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Arabzadeh S, Kamali F, Bervis S, Razeghi M. The hip joint mobilization with movement technique improves muscle activity, postural stability, functional and dynamic balance in hemiplegia secondary to chronic stroke: a blinded randomized controlled trial. BMC Neurol 2023; 23:262. [PMID: 37434123 DOI: 10.1186/s12883-023-03315-2] [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: 02/19/2023] [Accepted: 07/03/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND People with stroke generally experience abnormal muscle activity and develop balance disorder. Based on the important role of the proximal joints of the lower extremity in balance maintenance, hip joint mobilization with movement technique can be applied to enhance normal joint arthrokinematics. Therefore, the present study aimed to investigate the effectiveness of hip joint mobilization with movement technique on stroke patients' muscle activity and balance. METHODS Twenty patients aged between 35 and 65 years old with chronic stroke were randomly assigned either to an experimental group (n = 10) or to a control group (n = 10). Both groups participated in a 30-minute conventional physiotherapy session 3 times per week for 4 weeks. The experimental group received an additional 30-minute's session of hip joint mobilization with movement technique on the affected limb. The muscle activity, berg balance scale, time up and go, and postural stability were measured at baseline, 1-day and 2-week follow-up by a blinded assessor. RESULTS The experimental group showed a significant improvement in berg balance scale, time up and go, and postural stability (p ≤ 0.05). The rectus femoris, tibialis anterior, biceps femoris, and medial gastrocnemius muscles' activations of the affected limb during static balance test markedly changed along with the biceps femoris, erector spine, rectus femoris, and tibialis anterior muscles during dynamic balance test after hip joint mobilization with movement technique. The mean onset time of rectus abdominus, erector Spine, rectus femoris, and tibialis anterior muscles activity significantly decreased in the affected limb after hip joint mobilization with movement technique compared to the control group (p ≤ 0.05). CONCLUSIONS The results of the present study suggest that a combination of hip joint mobilization with movement technique and conventional physiotherapy could improve muscle activity and balance among chronic stroke patients. TRIAL REGISTRATION NUMBER The study was registered in the Iranian Registry of Clinical Trials (No; IRCT20200613047759N1). Registration date: 2/08/2020.
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Affiliation(s)
- Soudeh Arabzadeh
- Student Research Committee, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Kamali
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soha Bervis
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Eseonu K, Panchmatia J, Pang D, Fakouri B. A Review of the Clinical Utility of Therapeutic Facet Joint Injections in Whiplash Associated Cervical Spinal Pain. Spine Surg Relat Res 2022; 6:189-196. [PMID: 35800634 PMCID: PMC9200415 DOI: 10.22603/ssrr.2021-0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 11/12/2022] Open
Abstract
Background and Objective Whiplash neck injury was described by Crowe in 1928. Whiplash-associated disorder (WAD) is defined as a cervical spinal injury following an acceleration-deceleration mechanism. It is a constellation of symptoms due to psychological factors and neural adaptations, with significant social costs. Review Summary There are multiple classification systems for WAD in the literature. The Quebec Classification is most reported and is predictive of the likelihood of progression to chronicity. The facet joint has been identified as a pain generator in 50% of cases. We outline the likely anatomical cause of WAD and summarize the protocol of medial branch block injections for diagnostic and therapeutic purposes, as well as the indications for and published results of facet joint ablation in WAD. We also highlight the development of ultrasound as an alternative to computed tomography or fluoroscopy for injection guidance. Conclusions WAD is a complex condition associated with sensory disturbance, pain, motor chronic pain, and psychological distress. The literature supports a single diagnostic medial branch block followed by a therapeutic facet joint ablation for chronic pain. WAD should be managed in a multidisciplinary fashion, with an early involvement of psychological specialists when required.
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Affiliation(s)
| | | | - David Pang
- Spinal Surgery Dept, Guy's & St. Thomas' Hospitals
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Middendorf JM, Ita ME, Winkelstein BA, H Barocas V. Local tissue heterogeneity may modulate neuronal responses via altered axon strain fields: insights about innervated joint capsules from a computational model. Biomech Model Mechanobiol 2021; 20:2269-2285. [PMID: 34514531 PMCID: PMC9289994 DOI: 10.1007/s10237-021-01506-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
In innervated collagenous tissues, tissue scale loading may contribute to joint pain by transmitting force through collagen fibers to the embedded mechanosensitive axons. However, the highly heterogeneous collagen structures of native tissues make understanding this relationship challenging. Recently, collagen gels with embedded axons were stretched and the resulting axon signals were measured, but these experiments were unable to measure the local axon strain fields. Computational discrete fiber network models can directly determine axon strain fields due to tissue scale loading. Therefore, this study used a discrete fiber network model to identify how heterogeneous collagen networks (networks with multiple collagen fiber densities) change axon strain due to tissue scale loading. In this model, a composite cylinder (axon) was embedded in a Delaunay network (collagen). Homogeneous networks with a single collagen volume fraction and two types of heterogeneous networks with either a sparse center or dense center were created. Measurements of fiber forces show higher magnitude forces in sparse regions of heterogeneous networks and uniform force distributions in homogeneous networks. The average axon strain in the sparse center networks decreases when compared to homogeneous networks with similar collagen volume fractions. In dense center networks, the average axon strain increases compared to homogeneous networks. The top 1% of axon strains are unaffected by network heterogeneity. Based on these results, the interaction of tissue scale loading, collagen network heterogeneity, and axon strains in native musculoskeletal tissues should be considered when investigating the source of joint pain.
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Affiliation(s)
- Jill M Middendorf
- Department of Biomedical Engineering, College of Science and Engineering, University of Minnesota, Nils Hasselmo Hall, 312 Church St SE, Minneapolis, MN, USA
| | - Meagan E Ita
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Victor H Barocas
- Department of Biomedical Engineering, College of Science and Engineering, University of Minnesota, Nils Hasselmo Hall, 312 Church St SE, Minneapolis, MN, USA.
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Equine Cervical Pain and Dysfunction: Pathology, Diagnosis and Treatment. Animals (Basel) 2021; 11:ani11020422. [PMID: 33562089 PMCID: PMC7915466 DOI: 10.3390/ani11020422] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 01/14/2023] Open
Abstract
Simple Summary Neck pain and dysfunction in the horse is becoming an increasingly important topic among riders, trainers and veterinarians. Some horses may present for a subtle performance decline, while others may show dramatic, dangerous behavior. It is important to recognize how to carefully evaluate the horse in an effort to understand the different types of pain that may be contributing to the different behaviors. The musculoskeletal and nervous systems may both play a role in the development of clinical signs. Recognizing that there are many diagnostic options as well as several treatments choices is important. This synopsis covers the disease processes that may contribute to the development of neck pain and dysfunction in the horse, as well as several possible diagnostic and treatment options. Abstract Interest in the cervical spine as a cause of pain or dysfunction is increasingly becoming the focus of many equine practitioners. Many affected horses are presented for poor performance, while others will present with dramatic, sometimes dangerous behavior. Understanding and distinguishing the different types of neck pain is a starting point to comprehending how the clinical presentations can vary so greatly. There are many steps needed to systematically evaluate the various tissues of the cervical spine to determine which components are contributing to cervical pain and dysfunction. Osseous structures, soft tissues and the central and the peripheral nervous system may all play a role in these various clinical presentations. After completing the clinical evaluation, several imaging modalities may be implemented to help determine the underlying pathologic processes. There are multiple treatment options available and each must be carefully chosen for an individual horse. Provided is a synopsis of the current knowledge as to different disease processes that can result in cervical pain and dysfunction, diagnostic approaches and treatment strategies. Improving the knowledge in these areas will ideally help to return horses to a state of well-being that can be maintained over time and through the rigors of their job or athletic endeavors.
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Cho HK, Park GY, Sung WJ, Kawk SG, Jung WB. Effects of intra-articular pulsed radiofrequency current administration on a rabbit model of rheumatoid arthritis. Exp Ther Med 2020; 20:29. [PMID: 32952620 PMCID: PMC7480132 DOI: 10.3892/etm.2020.9157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/17/2020] [Indexed: 11/05/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial proliferation and inflammation. Intra-articular corticosteroid injections are commonly used for the treatment of arthritis affecting one or two joints. Although corticosteroid injections are fast-acting, repeated usage can result in severe adverse events. Recently, intra-articular pulsed radiofrequency (PRF) stimulation has been proposed to treat arthritis. The aim of the present study was to compare the effectiveness of intra-articular PRF with corticosteroid injection based on histopathological and motion analysis of an ovalbumin (OVA)-induced RA rabbit model. RA was induced in the right knee joint of 18 rabbits via OVA injection. The rabbits were randomly allocated into a PRF, an intra-articular corticosteroid injection or a sham PRF stimulation group. Movement was assessed in the rabbits before treatment, then at 2, 4 and 8 weeks after treatment using walking distance, fast walking time and mean walking speed. Histopathological evaluation of the distal femur and synovium was conducted 2, 4 and 8 weeks after treatment. Motion analysis demonstrated that changes in all movement variables showed significant group and time interaction as well as group effect among the three groups. The semiquantitative score based on the histopathological findings for the distal femoral condyle decreased 2 and 4 weeks after both the PRF and steroid groups, compared with the sham PRF group. Moreover, in the synovium, the semiquantitative histological score in the PRF and steroid groups tended to be lower compared with the sham PRF group, although this result was not statistically significant. Thus, intra-articular PRF stimulation may delay cartilage destruction and improve functional motion in RA.
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Affiliation(s)
- Hee Kyung Cho
- Department of Physical Medicine and Rehabilitation, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Gi-Young Park
- Department of Physical Medicine and Rehabilitation, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Woo Jung Sung
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Sang Gyu Kawk
- Department of Medical Statistics, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Won Bin Jung
- Department of Physical Medicine and Rehabilitation, Seongju Moo Gang Hospital, Seongju 40026, Republic of Korea
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Kwak DG, Kwak SG, Lee AY, Chang MC. Outcome of intra-articular lumbar facet joint corticosteroid injection according to the severity of facet joint arthritis. Exp Ther Med 2019; 18:4132-4136. [PMID: 31616521 PMCID: PMC6781832 DOI: 10.3892/etm.2019.8031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 08/21/2019] [Indexed: 12/29/2022] Open
Abstract
Lumbar facet joint osteoarthritis (FJOA) caused by degenerative change(s) is considered to be the main cause of facet joint-origin low back pain (LBP). Intra-articular lumbar facet joint (IA LFJ) corticosteroid injection is widely used for controlling pain induced by FJOA. In the current study, the outcomes of IA LFJ corticosteroid injection were evaluated according to the severity of FJOA. A total of 50 patients who received IA LFJ corticosteroid injections for the treatment of LFJ pain were recruited. Patients were classified into three groups according to the severity of FJOA, which was indicated during a lumbar axial MRI. A total of 10 patients were assigned to group A (patients with mild FJOA), 27 to group B (patients with moderate FJOA) and 13 to group C (patients with severe FJOA). Pain intensity was evaluated using a numerical rating scale (NRS) prior to treatment and at 1, 2 and 3 months after treatment. A total of 26 (52%) patients experienced successful treatment outcomes (defined as >50% reduction in NRS score at 3 months). Patients in all groups demonstrated a significant decrease in NRS scores at 1, 2 and 3 months after IA LFJ corticosteroid injection compared with the pre-treatment score (P<0.001). However, the effect of IA LFJ corticosteroid injection was not significantly different among the three groups (P=0.889). The results demonstrated that facet joint-origin LBP was significantly reduced after IA LFJ corticosteroid injection, regardless of the severity of FJOA. The results of the current study indicated that IA LFJ corticosteroid injection is a beneficial clinical option for managing LBP caused by FJOA.
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Affiliation(s)
- Dong Gyu Kwak
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, College of Medicine, Catholic University of Daegu, Daegu 42472, Republic of Korea
| | - Ah Young Lee
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Daegu 38453, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
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Li Y, Wang X, Jiang K, Chen J, Lin Y, Wu Y. Incidence and risk factors of facet joint violation following percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Acta Radiol 2019; 60:755-761. [PMID: 30205703 DOI: 10.1177/0284185118799515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Percutaneous kyphoplasty (PKP) has been widely used to osteoporotic vertebral compression fractures (OVCFs). No previous investigations have reported the incidence and risk factors of facet joint violation (FJV) caused by PKP. PURPOSE To determine the incidence and risk factors of FJV following PKP in patients with OVCFs. MATERIAL AND METHODS We reviewed a total of 153 patients who underwent bilateral PKP. Postoperative computed tomography (CT) scans were assessed to determine the degree of FJV owing to invasion by a puncture trocar. Clinical outcomes, including visual analogue scale (VAS) scores and Oswestry Disability Index (ODI) scores, were collected from all patients. Clinical and radiological data were analyzed to identify the risk factors for FJV. RESULTS FJV caused by PKP affected 18.9% of patients and 9.6% of facet joints; approximately 3.9% and 5.7% of facet joints were considered to have grade 1 and grade 2 violations, respectively. There were significant differences between the FJV and non-FJV groups in VAS and ODI scores after surgery. Significant differences were found with respect to the facet joint angle (FJA), the pedicle diameter (PD), and the distance from the entry point to the facet joint space (DEF). Multiple logistic regression analysis indicated that an FJA > 55°, a PD < 5 mm, and a DEF < 5 mm were independent risk factors for FJV. CONCLUSION The placement of a puncture trocar can cause FJV in patients with OVCFs and impact clinical outcomes after PKP. Special attention should be given to patients with an FJA > 55°, a PD < 5 mm, and a DEF < 5 mm.
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Affiliation(s)
- Yao Li
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, PR China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, PR China
| | - Xiangyang Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Kaixia Jiang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, PR China
| | - Jiaoxiang Chen
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Yan Lin
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Yaosen Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, PR China
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8
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Singh S, Kartha S, Bulka BA, Stiansen NS, Winkelstein BA. Physiologic facet capsule stretch can induce pain & upregulate matrix metalloproteinase-3 in the dorsal root ganglia when preceded by a physiological mechanical or nonpainful chemical exposure. Clin Biomech (Bristol, Avon) 2019; 64:122-130. [PMID: 29523370 PMCID: PMC6067996 DOI: 10.1016/j.clinbiomech.2018.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/22/2017] [Accepted: 01/15/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neck pain from cervical facet loading is common and induces inflammation and upregulation of nerve growth factor (NGF) that can sensitize the joint afferents. Yet, the mechanisms by which these occur and whether afferents can be pre-conditioned by certain nonpainful stimuli are unknown. This study tested the hypothesis that a nonpainful mechanical or chemical insult predisposes a facet joint to generate pain after a later exposure to typically nonpainful distraction. METHODS Rats were exposed to either a nonpainful distraction or an intra-articular subthreshold dose of NGF followed by a nonpainful distraction two days later. Mechanical hyperalgesia was measured daily and C6 dorsal root ganglia (DRG) tissue was assayed for NGF and matrix metalloproteinase-3 (MMP-3) expression on day 7. FINDINGS The second distraction increased joint displacement and strains compared to its first application (p = 0.0011). None of the initial exposures altered behavioral sensitivity in either of the groups being pre-conditioned or in controls; but, sensitivity was established in both groups receiving a second distraction within one day that lasted until day 7 (p < 0.024). NGF expression in the DRG was increased in both groups undergoing a pre-conditioning exposure (p < 0.0232). Similar findings were observed for MMP-3 expression, with a pre-conditioning exposure increasing levels after an otherwise nonpainful facet distraction. INTERPRETATION These findings suggest that nonpainful insults to the facet joint, when combined, can generate painful outcomes, possibly mediated by upregulation of MMP-3 and mature NGF.
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Affiliation(s)
- Sagar Singh
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Ben A Bulka
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Nicholas S Stiansen
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA; Department of Neurosurgery, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA.
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9
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Escaloni J, Butts R, Dunning J. The use of dry needling as a diagnostic tool and clinical treatment for cervicogenic dizziness: a narrative review & case series. J Bodyw Mov Ther 2018; 22:947-955. [DOI: 10.1016/j.jbmt.2018.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 01/21/2018] [Accepted: 02/08/2018] [Indexed: 12/20/2022]
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10
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The Impact of Facet Joint Violation on Clinical Outcomes After Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures. World Neurosurg 2018; 119:e383-e388. [PMID: 30071323 DOI: 10.1016/j.wneu.2018.07.170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine whether the facet joint violation (FJV) impacts clinical outcomes after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures. METHODS Patients undergoing bilateral PKP were enrolled and divided into FJV and non-FJV groups depending on their postoperative axial computed tomography scans. Radiologic parameters, visual analogue scale (VAS), and Oswestry Disability Index (ODI) scores were obtained preoperatively and each follow-up time postoperatively (1day, 1 week, 1 month, 3 months, 6 months, and 1 year). Finally, patient satisfaction surveys also were noted. RESULTS A total of 157 patients completed the 1-year follow-up. The incidence of FJV resulting from puncture trocars was 15.9% (25/157). Approximately 5.7% (9/157) and 10.2% (16/157) of patients were considered to have grade 1 and grade 2 violation, respectively. PKP decreased the VAS and ODI scores compared with the preoperative values in both groups. Patients with FJV had much greater VAS and ODI scores than did those without FJV at 1-day, 1-week, and 1-month follow-up. No significant differences were found between groups at 3-month, 6-month, and 1-year follow up. Patients in the FJV group were less satisfied with the surgical outcomes than were those without FJV at the last survey. CONCLUSIONS Approximately 15.9% of patients were diagnosed with FJV by postoperative computed tomography scans. FJV had a negative influence on clinical outcomes after PKP in osteoporotic vertebral compression fractures, primarily at short-term follow-up. In addition, FJV was also a risk factor in the long-term surgical satisfaction.
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11
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Kartha S, Bulka BA, Stiansen NS, Troche HR, Winkelstein BA. Repeated High Rate Facet Capsular Stretch at Strains That are Below the Pain Threshold Induces Pain and Spinal Inflammation With Decreased Ligament Strength in the Rat. J Biomech Eng 2018; 140:2679583. [PMID: 30003250 PMCID: PMC6056195 DOI: 10.1115/1.4040023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/12/2018] [Indexed: 12/21/2022]
Abstract
Repeated loading of ligamentous tissues during repetitive occupational and physical tasks even within physiological ranges of motion has been implicated in the development of pain and joint instability. The pathophysiological mechanisms of pain after repetitive joint loading are not understood. Within the cervical spine, excessive stretch of the facet joint and its capsular ligament has been implicated in the development of pain. Although a single facet joint distraction (FJD) at magnitudes simulating physiologic strains is insufficient to induce pain, it is unknown whether repeated stretching of the facet joint and ligament may produce pain. This study evaluated if repeated loading of the facet at physiologic nonpainful strains alters the capsular ligament's mechanical response and induces pain. Male rats underwent either two subthreshold facet joint distractions (STFJDs) or sham surgeries each separated by 2 days. Pain was measured before the procedure and for 7 days; capsular mechanics were measured during each distraction and under tension at tissue failure. Spinal glial activation was also assessed to probe potential pathophysiologic mechanisms responsible for pain. Capsular displacement significantly increased (p = 0.019) and capsular stiffness decreased (p = 0.008) during the second distraction compared to the first. Pain was also induced after the second distraction and was sustained at day 7 (p < 0.048). Repeated loading weakened the capsular ligament with lower vertebral displacement (p = 0.041) and peak force (p = 0.014) at tissue rupture. Spinal glial activation was also induced after repeated loading. Together, these mechanical, physiological, and neurological findings demonstrate that repeated loading of the facet joint even within physiologic ranges of motion can be sufficient to induce pain, spinal inflammation, and alter capsular mechanics similar to a more injurious loading exposure.
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Affiliation(s)
- Sonia Kartha
- Department of Bioengineering,
University of Pennsylvania,
Suite 240 Skirkanich Hall,
210 South 33rd Street,
Philadelphia, PA 19104
e-mail:
| | - Ben A. Bulka
- Department of Bioengineering,
University of Pennsylvania,
Suite 240 Skirkanich Hall,
210 South 33rd Street,
Philadelphia, PA 19104
e-mail:
| | - Nick S. Stiansen
- Department of Bioengineering,
University of Pennsylvania,
Suite 240 Skirkanich Hall,
210 South 33rd Street,
Philadelphia, PA 19104
e-mail:
| | - Harrison R. Troche
- Department of Bioengineering,
University of Pennsylvania,
Suite 240 Skirkanich Hall,
210 South 33rd Street,
Philadelphia, PA 19104
e-mail:
| | - Beth A. Winkelstein
- Fellow ASME
Department of Bioengineering,
University of Pennsylvania,
Suite 240 Skirkanich Hall 210,
South 33rd Street,
Philadelphia, PA 19104
e-mail:
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12
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Mousavi-Khatir R, Talebian S, Toosizadeh N, Olyaei GR, Maroufi N. Disturbance of neck proprioception and feed-forward motor control following static neck flexion in healthy young adults. J Electromyogr Kinesiol 2018; 41:160-167. [PMID: 29935422 DOI: 10.1016/j.jelekin.2018.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 11/16/2022] Open
Abstract
The highly complex proprioceptive system provides neuromuscular control of the mobile cervical spine. Static neck flexion can induce the elongation of posterior tissues and altered afferent input from the mechanoreceptors. The purpose of this study was to examine the effect of prolonged static neck flexion on neck proprioception and anticipatory postural adjustments. Thirty-eight healthy participants (20 females and 18 males) between the ages of 20-35 years with no history of neck, low back, and shoulder pain enrolled in this study. Neck proprioception and anticipatory muscle activity were tested before and after 10-min static neck flexion. For assessment of neck proprioception, each participant was asked to perform 10 trials of the cervicocephalic relocation test to the neutral head position after active neck rotation to the left and right sides. Anticipatory postural adjustments were evaluated during a rapid arm flexion test. Following the flexion, the absolute and variable errors in head repositioning significantly increased (p < 0.05). The results also showed that there was a significant delay in the onset of myoelectric activity of the cervical erector spinae muscles after flexion (p = 0.001). The results of this study suggested that a 10-min static flexion can lead to changes in the neck proprioception and feed-forward control due to mechanical and neuromuscular changes in the viscoelastic cervical spine structures. These changes in sensory-motor control may be a risk factor for neck pain and injury.
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Affiliation(s)
- Roghayeh Mousavi-Khatir
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran; Department of Physical Therapy, School of Rehabilitation, Babol University of Medical Sciences, Babol, Iran.
| | - Saeed Talebian
- Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences: Pich Shemiran, Tehran, Iran.
| | - Nima Toosizadeh
- Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ, United States; Department of Biomedical Engineering, University of Arizona, Tucson, AZ, United States.
| | - Gholam Reaza Olyaei
- Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences: Pich Shemiran, Tehran, Iran.
| | - Nader Maroufi
- Department of Physical Therapy, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
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13
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Ban E, Zhang S, Zarei V, Barocas VH, Winkelstein BA, Picu CR. Collagen Organization in Facet Capsular Ligaments Varies With Spinal Region and With Ligament Deformation. J Biomech Eng 2018; 139:2606399. [PMID: 28241270 DOI: 10.1115/1.4036019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Indexed: 12/14/2022]
Abstract
The spinal facet capsular ligament (FCL) is primarily comprised of heterogeneous arrangements of collagen fibers. This complex fibrous structure and its evolution under loading play a critical role in determining the mechanical behavior of the FCL. A lack of analytical tools to characterize the spatial anisotropy and heterogeneity of the FCL's microstructure has limited the current understanding of its structure-function relationships. Here, the collagen organization was characterized using spatial correlation analysis of the FCL's optically obtained fiber orientation field. FCLs from the cervical and lumbar spinal regions were characterized in terms of their structure, as was the reorganization of collagen in stretched cervical FCLs. Higher degrees of intra- and intersample heterogeneity were found in cervical FCLs than in lumbar specimens. In the cervical FCLs, heterogeneity was manifested in the form of curvy patterns formed by collections of collagen fibers or fiber bundles. Tensile stretch, a common injury mechanism for the cervical FCL, significantly increased the spatial correlation length in the stretch direction, indicating an elongation of the observed structural features. Finally, an affine estimation for the change of correlation length under loading was performed which gave predictions very similar to the actual values. These findings provide structural insights for multiscale mechanical analyses of the FCLs from various spinal regions and also suggest methods for quantitative characterization of complex tissue patterns.
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Affiliation(s)
- Ehsan Ban
- Department of Materials Science and Engineering, University of Pennsylvania, 211 LRSM, 3231 Walnut Street, Philadelphia, PA 19104 e-mail:
| | - Sijia Zhang
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104 e-mail:
| | - Vahhab Zarei
- Department of Mechanical Engineering, University of Minnesota-Twin Cities, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455 e-mail:
| | - Victor H Barocas
- Department of Biomedical Engineering, University of Minnesota-Twin Cities, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455 e-mail:
| | - Beth A Winkelstein
- Departments of Bioengineering and Neurosurgery, University of Pennsylvania, 240 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA 19104 e-mail:
| | - Catalin R Picu
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, 2048 Jonsson Engineering Center, 110 8th Street, Troy, NY 12180 e-mail:
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Comparison of Intra-articular Thoracic Facet Joint Steroid Injection and Thoracic Medial Branch Block for the Management of Thoracic Facet Joint Pain. Spine (Phila Pa 1976) 2018; 43:76-80. [PMID: 28591071 DOI: 10.1097/brs.0000000000002269] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective observational study. OBJECTIVE The aim of this study was to show the effect of intra-articular (IA) thoracic facet joint (TFJ) steroid injection for the management of TFJ pain, and to compare it with the effect of therapeutic thoracic medial branch block (MBB) with a local anesthetic and steroid. SUMMARY OF BACKGROUND DATA Several studies have shown the effects of thoracic MBB with local anesthetics with or without steroids and radiofrequency neurotomy in managing TFJ pain, but thus far, the effectiveness of IA TFJ steroid injection has not been studied. METHODS Forty patients with TFJ pain were recruited and randomly assigned to one of two groups, the IA steroid injection and the MBB group, each with 20 patients. For IA TFJ steroid injection and therapeutic MBB, we injected 0.5 mL of 0.5% bupivacaine, mixed with 10 mg (0.25 mL) of dexamethasone. We assessed the severity of TFJ pain using a numeric rating scale (NRS) before treatment and at 1, 3, and 6 months after treatment. RESULTS Compared to the pretreatment NRS scores, the NRS scores at 1, 3, and 6 months after each treatment showed a significant decrease in patients in both the groups. Intergroup changes in the NRS scores were not significantly different over time. Six months after the treatment, 65% of the patients in the IA steroid injection group reported successful pain relief (pain relief ≥50%), and 40% of the patients in the MBB group showed successful pain relief. CONCLUSION In the present study, both IA TFJ steroid injection and therapeutic MBB significantly relieved TFJ pain. Their effects persisted for at least 6 months after the procedure. Thus, we think that both IA TFJ steroid injection and therapeutic thoracic MBB are useful treatment options for managing TFJ pain. LEVEL OF EVIDENCE 2.
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Sperry MM, Ita ME, Kartha S, Zhang S, Yu YH, Winkelstein B. The Interface of Mechanics and Nociception in Joint Pathophysiology: Insights From the Facet and Temporomandibular Joints. J Biomech Eng 2017; 139:2597611. [PMID: 28056123 DOI: 10.1115/1.4035647] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Indexed: 12/16/2022]
Abstract
Chronic joint pain is a widespread problem that frequently occurs with aging and trauma. Pain occurs most often in synovial joints, the body's load bearing joints. The mechanical and molecular mechanisms contributing to synovial joint pain are reviewed using two examples, the cervical spinal facet joints and the temporomandibular joint (TMJ). Although much work has focused on the macroscale mechanics of joints in health and disease, the combined influence of tissue mechanics, molecular processes, and nociception in joint pain has only recently become a focus. Trauma and repeated loading can induce structural and biochemical changes in joints, altering their microenvironment and modifying the biomechanics of their constitutive tissues, which themselves are innervated. Peripheral pain sensors can become activated in response to changes in the joint microenvironment and relay pain signals to the spinal cord and brain where pain is processed and perceived. In some cases, pain circuitry is permanently changed, which may be a potential mechanism for sustained joint pain. However, it is most likely that alterations in both the joint microenvironment and the central nervous system (CNS) contribute to chronic pain. As such, the challenge of treating joint pain and degeneration is temporally and spatially complicated. This review summarizes anatomy, physiology, and pathophysiology of these joints and the sensory pain relays. Pain pathways are postulated to be sensitized by many factors, including degeneration and biochemical priming, with effects on thresholds for mechanical injury and/or dysfunction. Initiators of joint pain are discussed in the context of clinical challenges including the diagnosis and treatment of pain.
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Affiliation(s)
- Megan M Sperry
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104-6321 e-mail:
| | - Meagan E Ita
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104-6321 e-mail:
| | - Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104-6321 e-mail:
| | - Sijia Zhang
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104-6321 e-mail:
| | - Ya-Hsin Yu
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104-6321 e-mail:
| | - Beth Winkelstein
- Departments of Bioengineering and Neurosurgery, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104-6321 e-mail:
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Weisshaar CL, Kras JV, Pall PS, Kartha S, Winkelstein BA. Ablation of IB4 non-peptidergic afferents in the rat facet joint prevents injury-induced pain and thalamic hyperexcitability via supraspinal glutamate transporters. Neurosci Lett 2017; 655:82-89. [PMID: 28689926 DOI: 10.1016/j.neulet.2017.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 12/12/2022]
Abstract
The facet joint is a common source of neck pain, particularly after excessive stretch of its capsular ligament. Peptidergic afferents have been shown to have an important role in the development and maintenance of mechanical hyperalgesia, dysregulated nociceptive signaling, and spinal hyperexcitability that develop after mechanical injury to the facet joint. However, the role of non-peptidergic isolectin-B4 (IB4) cells in mediating joint pain is unknown. Isolectin-B4 saporin (IB4-SAP) was injected into the facet joint to ablate non-peptidergic cells, and the facet joint later underwent a ligament stretch known to induce pain. Behavioral sensitivity, thalamic glutamate transporter expression, and thalamic hyperexcitability were evaluated up to and at day 7. Administering IB4-SAP prior to a painful injury prevented the development of mechanical hyperalgesia that is typically present. Intra-articular IB4-SAP also prevented the upregulation of the glutamate transporters GLT-1 and EAAC1 in the ventral posterolateral nucleus of the thalamus and reduced thalamic neuronal hyperexcitability at day 7. These findings suggest that a painful facet injury induces changes extending to supraspinal structures and that IB4-positive afferents in the facet joint may be critical for the development and maintenance of sensitization in the thalamus after a painful facet joint injury.
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Affiliation(s)
- Christine L Weisshaar
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd St Philadelphia, PA 19104, USA
| | - Jeffrey V Kras
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd St Philadelphia, PA 19104, USA
| | - Parul S Pall
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd St Philadelphia, PA 19104, USA
| | - Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd St Philadelphia, PA 19104, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd St Philadelphia, PA 19104, USA; Department of Neurosurgery, University of Pennsylvania, 105 Hayden Hall, 3320 Smith Walk, Philadelphia, PA 19104, USA.
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Painful Cervical Facet Joint Injury Is Accompanied by Changes in the Number of Excitatory and Inhibitory Synapses in the Superficial Dorsal Horn That Differentially Relate to Local Tissue Injury Severity. Spine (Phila Pa 1976) 2017; 42:E695-E701. [PMID: 27755498 PMCID: PMC5393960 DOI: 10.1097/brs.0000000000001934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Immunohistochemistry labeled pre- and postsynaptic structural markers to quantify excitatory and inhibitory synapses in the spinal superficial dorsal horn at 14 days after painful facet joint injury in the rat. OBJECTIVE The objective of this study was to investigate the relationship between pain and synapse density in the spinal cord after facet injury. SUMMARY OF BACKGROUND DATA Neck pain is a major contributor to disability and often becomes chronic. The cervical facet joints are susceptible to loading-induced painful injury, initiating spinal central sensitization responses. Although excitatory synapse plasticity has been reported in the superficial dorsal horn early after painful facet injury, whether excitatory and/or inhibitory synapse density is altered at a time when pain is maintained is unknown. METHODS Rats underwent either a painful C6/C7 facet joint distraction or sham surgery. Mechanical hyperalgesia was measured and immunohistochemistry techniques for synapse quantification were used to quantify excitatory and inhibitory synapse densities in the superficial dorsal horn at day 14. Logarithmic correlation analyses evaluated whether the severity of facet injury correlated with either behavioral or synaptic outcomes. RESULTS Facet joint injury induces pain that is sustained until day 14 (P <0.001) and both significantly greater excitatory synapse density (P = 0.042) and lower inhibitory synapse density (P = 0.0029) in the superficial dorsal horn at day 14. Injury severity is significantly correlated with pain at days 1 (P = 0.0011) and 14 (P = 0.0002), but only with inhibitory, not excitatory, synapse density (P = 0.0025) at day 14. CONCLUSION This study demonstrates a role for structural plasticity in both excitatory and inhibitory synapses in the maintenance of facet-mediated joint pain, and that altered inhibitory, but not excitatory, synapse density correlates to the severity of painful joint injury. Understanding the functional consequences of this spinal structural plasticity is critical to elucidate mechanisms of chronic joint pain. LEVEL OF EVIDENCE N /A.
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Do KH, Ahn SH, Cho YW, Chang MC. Comparison of intra-articular lumbar facet joint pulsed radiofrequency and intra-articular lumbar facet joint corticosteroid injection for management of lumbar facet joint pain: A randomized controlled trial. Medicine (Baltimore) 2017; 96:e6524. [PMID: 28353611 PMCID: PMC5380295 DOI: 10.1097/md.0000000000006524] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aimed to demonstrate the effect of intra-articular (IA) lumbar facet joint (LFJ) pulsed radiofrequency (PRF) for the management of LFJ pain, and to compare the effect of IA LFJ PRF to IA corticosteroid injection (ICI). Pathology in the LFJ is a common source of lower back pain (LBP). It is responsible for chronic LBP in approximately 15% to 45% of patients. It has been reported that PRF stimulation can effectively reduce refractory joint pain. METHODS Sixty patients with LFJ pain were recruited and randomly assigned to 1 of 2 groups: the IA PRF group and the ICI group. There were 30 patients in each group. At pretreatment, 2 weeks, 1, 3, and 6 months after treatment, we assessed the severity of LBP using a numeric rating scale (NRS). RESULTS Compared with the pretreatment NRS scores, patients in both groups showed a significant decrease in NRS scores at 2 weeks, and 1, 3, and 6 months after each treatment. Between groups, changes in the NRS scores were significantly different over time. At 2 weeks and 1 month after each procedure, the NRS score after ICI was significantly lower than that after the PRF stimulation. However, at 3 and 6 months after the procedures, the decrements of NRS scores were not significantly different between the 2 groups. Six months after treatment, about half of patients in both groups reported successful pain relief (pain relief of ≥50%). CONCLUSION In the current study, both IA PRF stimulation and ICI into the LFJ significantly relieved LFJ pain. Their effects persisted for at least 6 months after the procedure. Thus, IA PRF is a useful therapeutic option for the management of LFJ pain.
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Affiliation(s)
- Kyung Hee Do
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul
| | - Sang Ho Ahn
- Dr Ahn's Spine & Pain Clinic, and Dr Ahn's Spine and Pain Institute, Daegu, Republic of Korea
| | - Yun Woo Cho
- Dr Ahn's Spine & Pain Clinic, and Dr Ahn's Spine and Pain Institute, Daegu, Republic of Korea
| | - Min Cheol Chang
- Dr Ahn's Spine & Pain Clinic, and Dr Ahn's Spine and Pain Institute, Daegu, Republic of Korea
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Zhang S, Cao X, Stablow AM, Shenoy VB, Winkelstein BA. Tissue Strain Reorganizes Collagen With a Switchlike Response That Regulates Neuronal Extracellular Signal-Regulated Kinase Phosphorylation In Vitro: Implications for Ligamentous Injury and Mechanotransduction. J Biomech Eng 2016; 138:021013. [PMID: 26549105 DOI: 10.1115/1.4031975] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Indexed: 12/26/2022]
Abstract
Excessive loading of ligaments can activate the neural afferents that innervate the collagenous tissue, leading to a host of pathologies including pain. An integrated experimental and modeling approach was used to define the responses of neurons and the surrounding collagen fibers to the ligamentous matrix loading and to begin to understand how macroscopic deformation is translated to neuronal loading and signaling. A neuron-collagen construct (NCC) developed to mimic innervation of collagenous tissue underwent tension to strains simulating nonpainful (8%) or painful ligament loading (16%). Both neuronal phosphorylation of extracellular signal-regulated kinase (ERK), which is related to neuroplasticity (R2 ≥ 0.041; p ≤ 0.0171) and neuronal aspect ratio (AR) (R2 ≥ 0.250; p < 0.0001), were significantly correlated with tissue-level strains. As NCC strains increased during a slowly applied loading (1%/s), a "switchlike" fiber realignment response was detected with collagen reorganization occurring only above a transition point of 11.3% strain. A finite-element based discrete fiber network (DFN) model predicted that at bulk strains above the transition point, heterogeneous fiber strains were both tensile and compressive and increased, with strains in some fibers along the loading direction exceeding the applied bulk strain. The transition point identified for changes in collagen fiber realignment was consistent with the measured strain threshold (11.7% with a 95% confidence interval of 10.2-13.4%) for elevating ERK phosphorylation after loading. As with collagen fiber realignment, the greatest degree of neuronal reorientation toward the loading direction was observed at the NCC distraction corresponding to painful loading. Because activation of neuronal ERK occurred only at strains that produced evident collagen fiber realignment, findings suggest that tissue strain-induced changes in the micromechanical environment, especially altered local collagen fiber kinematics, may be associated with mechanotransduction signaling in neurons.
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Zhang S, Bassett DS, Winkelstein BA. Stretch-induced network reconfiguration of collagen fibres in the human facet capsular ligament. J R Soc Interface 2016; 13:20150883. [PMID: 26819333 DOI: 10.1098/rsif.2015.0883] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Biomaterials can display complex spatial patterns of cellular responses to external forces. Revealing and predicting the role of these patterns in material failure require an understanding of the statistical dependencies between spatially distributed changes in a cell's local biomechanical environment, including altered collagen fibre kinematics in the extracellular matrix. Here, we develop and apply a novel extension of network science methods to investigate how excessive tensile stretch of the human cervical facet capsular ligament (FCL), a common source of chronic neck pain, affects the local reorganization of collagen fibres. We define collagen alignment networks based on similarity in fibre alignment angles measured by quantitative polarized light imaging. We quantify the reorganization of these networks following macroscopic loading by describing the dynamic reconfiguration of network communities, regions of the material that display similar fibre alignment angles. Alterations in community structure occur smoothly over time, indicating coordinated adaptation of fibres to loading. Moreover, flexibility, a measure of network reconfiguration, tracks the loss of FCL's mechanical integrity at the onset of anomalous realignment (AR) and regions of AR display altered community structure. These findings use novel network-based techniques to explain abnormal collagen fibre reorganization, a dynamic and coordinated multivariate process underlying tissue failure.
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Affiliation(s)
- Sijia Zhang
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Danielle S Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA
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Farrell SF, Osmotherly PG, Cornwall J, Rivett DA. Immunohistochemical investigation of nerve fiber presence and morphology in elderly cervical spine meniscoids. Spine J 2016; 16:1244-1252. [PMID: 27298080 DOI: 10.1016/j.spinee.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/18/2016] [Accepted: 06/06/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Innervation of anatomical structures is fundamental to their capacity to generate nociceptive impulses. Cervical spine meniscoids are hypothesized to be contributors to neck pain; however, their innervation is not comprehensively understood. PURPOSE This study aimed to examine the presence and morphology of nerve fibers within cervical spine meniscoids and adjacent joint capsules. STUDY DESIGN This is a cross-sectional study. PATIENT SAMPLE The sample consists of cervical hemispines of 12 embalmed cadavers (mean [standard deviation] age 82.9 [6.5] years, six female, six left). Either the right or the left half of the cervical spine (hemispine) of each cadaver was included in the sample. So six left sides and six right sides of the cadaver cervical spines made up the 12 hemispines that formed the sample. METHODS Cervical spine meniscoids and adjacent joint capsules were excised from lateral atlantoaxial and cervical zygapophyseal (C2-C3 to C6-C7) joints (n=67), then paraffin embedded. Meniscoids were sectioned sagittally (5 µm), slide mounted, and immunohistochemistry was performed using primary antibodies to neurofilament heavy (NF-H) and pan-neurofilament (Pan-NF) to identify nerve tissue. The study was supported by institutional graduate student funding. The authors have no conflicts of interest to declare. RESULTS Seventy-seven meniscoids (23 lateral atlantoaxial, 54 cervical zygapophyseal) were extracted and processed (154 sections in total). Sixty-four individual nerve fiber bundles were identified (26 NF-H positive, 38 Pan-NF positive) from 14 meniscoids. Nerves immunoreactive to both NF-H and Pan-NF were identified in 13 of 77 meniscoids (10 of 14 lateral atlantoaxial joint) from 11 joints (eight cadavers). Nerves were always located in joint capsules except three exclusively Pan-NF immunoreactive nerve fiber bundles from two adipose meniscoids. CONCLUSIONS The low nerve prevalence in elderly cervical spine meniscoids, with nerves only found in two adipose type meniscoids, suggests these structures may play a minimal role in cervical nociception generation in this demographic. The joint capsules, which were more frequently innervated, appear to be more likely generators of nociception in the elderly. Joint capsule nerves were mostly NF-H positive, indicating potential Aδ-fiber presence.
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Affiliation(s)
- Scott F Farrell
- Faculty of Health and Medicine, The University of Newcastle, University Drive, Callghan 2308, NSW, Australia.
| | - Peter G Osmotherly
- Faculty of Health and Medicine, The University of Newcastle, University Drive, Callghan 2308, NSW, Australia
| | - Jon Cornwall
- CS 705 Level 7, Wellington Hospital Clinical Services Block, Graduate School of Nursing, Midwifery and Health Victoria University of Wellington, Wellington 6021, New Zealand; Department of Physiology, University of Otago, 270 Great King St, Dunedin 9016, New Zealand; Centre for Health Sciences, Zurich University of Applied Science, Technikumstrasse 71, 8401 Winterthur, Zurich, Switzerland
| | - Darren A Rivett
- Faculty of Health and Medicine, The University of Newcastle, University Drive, Callghan 2308, NSW, Australia
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Persson M, Sörensen J, Gerdle B. Chronic Whiplash Associated Disorders (WAD): Responses to Nerve Blocks of Cervical Zygapophyseal Joints. PAIN MEDICINE 2016; 17:2162-2175. [DOI: 10.1093/pm/pnw036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Baeske R. Mobilisation with movement: a step towards understanding the importance of peripheral mechanoreceptors. PHYSICAL THERAPY REVIEWS 2016. [DOI: 10.1080/10833196.2015.1121014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Manchikanti L, Hirsch JA, Kaye AD, Boswell MV. Cervical zygapophysial (facet) joint pain: effectiveness of interventional management strategies. Postgrad Med 2015; 128:54-68. [PMID: 26653406 DOI: 10.1080/00325481.2016.1105092] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diagnostic facet joint nerve blocks have been utilized in the diagnosis of cervical facet joint pain in patients without disk herniation or radicular pain due to a lack of reliable noninvasive diagnostic measures. Therapeutic interventions include intra-articular injections, facet joint nerve blocks and radiofrequency neurotomy. The diagnostic accuracy and effectiveness of facet joint interventions have been assessed in multiple diagnostic accuracy studies, randomized controlled trials (RCTs), and systematic reviews in managing chronic neck pain. This assessment shows there is Level II evidence based on a total of 11 controlled diagnostic accuracy studies for diagnosing cervical facet joint pain in patients without disk herniation or radicular pain utilizing controlled diagnostic blocks. Due to significant variability and internal inconsistency regarding prevalence in a heterogenous population; despite 11 studies, evidence is determined as Level II. Prevalence ranged from 36% to 67% with at least 80% pain relief as the criterion standard with a false-positive rate ranging from 27% to 63%. The evidence is Level II for the long-term effectiveness of radiofrequency neurotomy and facet joint nerve blocks in managing cervical facet joint pain. There is Level III evidence for cervical intra-articular injections.
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Affiliation(s)
- Laxmaiah Manchikanti
- a Pain Management Center of Paducah , Paducah , KY , USA.,b Department of Anesthesiology and Perioperative Medicine , University of Louisville , Louisville , KY , USA
| | - Joshua A Hirsch
- c Neuroendovascular Program , Massachusetts General Hospital , Boston , MA , USA
| | - Alan D Kaye
- d Department of Anesthesia , LSU Health Science Center , New Orleans , LA , USA
| | - Mark V Boswell
- b Department of Anesthesiology and Perioperative Medicine , University of Louisville , Louisville , KY , USA
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Lazaro RP. Electromyography in musculoskeletal pain: A reappraisal and practical considerations. Surg Neurol Int 2015; 6:143. [PMID: 26417485 PMCID: PMC4561389 DOI: 10.4103/2152-7806.163816] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 06/19/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Patients with musculoskeletal pain (MSP) and local tenderness in the back and extremities are frequently referred to electromyography (EMG) laboratory to assess the integrity of the spinal nerve roots, peripheral nerves, and skeletal muscles. When focal muscle weakness and anatomical sensory deficits are clinically evident, this procedure is almost always abnormal. In some situations, when the presenting symptoms consist of local pain and tenderness without neuromuscular deficits, its diagnostic utility becomes questionable as illustrated in the present study. METHODS EMG findings of 75 patients referred for evaluation of local MSP and tenderness in the neck and lower back and in the upper and lower extremities were reviewed. These patients were selected from a group of 200 patients referred for evaluation of unilateral local pain and tenderness in various parts of the body. All EMG procedures and clinical neurologic examination were performed by the author and all underwent magnetic resonance imaging of the affected parts of the body prior to the procedure. None of the 75 patients studied had concurrent medical disorders or had previous spinal root injuries or surgeries to the spine. RESULTS All 75 patients in this study showed normal EMG of the affected extremities and normal peripheral nerve conduction study. Those with herniated disc in the cervical or lumbar spine presenting with local pain and tenderness in the neck and lower back but without neurologic deficits or clear radicular symptoms, had normal study also. The remaining 125 patients excluded from the study, had various EMG and peripheral nerve abnormalities that can be attributed to concurrent medical disorders and previous injuries to the spinal roots. CONCLUSIONS Use of EMG in the diagnosis of local MSP, unless associated with clinical neurologic deficits, almost always yields negative results. The utility of this procedure is limited to pathology in the motor unit. It cannot assess the function of the sensory components of the spinal roots, small-diameter sensory nerves, and the sensory innervation of the spine via sinuvertebral nerve. Therefore, if the motor unit is anatomically and physiologically intact, the procedure is of little value in the diagnosis of MSP. Likewise, peripheral nerve conduction study is likely to be normal unless clear neurologic deficits are present. The present study illustrates that a good history and meticulous neurologic examination should be an integral part of an ideal electrodiagnostic procedure.
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Affiliation(s)
- R P Lazaro
- Neurology and Electroneuromyography Clinic, Oneonta, New York, USA
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Kras JV, Weisshaar CL, Pall PS, Winkelstein BA. Pain from intra-articular NGF or joint injury in the rat requires contributions from peptidergic joint afferents. Neurosci Lett 2015; 604:193-8. [PMID: 26240991 DOI: 10.1016/j.neulet.2015.07.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 02/06/2023]
Abstract
Non-physiological stretch of the cervical facet joint's capsular ligament induces persistent behavioral hypersensitivity and spinal neuronal hyperexcitability via an intra-articular NGF-dependent mechanism. Although that ligament is innervated by nociceptors, it is unknown if a subpopulation is exclusively responsible for the behavioral and spinal neuronal responses to intra-articular NGF and/or facet joint injury. This study ablated joint afferents using the neurotoxin saporin targeted to neurons involved in either peptidergic ([Sar(9),Met (O2)(11)]-substance P-saporin (SSP-Sap)) or non-peptidergic (isolectin B4-saporin (IB4-Sap)) signaling to investigate the contributions of those neuronal populations to facet-mediated pain. SSP-Sap, but not IB4-Sap, injected into the bilateral C6/C7 facet joints 14 days prior to an intra- articular NGF injection prevents NGF-induced mechanical and thermal hypersensitivity in the forepaws. Similarly, only SSP- Sap prevents the increase in mechanical forepaw stimulation- induced firing of spinal neurons after intra-articular NGF. In addition, intra-articular SSP-Sap prevents both behavioral hypersensitivity and upregulation of NGF in the dorsal root ganglion after a facet joint distraction that normally induces pain. These findings collectively suggest that disruption of peptidergic signaling within the joint may be a potential treatment for facet pain, as well as other painful joint conditions associated with elevated NGF, such as osteoarthritis.
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Affiliation(s)
- Jeffrey V Kras
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Christine L Weisshaar
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Parul S Pall
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Morphological study of mechanoreceptors in collateral ligaments of the ankle joint. J Orthop Surg Res 2015; 10:92. [PMID: 26063220 PMCID: PMC4469580 DOI: 10.1186/s13018-015-0215-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/05/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of this study was to analyze the pattern and types of sensory nerve endings in ankle collateral ligaments using histological techniques, in order to observe the morphology and distribution of mechanoreceptors in the collateral ligaments of cadaver ankle joint, and to provide the morphological evidence for the role of the ligament in joint sensory function. METHODS Twelve lateral collateral ligaments including anterior talofibular ligament (ATFL; n = 6), posterior talofibular ligament (PTFL; n = 6), and calcaneofibular ligament (CFL; n = 6) were harvested from six fresh frozen cadavers. The ligaments were embedded in paraffin, sectioned at 4 μm, and then stained using a modified gold-chloride staining methods. The collateral ligament was divided into three segments: proximal, middle, and distal segments. Fifty-four ATFL slides, 90 PTFL slides, and 108 CFL slides were analyzed. Mechanoreceptors were classified based on Freemen and Wyke's classification. Mechanoreceptor distribution was analyzed statistically. One-way ANOVA (postHoc LSD) was used for statistical analysis. RESULTS All the four typical types of nerve endings (the Ruffini corpuscles, Pacinian corpuscles, Golgi tendon organs, and free nerve endings) were identified in these ligaments. Pacinian corpuscles were the predominant in all four complexes. More mechanoreceptors were found in synovial membrane near both ends of the ligaments attached to the bone. No statistical differences were found in the amount of mechanoreceptors among distal, middle, and proximal parts of the ligaments. CONCLUSIONS The four typical types of mechanoreceptors were all identified in the collateral ligaments of the human ankle. Pacinian corpuscles were the predominant in all four complexes. This indicates that the main function of ankle collateral ligaments is to sense joint speeds in motions.
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Abstract
Although most patients recover from acute whiplash injuries, those with chronic whiplash syndrome develop signs of central nervous system (CNS) amplification of pain and have a poor prognosis. In this context, specific pain generators from acute whiplash have been identified through clinical, biomechanical, and animal studies. This article gives a clinical perspective on current understanding of these pain generators, including the phenomenon of CNS sensitization.
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Affiliation(s)
- Richard Seroussi
- Department of Rehabilitation Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356490, Seattle, WA 98195, USA; Seattle Spine & Sports Medicine, 3213 Eastlake Avenue East, Suite A, Seattle, WA 98102, USA.
| | - Virtaj Singh
- Department of Rehabilitation Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356490, Seattle, WA 98195, USA; Seattle Spine & Sports Medicine, 3213 Eastlake Avenue East, Suite A, Seattle, WA 98102, USA
| | - Adrielle Fry
- Department of Rehabilitation Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356490, Seattle, WA 98195, USA
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Analgesic therapy for major spine surgery. Neurosurg Rev 2015; 38:407-18; discussion 419. [DOI: 10.1007/s10143-015-0605-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/13/2014] [Accepted: 11/16/2014] [Indexed: 12/11/2022]
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L’Heureux-Lebeau B, Godbout A, Berbiche D, Saliba I. Evaluation of Paraclinical Tests in the Diagnosis of Cervicogenic Dizziness. Otol Neurotol 2014; 35:1858-65. [DOI: 10.1097/mao.0000000000000506] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Crosby ND, Gilliland TM, Winkelstein BA. Early afferent activity from the facet joint after painful trauma to its capsule potentiates neuronal excitability and glutamate signaling in the spinal cord. Pain 2014; 155:1878-1887. [PMID: 24978827 DOI: 10.1016/j.pain.2014.06.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 06/19/2014] [Accepted: 06/22/2014] [Indexed: 11/25/2022]
Abstract
Cervical facet joint injury induces persistent pain and central sensitization. Preventing the peripheral neuronal signals that initiate sensitization attenuates neuropathic pain. Yet, there is no clear relationship among facet joint afferent activity, development of central sensitization, and pain, which may be hindering effective treatments for this pain syndrome. This study investigates how afferent activity from the injured cervical facet joint affects induction of behavioral sensitivity and central sensitization. Intra-articular bupivacaine was administered to transiently suppress afferent activity immediately or 4 days after facet injury. Mechanical hyperalgesia was monitored after injury, and spinal neuronal hyperexcitability and spinal expression of proteins that promote neuronal excitability were measured on day 7. Facet injury with saline vehicle treatment induced significant mechanical hyperalgesia (P<.027), dorsal horn neuronal hyperexcitability (P<.026), upregulation of pERK1/2, pNR1, mGluR5, GLAST, and GFAP, and downregulation of GLT1 (P<.032). However, intra-articular bupivacaine immediately after injury significantly attenuated hyperalgesia (P<.0001), neuronal hyperexcitability (P<.004), and dysregulation of excitatory signaling proteins (P<.049). In contrast, intra-articular bupivacaine at day 4 had no effect on these outcomes. Silencing afferent activity during the development of neuronal hyperexcitability (4 hours, 8 hours, 1 day) attenuated hyperalgesia and neuronal hyperexcitability (P<.045) only for the treatment given 4 hours after injury. This study suggests that early afferent activity from the injured facet induces development of spinal sensitization via spinal excitatory glutamatergic signaling. Peripheral intervention blocking afferent activity is effective only over a short period of time early after injury and before spinal modifications develop, and is independent of modulating spinal glial activation.
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Affiliation(s)
- Nathan D Crosby
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
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Increased interleukin-1α and prostaglandin E2 expression in the spinal cord at 1 day after painful facet joint injury: evidence of early spinal inflammation. Spine (Phila Pa 1976) 2014; 39:207-12. [PMID: 24253784 PMCID: PMC3946680 DOI: 10.1097/brs.0000000000000107] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study used immunohistochemistry and an enzyme immunoassay to quantify interleukin-1α (IL-1α) and prostaglandin E2 (PGE2) levels in the spinal cord of rats at 1 day after painful cervical facet joint injury. OBJECTIVE The objective of this study was to determine to what extent spinal inflammation is initiated early after a painful loading-induced injury of the C6-C7 facet joint in a rat model. SUMMARY OF BACKGROUND DATA A common source of neck pain, the cervical facet joint is susceptible to loading-induced injury, which can lead to persistent pain. IL-1α and PGE2 are associated with joint inflammation and pain, both locally in the joint and centrally in the spinal cord. Joint inflammation has been shown to contribute to pain after facet joint injury. Although spinal neuronal hyperactivity is evident within 1 day of painful facet injury, it is unknown if inflammatory mediators, such as IL-1α and PGE2, are also induced early after painful injury. METHODS Rats underwent either a painful C6-C7 facet joint distraction or sham procedure. Mechanical sensitivity was assessed, and immunohistochemical and enzyme immunoassay techniques were used to quantify IL-1α and PGE2 expression in the spinal cord at day 1. RESULTS Both IL-1α and PGE2 were significantly elevated (P≤ 0.04) at day 1 after painful injury. Moreover, although both spinal IL-1α and PGE2 levels were correlated with the withdrawal threshold in response to mechanical stimulation of the forepaw, this correlation was only significant (P = 0.01) for PGE2. CONCLUSION The increased expression of 2 inflammatory markers in the spinal cord at 1 day after painful joint injury suggests that spinal inflammation may contribute to the initiation of pain after cervical facet joint injury. Further studies will help identify functional roles of both spinal IL-1α and PGE2 in loading-induced joint pain. LEVEL OF EVIDENCE N/A.
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Smith AD, Jull G, Schneider G, Frizzell B, Hooper RA, Sterling M. Cervical Radiofrequency Neurotomy Reduces Central Hyperexcitability and Improves Neck Movement in Individuals with Chronic Whiplash. PAIN MEDICINE 2014; 15:128-41. [DOI: 10.1111/pme.12262] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Dong L, Crosby ND, Winkelstein BA. Gabapentin alleviates facet-mediated pain in the rat through reduced neuronal hyperexcitability and astrocytic activation in the spinal cord. THE JOURNAL OF PAIN 2013; 14:1564-72. [PMID: 24094695 DOI: 10.1016/j.jpain.2013.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 05/21/2013] [Accepted: 07/18/2013] [Indexed: 01/29/2023]
Abstract
UNLABELLED Although joint pain is common, its mechanisms remain undefined, with little known about the spinal neuronal responses that contribute to this type of pain. Afferent activity and sustained spinal neuronal hyperexcitability correlate to facet joint loading and the extent of behavioral sensitivity induced after painful facet injury, suggesting that spinal neuronal plasticity is induced in association with facet-mediated pain. This study used a rat model of painful C6-C7 facet joint stretch, together with intrathecal administration of gabapentin, to investigate the effects of one aspect of spinal neuronal function on joint pain. Gabapentin or saline vehicle was given via lumbar puncture prior to and at 1 day after painful joint distraction. Mechanical hyperalgesia was measured in the forepaw for 7 days. Extracellular recordings of neuronal activity and astrocytic and microglial activation in the cervical spinal cord were evaluated at day 7. Gabapentin significantly (P = .0001) attenuated mechanical hyperalgesia, and the frequency of evoked neuronal firing also significantly decreased (P < .047) with gabapentin treatment. Gabapentin also decreased (P < .04) spinal glial fibrillary acidic protein expression. Although spinal Iba1 expression was doubled over sham, gabapentin did not reduce it. Facet joint-mediated pain appears to be sustained through spinal neuronal modifications that are also associated with astrocytic activation. PERSPECTIVE Intrathecal gabapentin treatment was used to investigate behavioral, neuronal, and glial response in a rat model of painful C6-C7 facet joint stretch. Gabapentin attenuated mechanical hyperalgesia, reduced evoked neuronal firing, and decreased spinal astrocytic activation. This study supports that facet joint pain is sustained through spinal neuronal and astrocytic activation.
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Affiliation(s)
- Ling Dong
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
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Spinal neuronal plasticity is evident within 1 day after a painful cervical facet joint injury. Neurosci Lett 2013; 542:102-6. [PMID: 23523644 DOI: 10.1016/j.neulet.2013.03.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 02/20/2013] [Accepted: 03/04/2013] [Indexed: 01/17/2023]
Abstract
Excessive stretch of the cervical facet capsular ligament induces persistent pain and spinal plasticity at later time points. Yet, it is not known when such spinal modifications are initiated following this painful injury. This study investigates the development of hyperalgesia and neuronal hyperexcitability in the spinal cord after a facet joint injury. Behavioral sensitivity was measured in a model of painful C6/C7 facet joint injury in the rat, and neuronal hyperexcitability in the spinal cord was evaluated at 6h and 1 day after injury or a sham procedure, in separate groups. Extracellular recordings of C6/C7 dorsal horn neuronal activity (229 neurons) were used to quantify spontaneous and evoked firing. Rats exhibited no change in sensitivity to mechanical stimulation of the forepaw at 6h, but did exhibit increased sensitivity at 1 day after injury (p=0.012). At 6h, both spontaneous neuronal activity and firing evoked by light brushing, pinch, and von Frey filaments (1.4-26g) applied at the forepaw were not different between sham and injury. At 1 day, spontaneous firing was noted in a greater number of neurons after injury than sham (p<0.04). Evoked firing was also increased 1 day after injury compared to normal and sham (p<0.03). Dorsal horn hyperexcitability and increased spontaneous firing developed between 6 and 24h after painful facet injury, suggesting that the development of hyperalgesia parallels dorsal horn hyperexcitability following mechanical facet joint injury, and these spinal mechanisms are initiated as early as 1 day after injury.
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An anatomical and immunohistochemical characterization of afferents innervating the C6-C7 facet joint after painful joint loading in the rat. Spine (Phila Pa 1976) 2013; 38:E325-31. [PMID: 23324931 PMCID: PMC3600108 DOI: 10.1097/brs.0b013e318285b5bb] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study used retrograde neuronal tracing and immunohistochemistry to identify neurons innervating the C6-C7 facet joint and those expressing calcitonin gene-related peptide (CGRP) in the dorsal root ganglion (DRG) of rats after painful cervical facet joint injury. OBJECTIVE The objective of this study was to characterize the innervation of the C6-C7 facet joint after painful joint injury in the rat. SUMMARY OF BACKGROUND DATA The cervical facet joint is a source of neck pain, and its loading can initiate persistent pain. CGRP is a nociceptive neurotransmitter; peptidergic afferents have been identified in the facet joint's capsule. Although studies suggest that facet joint injury alters CGRP expression in joint afferents, the distribution of neurons innervating the C6-C7 facet joint and their expression of CGRP after a painful joint injury have not been investigated. METHODS Holtzman rats (Harlan Sprague-Dawley, Indianapolis, IN) received an intra-articular injection of cholera toxin subunit B in the C6-C7 facet joints. After injection, subgroups underwent either a painful joint distraction or sham procedure. Mechanical sensitivity was assessed, and immunohistochemical techniques were used to quantify CGRP expression and cholera toxin subunit B labeling in the C5-C8 DRGs. RESULTS Facet joint distraction-induced (P ≤ 0.0002) hypersensitivity. Neurons labeled by the joint injection were identified in the C5-C8 DRGs. Significantly, more (P ≤ 0.0001) cholera toxin subunit B-positive neurons were identified in the C7 DRG than any other level. At C7, 54.4% ± 15.3% of those neurons were also CGRP-positive, whereas only 41.5% ± 5.4% of all neurons were CGRP-positive; this difference was significant (P = 0.0084). CONCLUSION The greatest number of afferents from the C6-C7 facet joint has cell bodies in the C7 DRG, implicating this level as the most relevant for pain from this joint. In addition, peptidergic afferents seem to have an important role in facet joint-mediated pain.
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Yoganandan N, Stemper BD, Rao RD. Patient Mechanisms of Injury in Whiplash-Associated Disorders. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.semss.2012.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Dong L, Quindlen JC, Lipschutz DE, Winkelstein BA. Whiplash-like facet joint loading initiates glutamatergic responses in the DRG and spinal cord associated with behavioral hypersensitivity. Brain Res 2012; 1461:51-63. [PMID: 22578356 DOI: 10.1016/j.brainres.2012.04.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 04/05/2012] [Accepted: 04/13/2012] [Indexed: 12/25/2022]
Abstract
The cervical facet joint and its capsule are a common source of neck pain from whiplash. Mechanical hyperalgesia elicited by painful facet joint distraction is associated with spinal neuronal hyperexcitability that can be induced by transmitter/receptor systems that potentiate the synaptic activation of neurons. This study investigated the temporal response of a glutamate receptor and transporters in the dorsal root ganglia (DRG) and spinal cord. Bilateral C6/C7 facet joint distractions were imposed in the rat either to produce behavioral sensitivity or without inducing any sensitivity. Neuronal metabotropic glutamate receptor-5 (mGluR5) and protein kinase C-epsilon (PKCε) expression in the DRG and spinal cord were evaluated on days 1 and 7. Spinal expression of a glutamate transporter, excitatory amino acid carrier 1 (EAAC1), was also quantified at both time points. Painful distraction produced immediate behavioral hypersensitivity that was sustained for 7 days. Increased expression of mGluR5 and PKCε in the DRG was not evident until day 7 and only following painful distraction; this increase was observed in small-diameter neurons. Only painful facet joint distraction produced a significant increase (p<0.001) in neuronal mGluR5 over time, and this increase also was significantly elevated (p≤0.05) over responses in the other groups at day 7. However, there were no differences in spinal PKCε expression on either day or between groups. Spinal EAAC1 expression was significantly increased (p<0.03) only in the nonpainful groups on day 7. Results from this study suggest that spinal glutamatergic plasticity is selectively modulated in association with facet-mediated pain.
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Affiliation(s)
- Ling Dong
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
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Screening of patients suitable for diagnostic cervical facet joint blocks – A role for physiotherapists. ACTA ACUST UNITED AC 2012; 17:180-3. [DOI: 10.1016/j.math.2011.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 11/13/2011] [Accepted: 11/17/2011] [Indexed: 01/03/2023]
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Jaumard NV, Welch WC, Winkelstein BA. Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions. J Biomech Eng 2011; 133:071010. [PMID: 21823749 DOI: 10.1115/1.4004493] [Citation(s) in RCA: 200] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The facet joint is a crucial anatomic region of the spine owing to its biomechanical role in facilitating articulation of the vertebrae of the spinal column. It is a diarthrodial joint with opposing articular cartilage surfaces that provide a low friction environment and a ligamentous capsule that encloses the joint space. Together with the disc, the bilateral facet joints transfer loads and guide and constrain motions in the spine due to their geometry and mechanical function. Although a great deal of research has focused on defining the biomechanics of the spine and the form and function of the disc, the facet joint has only recently become the focus of experimental, computational and clinical studies. This mechanical behavior ensures the normal health and function of the spine during physiologic loading but can also lead to its dysfunction when the tissues of the facet joint are altered either by injury, degeneration or as a result of surgical modification of the spine. The anatomical, biomechanical and physiological characteristics of the facet joints in the cervical and lumbar spines have become the focus of increased attention recently with the advent of surgical procedures of the spine, such as disc repair and replacement, which may impact facet responses. Accordingly, this review summarizes the relevant anatomy and biomechanics of the facet joint and the individual tissues that comprise it. In order to better understand the physiological implications of tissue loading in all conditions, a review of mechanotransduction pathways in the cartilage, ligament and bone is also presented ranging from the tissue-level scale to cellular modifications. With this context, experimental studies are summarized as they relate to the most common modifications that alter the biomechanics and health of the spine-injury and degeneration. In addition, many computational and finite element models have been developed that enable more-detailed and specific investigations of the facet joint and its tissues than are provided by experimental approaches and also that expand their utility for the field of biomechanics. These are also reviewed to provide a more complete summary of the current knowledge of facet joint mechanics. Overall, the goal of this review is to present a comprehensive review of the breadth and depth of knowledge regarding the mechanical and adaptive responses of the facet joint and its tissues across a variety of relevant size scales.
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Affiliation(s)
- Nicolas V Jaumard
- Dept. of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
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The natural history and clinical syndromes of degenerative cervical spondylosis. Adv Orthop 2011; 2012:393642. [PMID: 22162812 PMCID: PMC3227226 DOI: 10.1155/2012/393642] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 09/08/2011] [Accepted: 09/26/2011] [Indexed: 11/18/2022] Open
Abstract
Cervical spondylosis is a broad term which describes the age related chronic disc degeneration, which can also affect the cervical vertebrae, the facet and other joints and their associated soft tissue supports. Evidence of spondylitic change is frequently found in many asymptomatic adults. Radiculopathy is a result of intervertebral foramina narrowing. Narrowing of the spinal canal can result in spinal cord compression, ultimately resulting in cervical spondylosis myelopathy. This review article examines the current literature in relation to the cervical spondylosis and describes the three clinical syndromes of axial neck pain, cervical radiculopathy and cervical myelopathy
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Dong L, Guarino BB, Jordan-Sciutto KL, Winkelstein BA. Activating transcription factor 4, a mediator of the integrated stress response, is increased in the dorsal root ganglia following painful facet joint distraction. Neuroscience 2011; 193:377-86. [PMID: 21821103 PMCID: PMC3171593 DOI: 10.1016/j.neuroscience.2011.07.059] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 07/01/2011] [Accepted: 07/24/2011] [Indexed: 02/06/2023]
Abstract
Chronic neck pain is one of the most common musculoskeletal disorders in the US. Although biomechanical and clinical studies have implicated the facet joint as a primary source of neck pain, specific cellular mechanisms still remain speculative. The purpose of this study was to investigate whether a mediator (activating transcription factor; 4ATF4) of the integrated stress response (ISR) is involved in facet-mediated pain. Holtzman rats underwent C6/C7 facet joint loading that produces either painful (n=16) or nonpainful (n=8) responses. A sham group (n=9) was also included as surgical controls. Behavioral sensitivity was measured and the C6 dorsal root ganglia (DRGs) were harvested on day 7 to evaluate the total and neuronal ATF4 expression. In separate groups, an intra-articular ketorolac injection was administered either immediately (D0 ketorolac) or 1 day (D1 ketorolac) after painful facet joint loading. Allodynia was measured at days 1 and 7 after injury to assess the effects on behavioral responses. ATF4 and BiP (an indicator of ISR activation) were separately quantified at day 7. Facet joint loading sufficient to elicit behavioral hypersensitivity produced a threefold increase in total and neuronal ATF4 expression in the DRG. After ketorolac treatment at the time of injury, ATF4 expression was significantly (P<0.01) reduced despite not producing any attenuation of behavioral responses. Interestingly, ketorolac treatment at day 1 significantly (P<0.001) alleviated behavioral sensitivity at day 7, but did not modify ATF4 expression. BiP expression was unchanged after either intervention time. Results suggest that ATF4-dependent activation of the ISR does not directly contribute to persistent pain, but it may sensitize neurons responsible for pain initiation. These behavioral and immunohistochemical findings imply that facet-mediated pain may be sustained through other pathways of the ISR.
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Affiliation(s)
- Ling Dong
- Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104, USA
| | - Benjamin B. Guarino
- Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104, USA
| | | | - Beth A. Winkelstein
- Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104, USA
- Department of Neurosurgery University of Pennsylvania Philadelphia, PA 19104, USA
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Basho R, Bhalla A, Wang JC. Neck Pain from a Spine Surgeon’s Perspective. Phys Med Rehabil Clin N Am 2011; 22:551-5, x. [DOI: 10.1016/j.pmr.2011.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
The cervical zygapophyseal joints, or facet joints, have long been implicated as a source of neck pain. This article examines the epidemiology of pain arising from these joints and relevant anatomy and histology. An emphasis on clinical findings, examination, and imaging are presented, as well as a focus on whiplash-associated pain.
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Affiliation(s)
- Alfred C Gellhorn
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98105, USA.
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Schneider GM, Smith AD, Hooper A, Stratford P, Schneider KJ, Westaway MD, Frizzell B, Olson L. Minimizing the source of nociception and its concurrent effect on sensory hypersensitivity: an exploratory study in chronic whiplash patients. BMC Musculoskelet Disord 2010; 11:29. [PMID: 20144214 PMCID: PMC2829507 DOI: 10.1186/1471-2474-11-29] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 02/09/2010] [Indexed: 12/21/2022] Open
Abstract
Background The cervical zygapophyseal joints may be a primary source of pain in up to 60% of individuals with chronic whiplash associated disorders (WAD) and may be a contributing factor for peripheral and centrally mediated pain (sensory hypersensitivity). Sensory hypersensitivity has been associated with a poor prognosis. The purpose of the study was to determine if there is a change in measures indicative of sensory hypersensitivity in patients with chronic WAD grade II following a medial branch block (MBB) procedure in the cervical spine. Methods Measures of sensory hypersensitivity were taken via quantitative sensory testing (QST) consisting of pressure pain thresholds (PPT's) and cold pain thresholds (CPT's). In patients with chronic WAD (n = 18), the measures were taken at three sites bilaterally, pre- and post- MBB. Reduced pain thresholds at remote sites have been considered an indicator of central hypersensitivity. A healthy age and gender matched comparison group (n = 18) was measured at baseline. An independent t-test was applied to determine if there were any significant differences between the WAD and normative comparison groups at baseline with respect to cold pain and pressure pain thresholds. A dependent t-test was used to determine whether there were any significant differences between the pre and post intervention cold pain and pressure pain thresholds in the patients with chronic WAD. Results At baseline, PPT's were decreased at all three sites in the WAD group (p < 0.001). Cold pain thresholds were increased in the cervical spine in the WAD group (p < 0.001). Post-MBB, the WAD group showed significant increases in PPT's at all sites (p < 0.05), and significant decreases in CPT's at the cervical spine (p < 0.001). Conclusions The patients with chronic WAD showed evidence of widespread sensory hypersensitivity to mechanical and thermal stimuli. The WAD group revealed decreased sensory hypersensitivity following a decrease in their primary source of pain stemming from the cervical zygapophyseal joints.
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Affiliation(s)
- Geoff M Schneider
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Position accuracy and electromyographic responses during head reposition in young adults with chronic neck pain. J Electromyogr Kinesiol 2009; 20:1014-20. [PMID: 20005126 DOI: 10.1016/j.jelekin.2009.11.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 10/30/2009] [Accepted: 11/05/2009] [Indexed: 11/20/2022] Open
Abstract
The head reposition test is traditionally used to examine the proprioceptive sensitivity of the neck. The aim of this study was to investigate the position accuracy and corresponding cervical electromyographic (EMG) responses of the neck pain subjects during sagittal head-to-neutral tasks. Twelve young subjects with chronic neck pain and twelve young healthy subjects were recruited. The position accuracy was measured by the constant error, variable error, and root mean square error of joint angles during head-to-neutral tasks in flexion and extension directions. Surface EMG of neck flexors and extensors were analyzed by the voluntary response index, including the similarity index (SI) and electromyographic magnitude (MAG) of muscle groups. The normalized average integration of EMG activity (NAIEMG) of individual muscle was also calculated. The results showed: (1) significantly larger constant error and root mean square error but similar variable error in patients compared with controls, (2) smaller SI but similar MAG in patients compared with controls, (3) greater synergistic/antagonistic NAIEMG in patients than controls. The findings suggested that young adults with chronic neck pain exhibit proprioceptive dysfunction and altered EMG pattern during voluntary sagittal neck motions. This study provides guidelines which could lead to the development of therapeutic exercise programs.
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Tsai CT, Hsieh LF, Kuan TS, Kao MJ, Hong CZ. Injection in the cervical facet joint for shoulder pain with myofascial trigger points in the upper trapezius muscle. Orthopedics 2009; 32:orthopedics.41914. [PMID: 19708635 DOI: 10.3928/01477447-20090624-04] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The goal of this double-blinded, randomized, controlled study was to confirm the effectiveness of the cervical facet joint injection in treating shoulder pain with the myofascial trigger point in the upper trapezius muscle secondary to cervical facet lesion. Eighty-nine patients with chronic unilateral shoulder pain due to myofascial trigger points in the upper trapezius muscle received an injection to the C4-5 facet joint in the experimental group and to the corresponding unilateral multifidi muscle in the control group. Subjective pain intensity and pressure pain threshold of the myofascial trigger point were assessed, and the prevalence of endplate noise in the myofascial trigger point region was measured in 28 patients before, immediately after, and 1 month after the injection. Half of the patients in the experimental group, but none of the control patients, reported being completely pain free 1 month after the injection. Both the decrease in the pain intensity and the increase in pressure pain threshold were significantly more in the experimental group than in the control group either immediately or 1 month after the injection. There was no significant difference in the change of endplate noise prevalence between the 2 groups. This study demonstrates that intra-articular or peri-articular injection into the cervical facet joint region can effectively inactivate the upper trapezius myofascial trigger point secondary to the facet lesion.
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Affiliation(s)
- Chien-Tsung Tsai
- Department of Rehabilitation Medicine, Da Chien General Hospital, Miao-Li City, Taiwan
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Head repositioning accuracy and posturography related to cervical facet nerve blockade and spinal manipulative therapy in healthy volunteers: a time series study. J Manipulative Physiol Ther 2009; 32:193-202. [PMID: 19362229 DOI: 10.1016/j.jmpt.2009.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 12/09/2008] [Accepted: 01/05/2009] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of the study was to investigate if changes in head repositioning accuracy (HRA), and standing balance could be evoked by unilateral facet nerve blockade (FNB) or spinal manipulative therapy (SMT). METHODS This time series research study (n = 6) was chosen because of the viability of the experiment, sample characteristics, and small sample size. Cervical proprioceptive functions were assessed by exploring HRA and static posture by computerized posturography. All participants were subjected to 2 interventions, unilateral FNB using local anesthetic and SMT. RESULTS No significant trends were seen in the subjects over the period of the study. All measurements were taken approximately 3 weeks apart. Visually, it was detected that most of subjects appeared to be greatly affected by the FNB, thus, increasing their deviation from the center point of measurement in extension and flexion movements. When comparing the changes with respect to the baseline after SMT, all subjects showed some differences, though there was a great deal of variation between the subjects. These trends were also seen when comparing the changes from baseline measurements to those after FNB. CONCLUSIONS Data from this time series research design suggest there was no uniform response to unilateral FNB or to SMT. However, differences indicate that there may be important effects of unilateral FNBs for some of the HRA aspects measured. Balance testing using computerized posturography did not show clear differences between baseline assessments and interventions. A future larger clinical study to detect changes in HRA evoked by unilateral FNB or SMT appears feasible.
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Dong L, Odeleye AO, Jordan-Sciutto KL, Winkelstein BA. Painful facet joint injury induces neuronal stress activation in the DRG: implications for cellular mechanisms of pain. Neurosci Lett 2008; 443:90-4. [PMID: 18675314 DOI: 10.1016/j.neulet.2008.07.059] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 07/16/2008] [Accepted: 07/16/2008] [Indexed: 12/20/2022]
Abstract
The cervical facet joint is implicated as one of the most common sources of chronic neck pain, owing to its rich nociceptive innervation and susceptibility to injurious mechanical loading. Injuries to the facet joint and its ligament can induce inflammation in the joint and spinal cord. Inflammatory molecules which are known to have a role in pain can also stimulate the integrated stress response (ISR). Therefore, we hypothesize that ISR is activated by facet joint injury in a rodent model of pain. To address this hypothesis, we assessed the expression of binding protein (BiP) (also known as growth-related protein 78 (GRP78)), a marker of endoplasmic reticulum stress response, in the dorsal root ganglion (DRG) after painful facet joint injury. In a rodent model of facet joint injury, dynamic distraction of the C6/C7 joint (injury, n=12) was imposed; sham procedures were performed separately (sham, n=8). Forepaw mechanical allodynia was assessed postoperatively for 7 days as a quantitative measure of pain symptoms. The C6 DRG was harvested and assessed for BiP expression using triple label immunofluorescent confocal microscopy and immunoblot analyses. BiP was significantly higher (p<0.001) in the DRG after injury than sham and was expressed predominantly in neurons. Similarly, quantification of BiP by immunoblot demonstrated a significant 2.1-fold increase (p=0.03) in injury compared to sham at day 7. Findings suggest neuronal stress activation is associated with painful facet joint injury, and that joint loading may directly mediate the behavior of DRG neurons in this class of injury.
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Affiliation(s)
- Ling Dong
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
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