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The C6-7 syndrome–clinical features & treatment response

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OBJECTIVES. (1) To confirm association of marked tenderness at the

coracoid tip, lateral pectoral and medial elbow sites, with

tenderness at the C6-7 level in the cervical spine. This had

been observed in subjects with prior neck pain, who lost

tenderness at C5-6 and standard upper body sites with neck

support during sleep, but remained symptomatic; (2) to

document apparent risk and prognostic factors; (3) to observe

the effects of a modified treatment strategy.

METHODS. A

protocol including possible risk and prognostic factors was

developed, and a case series assembled. Findings on entry

tested the hypothesized pattern of linked tender sites.

Subjects consenting to followup became a cohort in which

outcomes were studied.

RESULTS. In 151 subjects, there were

associations among the tenderness scores (mean r value of

0.59, p < 0.001) of points in the 6-7 group on the same side,

an intermediate level of association with contralateral but

homologous points (mean r value of 0.31), but weak

associations (mean r value 0.07) with contralateral and

different points. During followup, 47% obtained marked or

complete relief at their first followup visit, and a final

followup (median 18 months), 84% of those without previous

fibromyalgia (FM) achieved this satisfactory outcome, and 63%

of those with prior FM.

CONCLUSION. This experience supports the hypothesis that

mechanical factors determine patterns of symptoms and

tenderness in many subjects with regional and general pain

syndromes, and points to new strategies of diagnosis and

treatment which may be critical for success.

Smythe HA

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