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Cervicalgia is the name given to pain that appears in the area of the cervical spine, the posterior part of the neck. Sometimes, this pain can radiate to the head and arms, or also towards the dorsal (middle back) area. The cervical spine has a dual role: it needs to be stable enough to support the weight of the head, but also flexible enough to allow for a wide range of movement and to function properly. In addition, the cervical spine contains the spinal cord, from which the nerves that control the upper extremities branch out.
The cervical spine is made up of seven vertebrae, which are separated by fibrocartilaginous cushions called intervertebral discs. From the age of 35 onwards, as a consequence of thousands of movements, including flexion, extension, and rotation, neck pain and/or discomfort may appear.
To keep the head in a normal position, the muscles in the back of the neck must work properly, since the head and neck do not come together at a central point, but rather, the neck supports the posterior part of the head. The muscular tension required to maintain the head in a correct position, as well as damage to the small joints between these cervical vertebrae (osteoarthritis), are common causes of neck pain.
Mechanical and postural causes are often responsible for cervicalgia. These changes can produce compression lesions on the nerve structures that pass through the cervical region. The intervertebral discs can slide forward or backward, and even herniate, affecting the nerve structures.
Neck pain is one of the most frequent reasons for a visit to the doctor's surgery. We know that up to 70% of the population will suffer from this problem at some point in their lives.
Bad posture, the use of new technologies, work habits, traffic accidents, population ageing, stress, and worry all contribute to this high incidence.
Diagnosing this condition is based on the characteristics and mechanisms of the pain, as well as the results of a physical examination.
Neck pain can be either mechanical or inflammatory in nature. Mechanical causes are the most common; this kind of pain gets worse with movement and improves with rest. This kind of pain is caused by wear, practising sport, some types of work that cause mechanical stress on the neck, previous trauma, and degenerative disorders.
Inflammatory-type pain suggests the presence of inflammation, infection, and/or tumours. It is a continuous pain that does not improve with rest nor medication. It is usually accompanied by other symptoms such as fever, impaired general condition, neurological symptoms, etc. The physician will evaluate the need to carry out any tests and determine which one is most suitable for each case.
Generally speaking, mechanical neck pain improves in 2-3 weeks.
Treatment should include:
Taking pain relievers like paracetamol can help control the pain. Other treatments, such as taking anti-inflammatory medications or muscle relaxers, will be prescribed as needed by your physician. If the pain persists or new or different symptoms appear, talk to your doctor.
It is important to keep your head in a good position and to correct your posture. For this, exercises that strengthen the posterior cervical muscles (the extensors) are very useful, as they will help you maintain a correct, straight posture. This will prevent the pain from reappearing or becoming chronic.
Generally, acute neck pain does not require any diagnostic tests. With a conventional X-ray, the cervical vertebrae can be evaluated and a diagnosis can be made using just this, in most cases.
On another note, it is very common to find signs of osteoarthritis, such as impingement, on X-rays; these do not require any kind of treatment.
If the clinical case warrants them, your physician will decide (based on the symptoms) whether to carry out neurological tests like a CAT (computerised axial tomography) scan, NMR (nuclear magnetic resonance) scan, or an EMG (electromyogram). These tests are intended to diagnose more severe injuries or to assess nerve damage in the cervical spine.
Osteoporosis, which means "porous bone", is a skeletal disease in which the density and quality of the bone decrease. Due to this, the skeleton offers less resistance and is more likely to fracture, even with minor trauma like a fall from standing height or a light blow. These are called fragility or osteoporotic fractures. It is very prevalent. Worldwide, it is estimated that 1 out of every 3 women and 1 out of every 5 men will suffer an osteoporotic fracture during their lifetime.
This is a silent disease, because it shows no symptoms until the first fracture. Having suffered a first fracture makes the patient more likely to have subsequent fractures. These almost always occur in the spine, wrist, or hip, but they can happen in other places. Fractures of the spinal column are especially detrimental, because they can cause pain, deformity, and a loss of height. This is also true of hip fractures, which require hospital admission and entail a loss of quality of life and autonomy as well as a high socioeconomic cost.
The skeleton is a living tissue that is in a constant process of destroying old bone and forming new bone. With age, this destruction gradually outpaces the formation of new bone. It especially affects women after menopause, since during menopause this destructive process becomes faster due to the loss of the protective effect of oestrogens. This predisposes them to what is called postmenopausal osteoporosis. In addition, this is aggravated by the fact that women, in their youth, reach a lower peak bone mass than men do. Early menopause (before 45 years of age) is a risk factor. In men, bone loss generally only becomes important around the age of 70.
Thus, age has an influence on the loss of bone mass, but it can also affect children, teens, and premenopausal women. There are many other risk factors for osteoporosis, like having a family history, taking certain pharmaceuticals (corticosteroids, drugs used for prostate and breast cancer, etc.), tobacco use, excessive alcohol, being sedentary, and certain pathologies, such as rheumatic inflammatory diseases, endocrine diseases, liver diseases, blood diseases, kidney diseases, intestinal malabsorption problems, and inadequate calcium intake, among others.
The diagnosis must be made considering the risk factors that may trigger osteoporosis, which health professionals must evaluate.
A blood analysis must be carried out to detect possible abnormalities, as well as a DEXA (dual energy x-ray absorptiometry), which uses small doses of radiation. The hip and spinal column are evaluated. In general, the reference measurement comes from the bone density in a population of young adults (called the T-score). Thus, the WHO has established that osteoporosis should be diagnosed when the T-score for a person is under -2.5 SD.Osteopaenia means that the loss of bone mass cannot yet be called osteoporosis, and this is when the T-score is between -1 and -2.5 SD.
If the DEXA shows osteoporosis as a result, this doesn't mean that there necessarily has to be a fracture. Other risk factors must be evaluated and the overall clinical picture determined. Osteopaenia is very frequent and when treatment is initiated will depend on whether there are important risk factors and/or if there have been fractures. We have tools to calculate fracture risk that take into account all of the characteristics of each patient.
The objective is to avoid the loss of bone mass and reduce the risk of fractures. Having a healthy lifestyle is essential.
There are various types of pharmaceuticals and the prescription will depend on the profile and individual risk of each patient, depending both on the location of the fracture and other medical conditions. The duration of treatment is also variable.
We currently have a large selection of pharmaceuticals that have been proven safe and effective to reduce the risk of fracture in patients with osteoporosis. Most have an "anti-resorptive" effect, because they stop the loss of bone mass, and are also an anabolic treatment, since they stimulate the formation of bone.
Idiopathic scoliosis is a three-dimensional spinal deformity characterized by a lateral curvature and rotation of the vertebrae without a known cause. It often appears during growth and may require medical monitoring to prevent progression.
The word scoliosis comes from Greek and means “curvature”. It is not considered a disease, but rather, a three-dimensional deformity. This is why the Scoliosis Research Society (SRS) defines it as a lateral curvature of the spine with a rotation of the vertebrae inside the curve of more than a 10º Cobb angle.
It is important to distinguish structural scoliosis from non-structural scoliosis, also known as pseudoscoliosis. In structural scoliosis, the spine shows a lateral deviation (the severity of which can be measured using the Cobb angle, which quantifies spinal deformities) and a rotational deformation that is measurable via the Adams Forward Bend Test and a scoliometer. In non-structural scoliosis, the lateral deviation does not involve vertebral rotation and this condition can be corrected via postural training.
Scoliosis, in turn, is divided into the idiopathic and secondary types. Idiopathic scoliosisis that for which no cause can be established.
Idiopathic scoliosis in adolescents is a three-dimensional structural abnormality, with lateral deviation and a rotation in the curvature of the spine that affects the health of young people around the age of puberty. This diagnosis is established only when other potential causes of scoliosis, such as vertebral deformities, neuromuscular abnormalities, or other syndromic disorders, have been ruled out. If any of these are the cause, it is called secondary scoliosis.
Idiopathic scoliosis is classified according to the age at which it appears: infantile (0-3 years old), juvenile (3-10 years old), and adolescent (over 10 years old).
Idiopathic scoliosis affects between 2% and 3% of young people between 10 and 16 years old (the age range with the most risk). Recently, in China, the percentage of children in this age range who suffer from this deformity has been shown to be up to 5.14%.
In scoliosis, as the severity of the curve increases, the number of sufferers decreases. Scoliosis with curvatures above 20 degrees affects between 0.3% and 0.5% of these individuals, and it is estimated that the proportion of patients who require surgical treatment does not exceed 0.1%.
Detecting scoliosis is generally done using the Adams Forward Bend Test, which, as its name implies, consists of the patient bending their torso forward, allowing a “hump” to appear, which is subsequently measured with a scoliometer. However, a definitive diagnosis cannot be made without measuring the angle on an X-ray in which the patient is standing up.
The most common forms of secondary scoliosis are those associated with neuromuscular diseases. Sometimes, the first sign of some of these diseases is scoliosis, and until it manifests, the scoliosis can seem idiopathic, but in reality, it is secondary.
Children and adults of all ages.
The paediatrician will be able to detect this condition, and then the rehabilitation specialist will be in charge of making the diagnosis and evaluating treatment options, in collaboration with the orthopaedic team and the physiotherapist, who will be the ones to follow up and monitor the progression of this deformity.
In adolescents, the progression of the curve is prevented using conservative treatment based on observation and the use of a corrective brace if the curvature progresses and surpasses 25 degrees.
To treat small curves that are at low risk of progression,physiotherapyis recommended.
Surgical treatmentis only used in specific cases, such as adolescents who have a primary structural curve greater than 45 degrees and adults who do not respond to conservative treatment.
To diagnose scoliosis, imaging tests such as conventional X-rays are carried out. Using these, the degree of the curvature can be precisely quantified. If another clinical symptom is associated with the deformity, an MRI will be requested.
Poliomyelitis is a highly contagious disease caused by any of the three human poliovirus serotypes, which are part of the enterovirus family. Europe was certified free of poliomyelitis in June 2002. Immunisation and vigilance of the disease continue to ensure the region is free of poliomyelitis. Post-polio syndrome has no defined causal mechanism but it affects between 20% and 80% of patients afflicted with poliomyelitis.
Initial symptoms are those of a influenza-like illness (fever, headache, joint and muscle pain, vomiting, among other things) and can last up to 10 days. Its most serious forms may cause respiratory paralysis leading to death. Post-polio syndrome presents a new neurological weakness that may be progressive or abrupt on muscles previously affected or unaffected. It may or may not be accompanied by new health problems such as excessive fatigue, muscle pain, pain in the joints, intolerance to cold, reduced physical stamina and function, and atrophy.
It mainly affects children and the mechanisms for its transmission may be through faecal-oral channels or a common vehicle (contaminated water or food).
Post-polio syndrome affects patients who have had poliomyelitis for 20 years or more.
Diagnosis is given clinically, supplemented with laboratory and electromyographic (EMG) tests.
Symptomatic treatment with analgaesics, a ventilator where necessary, gentle exercise and possibility of orthopaedic devices to prevent deformities or to enable function.
In acute diagnoses, studying secretions, stools and cerebrospinal fluid. EMG in acute and later stages for diagnosing post-polio syndrome.
Poliomyelitis has no cure but it can be prevent by vaccination.
Cerebral palsy is a group of disorders affecting movement, posture and muscle tightness, caused by damage to the developing brain (in children up to approximately three years old). The severity of the symptoms varies widely: some patients can walk and lead independent lives, while others are more severely disabled. There may also be associated intellectual disabilities, problems with vision or hearing, problems when eating, seizures, etc.
These can be categorised according to the moment when the brain damage occurs: prenatal, perinatal and postnatal. Currently, the most frequent causes are: extremely premature birth, hypoxia of the brain during birth, and paediatric stroke.
In babies, we see slower psychomotor development, with difficulties in movements or activities. We usually see spasticity, which could be defined as increased tightness in a certain group of muscles. There are major musculoskeletal abnormalities, including spinal deformity, hip dislocation and ankle equinus.
Fundamentally clinical diagnosis, depending on the patient's history. But confirmation is needed by additional imaging tests such as cranial ultrasound and magnetic resonance imaging. However, these can be normal.
Unfortunately, there is no cure for cerebral palsy. However, we can deal with the pathology in different ways, both in prevention and in treatment:
No specific prevention is possible.
Apart from the physiotherapy and/or occupational therapy which can be offered or recommended to these patients, physical exercise can always be suggested, depending on the abilities of each person. We also recommend stretching certain muscle groups and trying to correct posture.
Low back pain is discomfort in the lower back, often caused by muscle, ligament, joint, or disc injuries. Early recognition, relative rest, heat application, and physiotherapy help relieve pain and prevent chronic complications.
Chronic lower back pain is defined as pain persisting for more than 3 months, and is one of the most frequent and costly musculoskeletal problems of modern society. It is estimated that up to 80% of the adult population will suffer from lower back pain at some time in their lives. The most common causes of chronic lower back pain include degenerative disc disease, lumbar facet arthrosis, spondylolisthesis, facet dysfunction, herniated disc, lumbar spinal stenosis, the after-effects of trauma or deformity, among others.
Pain in the lower back, which is usually mechanical in nature.
it can affect up to 80% of the population. In the case of younger people, it is usually caused by trauma and/or inflammation, while among the older population the cause is usually degenerative.
The main diagnostic tools are patient history and physical examination. They can be complemented by scans, which are helpful when considering invasive treatments.
Relative rest, local heat, medication, changes to activity. Once the acute pain episode is over, rehabilitation treatment can begin, with physiotherapy and back school therapy. There are cases where the causes of the pain indicate a need for surgery, and after more conservative therapies have been tried, an operation is required.
X-rays, tomography and MRI
Regular exercise and posture correction.
Arthrosis is a degenerative process characterised by lesions of the cartilage in joints. A joint is the area where a bone connects with another bone, allowing movement. Cartilage is a tissue that covers the joints, acts as a shock absorber for impacts, and also allows the joints to move without friction. Normally, this condition appears in the spinal column, neck, hip, knees, and hands.
The most common manifestation is pain that improves with rest, stiffness when initiating movement, deformities, and difficulty moving the affected joints. There can be a certain degree of inflammation, which will cause swelling due to the excessive accumulation of liquid in the joint.
However, it must be differentiated from arthritis, which is a rheumatic inflammatory disease rooted in joint inflammation that can cause pain which does not improve with rest. Arthrosis is often also called osteoarthritis, which can create some confusion.
This disease is very prevalent and has a high social and health impact. The EPISER2016 study, by the Spanish Society of Rheumatology, showed that the prevalence in the population over 40 years of age is 29%.
Age is the main risk factor. It is more frequent in women. A deterioration of the cartilage is clearly associated with obesity and a lack of regular physical exercise. A misaligned joint or poor posture can also be predisposing factors. Sometimes the cause is a traumatic injury or previous disorder of the affected joint. It has a genetic component (especially arthrosis of the hands).
A diagnosis is obtained by looking at the symptoms, physical examination, and the imaging tests.
Treatment for this disease is aimed at improving symptoms and quality of life for patients while slowing down its clinical evolution. A treatment plan must be individually prepared for each patient and type of joint.
Non-pharmaceutical treatment is essential. We recommend:
Pharmacological treatment normally consists of conventional pain relievers such as paracetamol, which is the analgesic treatment of choice. There are slow-acting treatments, such as chondroitin sulphate (taken orally) or hyaluronic acid (given as an injection), which can improve pain, especially in arthrosis of the knees. Surgery (joint replacement) is reserved for cases in which the joint is destroyed and other measures have failed.
Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease affecting the motor neurons in the brain and spinal cord, causing progressive paralysis of muscles, including the diaphragm. Early symptoms may include muscle weakness, difficulty speaking or swallowing, and the disease often leads to respiratory failure determining survival. Diagnosis is clinical and by exclusion, and current treatment focuses on symptom management and supportive care in multidisciplinary units.
ALS is a neurodegenerative disease caused by the death of motor neurons in the brain and the spinal cord.
There are two types of motor neuron: upper and lower. The first are found in the motor cortex and establish connections with the lower motor neurons located in the brain stem and spinal cord, which innervate muscles. When the upper motor neurons die, spasticity, weakness and hyperreflexia appear.
When the lower motor neurons die, twitching, weakness and muscle atrophy occur. Other neuron populations can also be affected, such as the temporal and frontal behavioural and executive circuits.
Epidemiologically speaking, ALS has an incidence of 1.5-2 new cases a year per 100,000 people (3 new cases are diagnosed per day in Spain). The total number of cases (prevalence) is 2-5 per 100,000. According to this data, the total number of patient with ALS in Spain is approximately 4,000 cases. This is why it is included in the rare or minority disease group.
90% of cases of ALS are sporadic (no family history). Around 10% of ALS cases are familial, usually inherited as dominant traits. The incorporation of new molecular genetics techniques in the field of research has allowed more than 25 genes involved in ALS to be identified.
As a consequence of the continuous decrease in motor neurons, symptoms of the disease appear. These usually depend on the location of the motor neurons undergoing the most advanced processes of degeneration. In most patients (70%) the first symptom is loss of strength with muscular atrophy in the hands or clumsiness when walking, with frequent falls. In approximately 25% of patients, the first symptom is difficulty talking or swallowing, which indicates that degeneration of the bulbar motor neuron population is the most intense. There are also other possibilities for clinical presentation of this disease, although much less frequent: respiratory failure, weight loss or unexplained lack of energy (asthenia), cramps and twitches in the absence of muscle weakness, spasticity in legs, rapid mood changes or cognitive impairment.
In advanced phases, the disease can also paralyse the eye muscles. In the final stages of the disease, paralysis of the respiratory muscles leads to respiratory failure, which is often the cause of death.
The condition particularly affects people aged between 40 and 70. The incidence is greater in men (3:2.2 per 100,000) in sporadic forms. The age of first onset of symptoms reaches its peak between 58 and 63 years old in sporadic cases and between 47 and 52 years in familial forms. Incidence decreases markedly after the age of 80. The risk of suffering ALS is 1:400 for women and 1:350 for men.
The differing ways in which ALS manifests is one of the two reasons for a delay in suspected diagnosis of the disease, which can be up to 15 months. The other is that there is no test or biomarker to objectively confirm the diagnosis in the initial stages of the condition. A diagnosis of ALS is a diagnosis of exclusion, based on clinical criteria and conducting tests (MRI, clinical analysis, genetic tests, electromyography, EMTC, neuropsychological exam, nuclear medicine techniques and others) to rule out other illnesses with similar clinical findings. In most specialised ALS units, the disease diagnostic criteria used are the revised El Escorial criteria and the Awaji-shima criteria.
There is currently no medication that can cure or stop the disease. Riluzole and Edaravone are the only medications approved for ALS treatment, although their effect on survival is moderate (months).
The European (EFNS) and American (ANA) associations of neurology recommend that patients with ALS be treated in specialised centres, where possible in multidisciplinary units, so that they might be prepared for any complications. These units should offer solutions to control the symptoms, including the use of a feeding tube, control of saliva secretions, cough assist devices, respirators for mechanical ventilation, technology to improve the patient’s ability to move around and facilitate communication in patients who have lost the ability to speak.
These multidisciplinary units are the centres preferred by those running new drug trials.
The reality is that there is currently no effective treatment, although patients and their relatives often desperately search online for miracle drugs that might cure the condition. ALSuntangled, a group made up of 80 international experts in ALS, was born with the aim of protecting these patients from the numerous products advertised. It mission is to review the veracity and safety of the alternative treatments offered online that have not gone through the proper regulatory channels. It publishes its results in the official magazine for the disease and on its website.
Diagnostic imaging techniques (MRI, CAT, PET), electrophysiology (electromyography, EMTC, PESs), laboratory analysis (haematology, biochemistry, antibodies, hormones, enzymes, serology, genetics), respiratory functional tests, gasometry, pulse oximetry, overnight pulse oximetry, capnography, BMI, calorimetry, lumbar puncture, functional scale for the disease (ALS-FRS-R). A muscular biopsy may be required in exceptional cases. It is advisable to admit the patient in order to arrange for testing and offer them a report on discharge detailing the ALS diagnostic category and degree of functional repercussion (ALS-FRS-R).
Although various environmental risk factors have been suggested (geographic, occupational, dietary habits, proximity to electrical channels, contact with pesticides or other neurotoxins), there is no agreement on preventative measures to take.
In family forms, it is possible to offer genetic counselling to people with a desire for offspring.
During the natural course of the disease, complications often appear that may be prevented and treated. Among the most significant are malnutrition, respiratory failure, hypersalivation, spasticity, pain, loss of independent movement and communication, depression, anxiety, sleep disorders, bed sores, cognitive deficits and burden on carers.
Acute spinal cord injuries, both in adults and children, are a complex and significant health problem that negatively affects the patient in terms of morbidity and mortality, but that also has an impact on their personal environment.
The main symptoms are those derived from motor paralysis and lack of feeling below the area of the injury, and also and above all, effects on the autonomic nervous system which produce: changes to the cardiovascular and respiratory systems, to the urinary tract including changes to the capacity to store and evacuate urine, to the digestive system causing severe constipation, incontinence and faecal impaction, as well as changes to sexual function.
Treatment is integrated rehabilitation aimed at early intervention once the acute spinal cord injury has occurred in order to prevent complications and achieve the greatest functional independence possible in all physical, emotional and social aspects. Re-establish self-esteem by maximising the remaining abilities; encouraging the best social reintegration possible (active, independent and satisfying); and informing and advising the family to help them understand and manage the disability.
When it comes to young people, prevention of complex spinal cord injuries is focused on avoiding risky activities: reckless driving or driving under the influence of alcohol and drugs, diving into shallow water and dangerous sports such as climbing, MTB or skiing. In the case of adults, especially the elderly, it centres on eliminating risks to prevent falling such as carpets or heights, by using walking sticks and controlling medication to avoid orthostatic hypertension which can cause falls.
Parkinson's disease is a dysfunction of the basal ganglia caused by degeneration of the cells that produce dopamine in the substantia nigra.
It is a progressive neurodegenerative disease of the central nervous system that affects the parts of the brain involved in controlling and coordinating movement, muscle tone and posture.
The prevalence of Parkinson’s in Catalonia is 229 in every 100,000 people.
This is focused on empowering patients and their carers to achieve behavioural changes within their own control and to motivate them to continue treatment long term. It centres on reducing medication and gaining quality of movement. The main goal is functional independence for the individual and general physical condition from the onset of the disease. It is all geared towards minimising secondary complications and the risk of falls.
There are a growing number of studies emphasising that aerobic activity may have a neuro-protective effect. Likewise, during treatment, preventing inactivity, falling and fear of getting around or falling is stressed.
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