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IAOM-US

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IAOM-US

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• WHO

•PAIN, ARM PARESTHESIA, AND HEADACHES

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• WHERE• PAIN

• PARESTHESIA

• HEADACHES

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• WHAT• PAIN, PARESTHESIA, AND HEADACHES

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IAOM-US

• WHAT•

• HEADACHES WITH REFERRAL TO JAW•

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Bogduk N.)Cervicogenic)Headache:)Anatomic)Basis)and)Pathophysiologic)Mechanisms.)Current)Pain)and)Headache)Reports)2001,)5:382–386.Bogduk N.)The)Neck)and)Headaches.)Neurol)Clin.)2014;))32:471–487.Chua)NHL)et)al.)Understanding)cervicogenic)headache.)Anesth Pain.)2012;2(1):3P4.LaGrew J,)et)al.)Incidence)of)Cervicogenic)Headache)Following)Lower)Cervical)Radiofrequency)Neurotomy.)Pain)Physician.)2019;)22:E127PE132.

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WHAT

• PROJECTION NEURONS IN UPPER 3 CERVICAL SEGMENTS RECEIVE BOTHTRIGEMINAL & CERVICAL AFFERENT INPUT.

• PAIN INTERPRETATION FROM CERVICALSTRUCTURE CAN BE NECK OR HEAD

IAOM-US

Biondi.'DM.'Cervicogenic'headache:'mechanisms,'evaluation,'and'treatment'strategies.'J'Am'Osteopath'Assoc.'2000.'Sep;'100(9suppl):S7F14.Sjaastad O,'et'al.'The'localization'of'the'initial'pain'of'attack.'A'comparison'between'classic'migraine'and'cervicogenic'headache.'Funct Neurol.'1989;'4(1):73F78.Li''S,''Feng'D.'Pulsed'radiofrequency'of'the'C2'dorsal'root'ganglion'and'epidural'steroid'injections'for'cervicogenic'headache.'Neurological'Sciences.'2019;Vol.'40'Issue'6,'pp.'1173–1181.

• WHAT• PAIN

• PAIN•

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IAOM-US

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Peng B, DePalma M. Cervical disc degeneration and neck pain. J Pain Res. 2018; 11:2853-2857.Peng G, Bogduk N. Cervical Discs as a Source of Neck Pain. An Analysis of the Evidence. Pain Med. 2019; 20:446-455.Onyewu O, et al. An update of the appraisal of the accuracy and utility of cervical discography in chronic neck pain. Pain Physician. 2012; 15:E777-E806.*Yin W, Bogduk N. The Nature of Neck Pain in a Private Pain Clinic in the United States. Pain Medicine. 2008; 9:196-203.Brismee JM, et al. Immunohistochemical and histological study of human uncovertebral joints. Spine. 2009; 34:1257-1263.

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• TO WHAT EXTENT•

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• CLINICAL REASONING•

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IAOM-USKane P, et al. Double crush syndrome: Review article. J Am Acad Orthop Surg 2015;23: 558-562.

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Schellhas KP,+et+al.+Cervical+discogenic+pain.+Prospective+correlation+of+magnetic+resonance+imaging+and+discography+in+asymptomatic+subjects+and+pain+sufferers.+Spine.+1996;21:300E312.Bogduk N.+Functional+anatomy+of+the+spine.+Handbook+of+Clinical+Neurology.+2016;+Vol+136:+675E688.Wu+B,+et+al.+Ingrowth+of+nociceptive+receptors+into+diseased+cervical+and+intervertebral+disc+is+associated+with+discogenic+neck+pain.+Pain+Medicine.+2019;+20:1072E1077.Peng+B,+Bogduk N.+Cervical+discs+as+a+source+of+pain.+An+analysis+of+the+evidence.+Pain+Medicine.+2019;+20:446E455.

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• WHERE•

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IAOM-US

Slipman C, et al. Provocative cervical discography symptom mapping. The Spine Journal. 2005; 5:381-388.Schellhas K, et al. Cervical discogenic pain: prospective correlation of magnetic resonance imaging and discography in asymptomatic subjects and pain sufferers. Spine 1996; 21(3):300–11. Grubb SA, Kelly CK. Cervical discography: Clinical implications from 12 years of experience. Spine 2000; 25:1382–9.Diener'H,'et'al.'Lower'cervical'disc'prolapse'may'cause'cervicogenic'headache:'prospective'study'in'patients'undergoing'surgery.'Cephalalgia.'2007@27(9):1050F4.''

IAOM-US

Dreyfuss(P,(et(al.(Atlanto2occipital(and(lateral(atlanto2axial(joint(pain(patterns.(Spine.(1994(May(15;19(10):1125231.Paluzzi A,(et(al.(The(role(of(the(C2(articular(branches(in(occipital(headache:(An(anatomical(study.(Clinical(Anatomy.(2006;(19:4072502.Cooper(G,(et(al.(Cervical(zygapophysial(joint(pain(maps.(Pain(Med.(2007;(8(4):3442353.

WHAT• Headaches with referral to jaw• C1-2

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IAOM-US

WHAT• Pain and headaches• Disc segments

• Facet• uncovertebral

Cooper&G,&et&al.&Cervical&zygapophysial&joint&pain&maps.&Pain&Med.&2007;&8(4):344E353.Bogduk N.&Functional&anatomy&of&the&spine.&Handbook&of&Clinical&Neurology.&2016;&Vol&136:&675E688.Brismee&JM,&et&al.&Immunohistochemical&and&histological&study&of&human&uncovertebral&joints.&Spine.&2009;&34:1257E1263.Dwyer&A,&Aprill C,&Bogduk N.&Cervical&zygapophyseal&joint&pain&patterns.&I:&A&study&in&normal&volunteers.&Spine&(Phila&Pa&1976).&1990&Jun;15(6):453E7.&

IAOM-US Cooper&G,&et&al.&Cervical&zygapophysial&joint&pain&maps.&Pain&Med.&2007;&8(4):344E353.Bogduk N.&Functional&anatomy&of&the&spine.&Handbook&of&Clinical&Neurology.&2016;&Vol&136:&675E688.Dwyer&A,&Aprill C,&Bogduk N.&Cervical&zygapophyseal&joint&pain&patterns.&I:&A&study&in&normal&volunteers.&Spine&(Phila&Pa&1976).&1990&Jun;15(6):453E7.&

WHERE• Neck pain, Headaches

• C2-3• Neck pain, Headaches with

referral to Jaw/Face• C3-4

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• WHERE•

• FACET JOINT PAIN•

PARTICULAR CERVICALZYGAPOPHYSIAL JOINTS VARIESCONSIDERABLY; MORE SO THAN INSTUDIES OF NORMAL VOLUNTEERS

IAOM-US

**Cooper(G,(et(al.(Cervical(zygapophysial(joint(pain(maps.(Pain(Med.(2007@(8(4):344G353.

WHERE & WHAT: PAIN, (PARESTHESIA)

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IAOM-US

Weller%J,%et%al.%Myofascial pain.%Semin Neurol 2018;38:640–643.

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PARESTHESIA &/OR VAGUE PAIN IN ONE

IAOM-US

Mellick'GA,'Mellick'LB.'Clinical'presentation,'quantitative'sensory'testing,'and'therapy'of'2'patients'with'fourth'thoracic'syndrome.'J'Manipulative'Physiol Ther.'2006;29(5):403N8.'Conroy'JL,'Schneiders AG.'The'T4'syndrome.'Manual'Therapy'2005;10:292N296.Evans'P.'The'T4:'syndrome'some'basic'science'aspects.'Physiotherapy'1997;83(4):186N189

IAOM-US Wang E, Wang D. Treatment of cervicogenic headache with cervical epidural steroid injection. Curr Pain Headache Rep. 2014; 18:442.Slipman CW, et al. Symptom provocation of fluoroscopically guided cervical nerve root stimulation. Are dynatomal maps identical to dermatomal maps. Spine. 1998;23:2235-2242.Woods B, Hilibrand A. Cervical Radiculopathy Epidemiology, Etiology, Diagnosis, and Treatment. J Spinal Disord Tech. 2015; 28,E251-E259.

Where & what: pain, (paresthesia) Cervical nerve roots• Dynatome versus dermatome

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• WHEN

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IAOM-US

• TO WHAT EXTENT

• ABOUT 4 YEARSAGO, GRADUALLY

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• PAST MEDICAL HISTORY

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IAOM-US

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IAOM-US

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IAOM-US

Maus T. Imagine of spinal stenosis: Neurogenic intermittent claudication and cervical spondylolytic myelopathy. Radiol Clin N Am. 2012; 50:651-670.Joao LM, et al. Spinal stenosis. Handbook of Clinical Neurology. 2014. Vol 119.Hartman J. Anatomy and Clinical Significance of the Uncinate Process and Uncovertebral Joint: A Comprehensive Review. Clinical Anatomy. 2014; 27:431-440.

By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 579, Public Domain, https://commons.wikimedia.org/w/index.php?curid=560932

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IAOM-USFelbaum D, et al. Relief of lumbar symptoms after cervical decompression in patients with tandem spinal stenosis presenting with primarily lumbar pain. Cureus.2016; 8(12):e940.Ghobrial GM, et al. Management of asymptomatic cervical spinal stenosis in the setting of symptomatic tandem lumbar stenosis: a review. Clin Neurol Neurosurg. 2014, 124:114–118.

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• ANATOMICAL VARIATION IN THE CERVICAL REGION, MOST ANOMALIES IN THEBODY OCCUR AT C0-2 JUNCTION• UPPER CERVICAL: UP TO 20% BONY VARIABILITY

• ATLANTO-OCCIPITAL FUSION• ODONTOID ANOMALIES• CONGENITAL LAXITY OF THE TRANSVERSE ATLANTAL LIGAMENT• BASILAR IMPRESSION (CERVICAL SPINE/DENS)INDENTS FLOOR OF

SKULL

• CHIARI MALFORMATION: HINDBRAIN DESCENDS INTO THE FORAMENMAGNUM

• FUSION OF 2 VERTEBRAL SEGMENTS: KLIPPEL-FEIL• 124°, GREATER RISK FOR BRAIN STEM LESION WITH HEAD OR NECK

TRAUMA

IAOM-US

Lampropoulou)Adamidou K,/et/al./Congenital/variations/of/the/upper/cervical/spine/and/their/importance/in/preoperative/diagnosis./A/case/report/and areview/of/the/literature./Eur/J/Orthop Surg/Traumatol./2013;/Suppl/1:S101)105.McLemore/LJ./Disorders/of/the/cervical/spine./Radiologic/technology./2011;/83:165)191.Hughes/JE,/Sundaresan N./Anatomy/of/the/Cervical/Spine./In/Clark,/CR./Ed./The/Cervical/Spine./3rd/ed./1998./Philadephia Lippincott)Raven/Publishers.Jain/N,/et/al./CT/and/MR/imaging/of/odontoid/abnormalities:/A/pictorial/review./Indian/J/Radiol Imaging./2016;/26:108)119.Wolff/HD./Die/Sonderstellung/des/Kopfgelenkbereichs:/Grundlagen,/Klinik,/Begutachtung./Berlin:/Springer)Verlag;/1988.

• MULTIFOCALNEUROPATHY

• MULTIFOCAL NEUROPATHY

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IAOM-US

https://www-sciencedirect-com.ezproxy.ttuhsc.edu/topics/medicine-and-dentistry/neuropathy

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Dommerholt J,+Gerwin R.+Nutritional+and+Metabolic+Perpetuating+Factors+in+Myofascial+Pain.+In:+Myofascial+Trigger+Points,+Dommerholt J,+Huijbregts P,+eds.+Jones+and+Bartlett+Publishers;+Sudberry,+Massachusetts.+2011;+25L29.Bennett+RM,+et+al.+Low+levels+of+somatomedin+C+in+patients+with+fibromyalgia+syndrome.+A+possible+link+between+sleep+and+muscle+pain.+Arthritis+and+Rheumatism.+1992;+35:1113L1116.Masi AT,+Hannon+JC.+Human+resting+muscle+tone+(HRMT):+Narrative+introduction+and+modern+concepts.+J+Bodyw Mov+Ther.+2009;+13,2:117L118.Simons+DG,+Mense S.+Understanding+and+measurement+of+muscle+tone+as+related+to+clinical+muscle+pain.+Pain+1998;+75:1L17.Chen+CAN,+et+al.+Human+pain+responsivity+in+a+tonic+pain+model:+Psychological+determinants.+Pain.+1989;+37:143L160.

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Edwards'J.'The'importance'of'postural'habits'in'perpetuating'myofascial'trigger'point'pain.'Acupuncture)in)Medicine.'2005;'23,2:77B82.Blumenfeld'A,'Siavoshi S.'The'challenges'of'cervicogenic'headache.'Current'Pain'and'Headache'Reports.2018;'22:47.BodesBPardo'G,'et'al.'Manual'treatment'for'cervicogenic'headache'and'active'trigger'point'in'the'sternocleidomastoid'muscle:apilot randomized'clinical'trial.'J'Manipulative'Physiol Ther 2013;36:403B411.Fernandez'de'las'Penas C,'et'al.'Myofascial'trigger'points,'neck'mobility,'and'forward'head'posture'in'episodic'tensionBtype'headache.'Headache.'2007'May;47(5):662B72.Cagnie B,'et'al.'Evidence'for'the'use'of'ischemic'compression'and'dry'needling'in'the'management'of'trigger'points'of'the'upper'trapezius'in'patients'with'neck'pain:'A'Systematic'Review.'Am'J'Phys'Med'&'Rehab.'2015;'94:573B583.

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BOW HUNTER’S SYNDROME

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IAOM-US

Duan G,'et'al.'Advances'in'the'Pathogenesis,'Diagnosis'and'Treatment'of'Bow'Hunter’s'Syndrome:'A'Comprehensive'Review'of'the'Literature.'InterventNeurol'2016;5:29–38.Yang'L,'et'al.'Cervical'intervertebral'disc'degeneration'contributes'to'dizziness:'A'clinical'and'immunohistochemical'study.'World'Neurosurgery.'2018;'119:'e686Ue693.Gigliotti'M,'et'al.'A'72UYearUOld'Female'With'Bow'Hunter'Syndrome:'A'Rare'Surgical'Approach'to'C4U5'Vertebral'Artery'Decompression:'2UDimensional'Operative'Video.'Oper Neurosurg.'2020;'19:E310.

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•• IN FVBI&THERE ARE NO OBJECTIVEFINDINGS

IAOM-USMohamed,)E)et)al.)Evaluation)of)patients)with)vertigo)of)vertebrobasilar)insufficiency)origin)using)auditory)brainstem)response,electronystagmography,)and)transcranial)Doppler)International)Journal)of)Audiology)2012;)Early)Online:)1–10.

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• 3 MOST COMMON COMPLAINTS:• – HEADACHE

– DIZZINESS– NECK PAIN

• 50% COMPLAIN OF:- SHOULDER OR ARM PAIN, - PROBLEMS WITH SWALLOWING, - PARESTHESIA IN THE EXTREMITIES

• TREATMENT- MYOFASCIAL- UPPER THORACIC, SYMPATHETIC DAMPENING

IAOM-US Oostendorp A.-Functional-Basilar-Insufficiency.-Nederlandse Tijdschrift of-Fysiotherapie.-1989?9(6):181D186.--

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