cervical disc 1

8/11/2019 Cervical Disc 1

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Pathogenesis and TCM

Treatment ofCervicalHerniated Disc

East West Healing Center

By Dr. Leon Chenwww.eastwesthealingcenter.net


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Definition

Cervical spondylosis is a disorder caused

by abnormal wear on cervical vertebrae

with degeneration and mineral deposits in

the attachments of the cervical vertebrae,

causing pain and weakness in the neck

and arm, and changes in sensation.


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Local anatomy

1. Cervical aspect: There are sevencervical vertebrae-- the atlas(C1), theaxis(C2), and cervical vertebrae numbers

three through seven. (C3-C7).There is no disc between the atlas and

the axis.

The 7th

spinous process is the longest.Cervical vertebrae have transverse

foramina that differ from other vertebrae.


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Transverse foramen

Vertebral foramen

Odontoid process

(dens) of axis

Transverse

ligament of atlas

Atlas (C1)

Axis (C2)

Spinous

process

Anterior arch of atlas

Posterior arch of C1


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C1, C2


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Transverse foramen

Vertebral foramen

Transverse process

Centrum

Bifurcated spinous process

Lamina

Pedicle

Superior articularfacet

C3- C7


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2. Ligaments:

Supraspinous ligament.

Interspinous ligament.

Ligamentum FlavumPosterior longitudinal ligament.

Anterior longitudinal ligament.

Transverse ligament of the atlas(intertransverse ligament.)


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3. Discs:

1) *Hyaline Cartilage: is the cartilage of thesuperior and inferior surfaces of the vertebralbody. It also forms the top and bottom border ofnucleus pulposus. It bears the weight and

protects the nucleus pulposus.2) *Annulus Fibrosus: is a fibrous ring, like a

radial tire. It is elastic, embracing and holdingthe nucleus pulposus, not letting it herniate.

3) *Nucleus Pulposus: is a kind of gelatinous,flexible, semifluid material, located in the centerof the annulus fibrosus. Both top and bottomsurface are sealed by hyaline cartilage.


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protrusion or bulging

sequestration

Normal disc

extrusion


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4. Cervical plexus:

The cervical plexus is formed by the ventral

rami of the C1-C4 spinal nerves. These

nerves supply the muscles and skin of the

head, neck, shoulder, and chest.


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5. Brachial plexus:

The brachial plexus is composed C5, C6, C7, C8and T1 spinal nerves.

Those include a radial nerve, a median nerve, a

ulnar nerve.The radial nerve: C5-C8,T1 of spinalnerves.

The Ulnar nerve: C8 and T1 of spinal

nerves.The median nerve: C5-C8,T1 of spinalnerves


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S2

S1

45

C3

4 5 67

8

345

C

S2

L1

L2

L3

L4

L5

S1

T1

T1 23

12

4 56

78

910

11

C5

C6C8

C7

C8

C7

C6

S2

L5

L4

L5

L4

L5L4

3


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The radial nerve

1) The radial nerveis a nervein the human bodythat supplies the arm, the forearmand thehand.

2) It originates from the posterior cord of the

brachial plexuswith roots from C5, 6, 7, 8, andT1.

3) It supplies the triceps, extensors of the wristand hands (lift the hand), and extension thumb

(adduct the thumb ).4) It provides the cutaneous nerve supply to mostof the back of the hand.
http://en.wikipedia.org/wiki/Nervehttp://en.wikipedia.org/wiki/Armhttp://en.wikipedia.org/wiki/Forearmhttp://en.wikipedia.org/wiki/Handhttp://en.wikipedia.org/wiki/Brachial_plexushttp://en.wikipedia.org/wiki/Brachial_plexushttp://en.wikipedia.org/wiki/Handhttp://en.wikipedia.org/wiki/Forearmhttp://en.wikipedia.org/wiki/Armhttp://en.wikipedia.org/wiki/Nerve


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The ulnar nerve

1) The ulnar nerveis a nerve which runs from theshoulder to the hand, at one part running near the ulnabone.

2) It is composed of C8-T1 of the spinal nerves which arethe medial cord of the brachial plexus.

3) There it supplies one and a half muscles of the upperlimb (flexor carpi ulnaris and medial half of flexor digitiprofundus).

4) The ulnar nerve also provides sensory innervationtothe part of the hand corresponding to the fourth andfifth digits.

5) If the ulnar nerve is damaged, the 4thand 5thfingercannot fully extend, or the 5thfinger cannot fully extend(to a fully straightened position).
http://en.wikipedia.org/wiki/Ulnahttp://en.wikipedia.org/wiki/Brachial_plexushttp://en.wikipedia.org/wiki/Sensory_innervationhttp://en.wikipedia.org/wiki/Sensory_innervationhttp://en.wikipedia.org/wiki/Brachial_plexushttp://en.wikipedia.org/wiki/Ulna


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The median nerve

1) The median nerve is formed from parts of themedial and lateral cords of the brachial plexus,C5-C7, T1 of the spinal nerves, and continuesdown the arm to enter the forearm with thebrachial artery.

2) The median nerve is the only nerve thatpasses through the carpal tunnel, where it maybe compressed to cause carpal tunnelsyndrome.

3) If damaged the nerve may cause an inability toflex the palm.
http://en.wikipedia.org/wiki/Brachial_plexushttp://en.wikipedia.org/wiki/Brachial_arteryhttp://en.wikipedia.org/wiki/Carpal_tunnelhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndromehttp://en.wikipedia.org/wiki/Carpal_tunnel_syndromehttp://en.wikipedia.org/wiki/Carpal_tunnel_syndromehttp://en.wikipedia.org/wiki/Carpal_tunnel_syndromehttp://en.wikipedia.org/wiki/Carpal_tunnelhttp://en.wikipedia.org/wiki/Brachial_arteryhttp://en.wikipedia.org/wiki/Brachial_plexus


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6. Vertebral artery

The vertebral artery, which is the first

branch of the subclavian artery, provides

one of the major blood supplies to the

brain.

The vertebral artery originates at the

subclavian, and reaches the cranial cavity

by passing through the transverseforamina of cervical vertebrae 6 through 1.


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7. Main muscles of neck

1) Scalene muscles:Middle scalene;

Anterior scalene;Posterior scalene.

2) Sternocleidomastoid:

Sternal head;Clavicular head.

3) Semispinalis capitis

4) Splenius capitis

5) Levator scapula

6) Trapezius


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Trapezius

Sternocleidomastoid


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Pathogenesis

1) Intervertebral disc herniation:

Injury;degenerative changes.

2) Degeneration of cervical vertebrae:Osteophytosis of the vertebral bodies.

Hypertrophy of the facets and laminal

arches.3) ligamentous and segmental instability.


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Pattern of Cervical Spondylosis

1) Radicular pattern

2) Vertebral artery pattern3) Myelopathy pattern

4) Sympathetic pattern

5) Combination pattern


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Points of Diagnosis

1) Age: the most cases are over 40 years old, and menmore than woman.

2) Pain in the neck, headache (back of head), shoulder,or radiating pain in the arm or fingers.

3) Numbness or tingling in the arm or fingers or thumb.

4) Dizziness.

5) Loss of balance.

6) Dry eyes, visual disturbances (eg, blurred vision,diplopia)

7) Tinnitus.

8) Disturbed concentration and memory

9) Hot flash (rarely).

10) X-ray, MRI, CT: will find particular problem.


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Complications

Chronic neck pain

Progressive loss of muscle function orfeeling

Permanent disability (occasional)

Inability to retain feces (fecal incontinence)or urine (urinary incontinence)


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Symptoms

Neck pain (may radiate to the arms or shoulder)

Loss of sensation or abnormal sensations of theshoulders, arms, or (rarely) legs

Weakness of the arms or (rarely) legs Neck stiffness that progressively worsens

Loss of balance

Headaches, particularly in the back of the head

Loss of control of the bladder or bowels (if spinalcord is compressed)


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Radiation of cervical nerves


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Physical Examination

1) Cervical movement: Flexion 35-45;

Extension 35-45; Lateral bending 45;Rotation 60-80.

2) Tension arm test.

3) Percussion head test.

4) Spurling test.

5) Jackson test.

6) Compression shoulder test.

7) Traction test.

T i t t


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Tension arm test


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Percuss head test


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Jackson test

C i h ld t t


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Compression shoulder test


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Traction test


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Imaging

A spine or neck x-ray shows abnormalities thatindicate cervical spondylosis.

A CT scan or spine MRI confirms the diagnosis.

A myelogram (x-ray or CT scan after injection ofdye into the spinal column) may berecommended to clearly identify the extent ofinjury.

An EMG may also be recommended. An x-ray of the lower (lumbar) spine may reveal

degenerative changes in this region.


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Differential Diagnosis

1) Brain tumor.

2) Migraine.

3) Thoracic outlet syndrome (TOS).

4) Cervical strain.

5) Frozen shoulder.

6) Tennis elbow.


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Sternocleidomastoid


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Treatment by TCM

1) TuiNa: RouGun (rolling and kneading), NaRou(Grasping and kneading), An (pressing), Ban(adjustment).

2) Acupuncture: GB20 ()GB21 ()DU14 (

)SI11 ()LI12 ()SJ 14 ()LI 4 ()DU20 ()DU ().

3) Chinese herbs:

Wind Bi: FangFengTongShenWan,DuHuoJiShengWan.

Blood stagnation: FuFangDanShengWan.

ShenYang deficiency: ShenQiWan,BuYangHuanWuWan, TanWangBuXinWan.

4) Traction.


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I Prognosis

Most patients with cervical spondylosis will

have some chronic symptoms, but they

generally respond to non-operativeinterventions and do not require surgery.


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Thank you

Phone630-916-0781

E-mail: [email protected]

Webwww.eastwesthealingcenter.net
mailto:[email protected]://www.eastwesthealingcenter.net/http://www.eastwesthealingcenter.net/mailto:[email protected]

cervical disc 1

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