to radiculopathy penn state university方法对神经根型颈椎病宾夕法尼亚州立大学课件

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1、CervicalandlowbackpainandradiculopathyJeniceRobinson,MDAssistantProfessorofNeurologyPennStateCollegeofMedicineNBS725January12,2009LearningObjectives:Afterreviewingthecontentofthelecture,thestudentwillbeableto:1)Distinguishsomaticandradicularneckandlowbackpainbymechanismofpain

2、andbyassociatedclinicalsymptomsandsigns2)Describetheanatomyoftheventralanddorsalnerveroots,thelocationofthecellbodiesintheventralhornanddorsalrootganglia,andtheformationofthespinalnerves3)Listcommonsymptomsandsignsofcervicalandlumbosacraldiskherniationcausingnerverootcompress

3、ion4)DrawtheanatomyofthenerverootsattheL4-L5andL5-S1levelsanddemonstratehowadiskherniationattheselevelsmaycompressthenerveroots5)Describediagnosticimagingmethodsforusetoevaluateradicularpain6)Describebasictreatmentofradiculopathycausedbydischerniation7)List‘redflags’intheeval

4、uationofneckandlowbackpainindicatingincreasedriskforapossibleseriousunderlyingcauseofthepainBackandneckpain:VerycommonUpto50%ofworkingadultshavehadabackinjuryinthepastyearBacksymptomsmostcommoncauseofdisabilityinpatients<45NeckpainalsoverycommonSocietalcostofbackpainestimated

5、tobe>$20billiondollarsperyearSomaticpain:MostcervicalandlowbackpainfallintothecategoryofsomaticpainSomaticpainarisesfromthestimulationofA(smallmyelinated)andC(unmyelinated)nociceptivenerveendingsActivationcanbechemicalviatissuedamageDirectmechanicalstimulationPainsensitivest

6、ructures:MusclesLigamentsPainsensitivestructures:MusclesLigamentsFacetjoints(zygapophyseal)DuramaterIntravertebraldiscs:annulusfibrosisEpiduralveinsSomaticpain:Aching/expandingpressureFeltlocallyinareaofinjury,butalsomybereferredtootherareasReferredtoareasinnervatedbythesames

7、pinalcordsegmentMechanismisconvergenceinspinalcordandthalamusAfferentsfromtheprimarysourceofpainconvergewithafferentsfromthesiteofreferralReferredpainfromstimulationofzygapophysealjointsSomaticpain:SummaryAching/pressurequalityOccursinbroadareasreflectingareasofreferralfromth

8、esamespinalsegment,severecouldradiatetolimbsOtherwiseknownasbackstra