptoms, decreased cervical range of motion, decreased neck and shoulder flexibility and increased number of ACR tender points compared with patients with dizziness alone. The group having dizziness as their primary complaint and also reporting neck pain had the highest symptom severity and tended to report rocking vertigo and increased neck tenderness. The group with neck pain as their primary complaint was more likely to report headache. CONCLUSION Neck pain is associated with certain dizziness characteristics, increased severity of dizziness and increased physical impairment when compared with dizzy patients without neck pain.
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Affiliation(s)
- Mari Kalland Knapstad
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Stein Helge Glad Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, The Outpatient Spine Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tove Ask
- Department of Physical Therapy, The Outpatient Spine Clinic, Haukeland University Hospital, Bergen, Norway
| | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Knapstad MK, Goplen FK, Ask T, Skouen JS, Nordahl SHG. Associations between pressure pain threshold in the neck and postural control in patients with dizziness or neck pain - a cross-sectional study. BMC Musculoskelet Disord 2019; 20:528. [PMID: 31707980 PMCID: PMC6844061 DOI: 10.1186/s12891-019-2922-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND It is theorized that neck pain may cause reduced postural control due to the known physiological connection between the receptors in the cervical spine and the vestibular system. The purpose of this study was to examine whether the pressure pain threshold in the neck is associated with postural sway in patients with dizziness or neck pain. METHODS Consecutive patients with dizziness (n = 243) and neck pain (n = 129) were recruited from an otorhinolaryngological department and an outpatient spine clinic, respectively. All subjects underwent static posturography. Pressure pain thresholds were measured at four standardized points in the neck, and generalized pain was assessed using the American College of Rheumatology tender points. The relationship between postural sway and pressure pain threshold was analyzed by linear regression, and the covariates included age, sex, and generalized pain. RESULTS In the dizzy group, there was a small, inverse relationship between pressure pain thresholds and sway area with eyes closed, after adjusting for age, sex, and generalized pain (bare platform; lower neck, p = 0.002, R2 = 0.068; upper neck, p = 0.038, R2 = 0.047; foam rubber mat; lower neck, p = 0.014, R2 = 0.085). The same inverse relationship was found between pressure pain thresholds in the neck and the Romberg ratio on a bare platform after adjusting for age, sex and generalized pain (upper neck, p = 0.15, R2 = 0.053; lower neck, p = 0.002, R2 = 0.069). Neither of these relationships were present in the neck pain group. CONCLUSION Our findings indicate that the pressure pain threshold in the neck is associated with postural sway in patients suffering from dizziness after adjusting for age, sex, and generalized pain, but only with closed eyes. The association was small and should be interpreted with caution. TRIAL REGISTRATION Trial registration: Clinicaltrial.gov NCT03531619. Retrospectively registered 22 May 2018.
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Affiliation(s)
- Mari K Knapstad
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology & Head and Neck Surgery, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Frederik K Goplen
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology & Head and Neck Surgery, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tove Ask
- Department of Physical Therapy, Haukeland University Hospital, Bergen, Norway
| | - Jan S Skouen
- Department of Physical Medicine and Rehabilitation, The Outpatient Spine Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stein Helge G Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology & Head and Neck Surgery, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Knapstad MK, Nordahl SHG, Goplen FK. Clinical characteristics in patients with cervicogenic dizziness: A systematic review. Health Sci Rep 2019; 2:e134. [PMID: 31624772 PMCID: PMC6784794 DOI: 10.1002/hsr2.134] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/24/2019] [Accepted: 06/19/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS Cervicogenic dizziness (CD) is a clinical syndrome of dizziness associated with neck dysfunction. CD represents a considerable diagnostic challenge since dizziness and neck pain are common symptoms with complex and multifactorial etiologies. Both research and clinical work on CD is limited by the lack of accepted diagnostic criteria. The aim of this study was to review clinical studies on CD and to assess current evidence regarding the clinical characteristics of this syndrome. METHODS A comprehensive PubMed and MEDLINE search was conducted from the date of inception of the database, with the last search conducted in September 2018. Included studies had to contain operable diagnostic criteria as well as a comparison between patients considered to have CD and a clinical comparison group. Data extracted were clinical outcomes, diagnostic criteria, age, sex, and sample size. Studies were assessed for methodological quality using the Crowe Critical Appraisal Tool. RESULTS Out of 2161 screened studies, eight studies comprising 225 patients met the inclusion criteria. Studies were of low to acceptable methodological quality. The most frequent and consistent clinical characteristic in patients classified as having CD, compared with other populations, was reduced posturographic stability. The most consistent diagnostic criteria were based on the concurrence of neck pain with dizziness after exclusion of other possible reasons for dizziness. CONCLUSION There are few studies examining clinical characteristics in patients with cervicogenic dizziness. Altered posturography appeared to be the only consistent characteristic used when distinguishing CD from other populations. Diagnostic criteria currently used in research are likely to have low specificity, since they rest on the exclusion of other causes rather than on positive distinctive features. More studies are needed to better understand the clinical interrelations between dizziness and neck pain.
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Affiliation(s)
- Mari Kalland Knapstad
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck SurgeryHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Stein Helge Glad Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck SurgeryHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck SurgeryHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
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Ferrer-Peña R, Vicente-de-Frutos G, Flandez-Santos D, Martín-Gómez C, Roncero-Jorge C, Calvo-Lobo C. Patient-reported outcomes measured with and without dizziness associated with non-specific chronic neck pain: implications for primary care. PeerJ 2019; 7:e7449. [PMID: 31410311 PMCID: PMC6689216 DOI: 10.7717/peerj.7449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/10/2019] [Indexed: 01/24/2023] Open
Abstract
Background The aim of this study was to compare health-related quality of life (HRQoL) and disability and fear of movement in patients with non-specific chronic neck pain (NSCNP) associated with dizziness with respect to patients with isolated NSCNP in primary care settings. Methods A cross-sectional study was carried out in a primary care center. A total of 120 patients were divided into two groups and analyzed in this study. One group of patients reported dizziness combined with NSCNP (n = 60), and the other reported no dizziness with their NSCNP (n = 60). Patient-reported outcome measurements were HRQoL (primary outcome) and disability and kinesiophobia (secondary outcomes) assessed by the EuroQoL Five Dimensions and Five Levels (EQ-5D-5L), neck disability index (NDI) and Tampa Scale of Kinesiophobia (TSK-11), respectively. Results Statistically significant differences (P < 0.05) for a 95% confidence interval (CI) with a large effect size (Cohen d) were found between both groups with greater values of disability (mean difference = 6.30 points; 95% CI [3.84-8.75]; d = 0.94) and kinesiophobia (mean difference = 8.36 points; 95% CI [6.07-10.65]; d = 1.33), and an impairment of HRQoL (mean difference = 16.16 points; 95% CI [11.09-21.23]; d = 1.16), for patients with NSCNP associated with dizziness with respect to patients with isolated NSCNP. Conclusions Patients with NSCNP in conjunction with dizziness present higher HRQoL impairment and higher disability and kinesiophobia compared to patients with isolated NSCNP.
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Affiliation(s)
- Raúl Ferrer-Peña
- Department of Physiotherapy, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Salud Entrevías, Gerencia de Atenciín Primaria, Fundación para la Investigación e Innovación Biomédica en Atención Primaria de la Comunidad de Madrid (FIIBAP), Servicio Madrileño de Salud, Madrid, Spain
| | - Gonzalo Vicente-de-Frutos
- Department of Physiotherapy, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Diego Flandez-Santos
- Department of Physiotherapy, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carlos Martín-Gómez
- Department of Physiotherapy, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carolina Roncero-Jorge
- Servicio de Hospitalización Médica, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - César Calvo-Lobo
- Institute of Biomedicine (IBIOMED), Nursing and Physical Therapy Department, Universidad de León, Ponferrada, León, España
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