Cervical Muscle Activity During Loaded Arm Lifts in Patients 10 Years Postsurgery for Cervical Disc Disease

Effects of an exercise program plus manual therapy in a patient with failed neck surgery syndrome: A case report

BACKGROUND

Patients who have undergone cervical surgery may present pain and dysfunction in the upper limb, which is often referred to as failed neck surgery syndrome. Little is known about the effects of an exercise program plus manual therapy in the treatment of prolonged neuropathic pain of the upper quadrant in a patient with failed neck surgery.

CASE DESCRIPTION

A 66-year-old woman consulted for neuropathic pain and dysfunction during grasping activities, as a result of failed neck surgery after 12 months. Clinical, functional, and electromyographic measurements were recorded at baseline and after treatment. The patient underwent a treatment for six weeks based on manual therapy for the upper limb and cervical spine and an exercise program for the scapular muscles, rotator cuff and wrist extensor muscles.

OUTCOMES

Positive clinically significant changes were observed in the Neuropathic Pain Questionnaire (DN4) (baseline = 7 points; post-treatment = 4 points), Neck Disability Index (NDI) (baseline = 36; post-treatment = 18 points), QuickDASH (baseline = 78; post- treatment = 32 points), Upper Limb Neurodynamic Test 1 (ULNT-1) (baseline = 75°; post- treatment = 42°) and grip strength (GS) (baseline = 23 kgf; post-treatment = to 32 kgf). Improvements in the surface electromyographic (sEMG) activity of the upper trapezius (UT), infraspinatus (IS) and radial wrist extensors (RWE) muscles also seemed to occur after treatment.

CONCLUSION

Treatment helped relieve neuropathic pain, decrease neck disability, and improve general upper limb function.

The Relationship of Ultrasound Measurements of Muscle Deformation With Torque and Electromyography During Isometric Contractions of the Cervical Extensor Muscles

OBJECTIVES

Speckle tracking analysis (STA) of ultrasound (US) images quantifies the longitudinal deformation of a region of muscle tissue to provide a mechanical measure of muscle activity. As the validity and reliability of this method has not yet been adequately assessed, the aim of this study was to determine the validity and reliability of STA in the dorsal neck muscles during isometric neck extension contractions.

METHODS

Twenty volunteers performed 3 repetitions of isometric neck extension in a dynamometer at 10%, 20%, 40%, 60%, and 80% of maximal voluntary torque while US and surface electromyography (EMG) data were recorded. Speckle tracking analysis was then used to calculate measurements of muscle deformation. The relationship among torque, muscle deformation (separate for each muscle and summed), and EMG was evaluated using linear regressions and Spearman's correlation coefficients. The reliability of EMG and muscle deformation was determined using intraclass correlation coefficients (ICCs).

RESULTS

Muscle deformation in 4 of the 5 muscles when examined separately and collectively was significantly related to torque (P < .05); however, the relationship was weak (r² = 0.03-0.18). In contrast, a strong linear relationship was observed between torque and EMG (P < .001, r² = 0.83). Poor to moderate reliability of muscle deformation measures (ICC: 0.02-0.69) was found compared with EMG, which was highly reliable (ICC: 0.67-0.90).

CONCLUSION

These results suggest that the validity of US STA measurements for isometric contractions of the dorsal neck muscles is questionable. Further investigation into this method is required before it can be used as a tool to measure muscle activity.

Effectiveness of rehabilitation after cervical disk surgery: a systematic review of controlled studies

Objectives:

To present a synopsis of evidence on the efficacy of rehabilitation after cervical disk surgery performed for neck pain and radiculopathy.

Data sources:

The databases of Medline, EMBASE, and Cochrane Central were searched for studies reporting effects of rehabilitation interventions in patients undergoing surgery due to cervical disk disease with pain and radicular syndrome, published before 31 August 2018.

Review methods:

Project was registered with PROSPERO database (number CRD42018085937). Randomized controlled trials that evaluated the efficacy of rehabilitation interventions versus other, sham, or no treatment were selected. The primary outcomes were disability and pain. Secondary outcomes were other measures assessing biological, psychological or social effect of rehabilitation. Two reviewers independently screened studies for eligibility, assessed risk of bias and extracted data. Evaluation of evidence was performed with the GRADE system.

Results:

Five papers were included in the review. The eligible studies were heterogeneous in intervention and outcome reporting. There are low- to very-low-quality evidence that some interventions (use of cervical collars after non-plated anterior cervical diskectomy an fusion, structured physiotherapy, and interactive patients’ education) provide some benefit within functioning, pain, and selected psychological variables in patients undergoing cervical disk surgery. Controlled trials addressing comprehensive interdisciplinary rehabilitation, multidisciplinary pain management, occupational therapy, psychotherapy, social and vocational interventions were not identified.

Conclusion:

There is insufficient evidence with few trials of low quality to allow any conclusion to be drawn about the effectiveness, harms, and general ineffectiveness of rehabilitation for people who have had cervical disk surgery for pain or radiculopathy.

The Effects of Forward Head Posture on Neck Extensor Muscle Thickness: An Ultrasonographic Study

OBJECTIVE

This study aimed to compare neck extensor muscle thickness, thickness changes, and strength between participants with forward head posture (FHP) and controls with normal head posture (NHP).

METHODS

Twenty college students with FHP (mean age 21.30 ± 2.36 years) and 20 students with NHP (mean age 21.85 ± 2.78 years) participated in this case-control study. The thickness of neck extensor muscles was measured at rest and at maximal voluntary isometric contraction (MVIC). In addition, the craniovertebral angle (CVA) was calculated. To compare thickness changes between the 2 groups and among 5 muscles, a 2-way repeated measures analysis of variance was applied. In addition, Pearson's correlation test was performed to investigate the relationship between neck extensor MVIC and CVA.

RESULTS

The FHP group demonstrated lower MVIC compared with the NHP group (P = .03). Semispinalis capitis showed the smallest thickness changes during neck extensor MVIC in FHP compared with the controls (P < .001). However, no significant difference in terms of muscle thickness was observed between the 2 groups at the state of rest (P = .16-.99). A positive association was also found between the MVIC and CVA (P = .02).

CONCLUSIONS

Semispinalis capitis had less thickness changes during MVIC of neck extensors in individuals with FHP compared with those with NHP. This indirectly implies lower activity of this muscle in FHP condition. This study finding may help researchers develop therapeutic exercise protocols to manage FHP.

Musculoskeletal diagnostic ultrasound imaging for thickness measurement of four principal muscles of the cervical spine -a reliability and agreement study

BACKGROUND

The reliability of musculoskeletal diagnostic ultrasound imaging (MSK-DUSI) for the evaluation of neck musculature has been sparsely documented in the research literature. Until now, research has featured a limited number of subjects and only few studies have tested for both inter- and intra-reliability using appropriate methodology.

METHODS

Four examiners conducted an inter- and intra-rater reliability and agreement study. Fifty females with and without neck pain (NP) between the ages of 20-70 were recruited from October 2014 to April 2015. The muscles that were evaluated were the longus colli (Lcol), the rectus capitis posterior major (Rcpm), the deep cervical extensors (Dce) and the semispinalis capitis (Sscap). Each of the examiners captured ultrasound images of their allocated muscle and measured the thickness of that muscle twice, on separate occasions, for the first part of the intra-rater reliability study. For the second part, a second image of the same muscle was taken on the same subject and measured by the same examiner. The four examiners then met to measure on each other's images, to test inter-rater reliability. Their results were compared pair-wise using Interclass Correlation Coefficients (ICC) and Bland-Altman plots. Linear regression analysis was performed to evaluate for possible bias.

RESULTS

Inter-rater reliability was found to be good for Lcol and Sscap muscles and moderate towards poor for the deeper Rcpm and Dce muscles. Intra-rater reliability was good for all the muscles, with the exception of the Dce, which was found to be moderate in the second part of the study. The B&A plots showed good agreement, few outliers, and no bias. However, the agreement intervals indicated a measurement error within the variance of the method that may not have been acceptable for these small muscles if the aim is to evaluate change in thickness.

CONCLUSIONS

This study found that MSK-DUSI had variable reliability in assessing the thickness of the Lcol, Rcpm, Dce, and Sscap muscles. No bias was demonstrated, but agreement intervals were wide.

Differential Activation of the Dorsal Neck Muscles During a Light Arm-Elevation Task in Patients With Chronic Nonspecific Neck Pain and Asymptomatic Controls: An Ultrasonographic Study

BACKGROUND

Disturbance in neck muscle function is a well-known complication of chronic nonspecific neck pain (CNNP). It is, however, unclear which muscles are more susceptible to functional impairment in patients with CNNP during upper limb tasks.

OBJECTIVES

To compare ultrasonographic changes in dorsal neck muscles thickness in patients with CNNP and asymptomatic controls while they performed a light load upper-limb movement.

DESIGN

Case control.

SETTING

University research laboratory.

PARTICIPANTS

Twenty individuals with CNNP with a mean age of 23.35 ± 2.94 and 20 asymptomatic controls with a mean age of 22.30 ± 2.86, without any history of cervical diskopathy, fracture, trauma, inflammation, and spinal deformity were recruited for this study.

METHODS

Ultrasonographic measurement of dorsal neck muscles thickness was performed during a light load 3-second arm-elevation task (shoulder scaption to 120°) in the 2 groups. Associations between pain intensity and patients' perceived disability and between pain intensity and muscle thickness also were evaluated at the state of rest.

MAIN OUTCOME MEASUREMENTS

The thickness changes of the dorsal neck muscles throughout the arm elevation were calculated. The pain intensity and the patient's perceived disability also were measured.

RESULTS

A significant main effect of muscle activity status was revealed for the multifidus and semispinalis cervicis and the splenius capitis, indicating an increase in their thickness throughout the arm elevation (P < .001). The only muscle that showed a difference between groups was the multifidus (P = .007). Direct associations between pain and disability (r = .48, P = .03) and between pain and multifidus thickness (r = -.49, P = .03) also were observed.

CONCLUSION

The deteriorating effect of CNNP on the neck muscles targets the deep layer of the dorsal neck muscles (ie, the multifidus) more than the superficial muscles during light upper-limb tasks.

LEVEL OF EVIDENCE

III.

Function in patients with cervical radiculopathy or chronic whiplash-associated disorders compared with healthy volunteers

OBJECTIVE

The purposes of this study were to examine whether any differences in function and health exist between patients with cervical radiculopathy (CR) due to disk disease scheduled for surgery and patients with chronic whiplash-associated disorders (WADs) and to compare measures of patients' physical function with those obtained from healthy volunteers.

METHODS

This is a cross-sectional study of patients with CR (n = 198) and patients with chronic WAD (n = 215). Patient data were compared with raw data previously obtained from healthy people. Physical measures included cervical active range of motion, neck muscle endurance, and hand grip strength. Self-rated measures included pain intensity (visual analog scale), neck disability (Neck Disability Index), self-efficacy (Self-Efficacy Scale), and health-related quality of life (EuroQol 5-dimensional self-classifier).

RESULTS

Patient groups exhibited significantly lower performance than the healthy group in all physical measures (P < .0005) except for neck muscle endurance in flexion for women (P > .09). There was a general trend toward worse results in the CR group than the WAD group, with significant differences in neck active range of motion, left hand strength for women, pain intensity, Neck Disability Index, EuroQol 5-dimensional self-classifier, and Self-Efficacy Scale (P < .0001).

CONCLUSIONS

Patients had worse values than healthy individuals in almost all physical measures. There was a trend toward worse results for CR than WAD patients.