Visualization of chronic neck-shoulder pain: impaired microcirculation

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This study pertains to the 71 patients who had received a diagnosis

of cervico-brachial pain syndrome after thorough clinical

examination of a total series of 300 patients, who had been

referred to the National Insurance Hospital in Tranas because

of chronic neck pain that interfered with their ability to

work. Changes in trapezius muscle blood flow and EMG were

examined and related to the anamnesis and physical findings.

The microcirculation in the upper part of the right and left

trapezius muscles was examined simultaneously by using optical

laser-Doppler single-fibres after insertion into the muscle

directly via the skin. Continuous recordings were made during

stepwise increased static contraction determined

electro-myographically. Signal processing was performed

on-line by computer.

MRT of the cervical spine was performed

in 12 patients. None showed nerve root affliction. Ten showed

a bulging intervertebral disc and two, a narrowed nerve hole

(lateral stenosis). The muscle blood flow (LDF) was

significantly lower in the most painful side compared with the

opposite side in the group of 41 patients with predominantly

unilateral pain (21 women and 20 men). A lowered blood flow

was also found when the 21 females in this group was compared

with a normal control group of 20 healthy women. The patients

had lower rms-EMG and EMG mean power frequency (MPF) in the

painful side compared with the opposite side. A further

lowering of the MPF was observed with induced fatigue. It was

concluded that the chronic neck pain in cervico-brachial

syndrome can become visualized by the finding of lowered blood

flow of the trapezius muscle which seems to be an expression

of the chronic neck pain.

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