Lisiński Przemysław, Huber Juliusz
Department of Rheumatology and Rehabilitation.
Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, Poznań, Poland.
Spine (Phila Pa 1976). 2017 Feb;42(3):151-159. doi: 10.1097/BRS.0000000000001691.
STUDY DESIGN: Comparative clinical and neurophysiological study in three groups of patients with general diagnosis of neck pain. OBJECTIVE: To determine symptoms of muscles dysfunction in patients with myofascial pain syndrome, disc-root conflict, and degenerative changes at cervical spine. SUMMARY AND BACKGROUND DATA: The explanation for cervical pain origin should be based on results from chosen clinical and neurophysiological studies in correlation with neuroimaging findings. METHODS: Three subgroups of patients (N = 60 each) with certain symptoms were examined. Clinical evaluation included examination of pain intensity in VAS scale, muscle strength in Lovett scale, evaluation of reflexes, Spurling test, assessment of active trigger points (TRPs), and superficial sensory perception. Neurophysiological testing included surface electromyography at rest (rEMG) and during maximal contraction (mcEMG) as well as electroneurography (ENG). RESULTS: The greatest pain intensity with its decentralization phenomenon occurred in patients with disc-root conflict. Significant decrease of muscle strength was detected in trapezius muscle in myofascial pain syndrome subgroup. Weakness of abductor pollicis brevis muscle in patients with disc-root conflict differed them from patients with myofascial pain syndrome (P = 0.05). Patients with disc-root conflict and degenerative spine disease showed differences (P = 0.03) in reflexes evoked from triceps brachii. Positive Spurling symptom was most common (56.7%) in disc-root conflict subgroup. TRPs in trapezius muscle were found in all patients with myofascial pain syndrome. Results of rEMG amplitude measurements differed patients at P = 0.05. Only mcEMG recording from abductor pollicis brevis muscle allows for their clear cut differentiation. ENG studies showed abnormalities in patients with disc-root conflict and degenerative spine disease (P from 0.05 to 0.02). Positive correlation of VAS, TRPs, and rEMG as well as Lovett scores, mcEMG, and ENG results was found. CONCLUSION: Only applying several clinical and neurophysiological tests together makes it possible to differentiate patients with different etiological reasons of pain at cervical spine. LEVEL OF EVIDENCE: 4.
研究设计：对三组颈部疼痛患者进行比较临床和神经生理学研究。 目的：确定肌筋膜疼痛综合征、椎间盘神经根冲突和颈椎退行性变患者的肌肉功能障碍症状。 总结与背景数据：颈部疼痛起源的解释应基于所选临床和神经生理学研究结果，并与神经影像学发现相关联。 方法：对有特定症状的三组患者（每组N = 60）进行检查。临床评估包括采用视觉模拟量表（VAS）评估疼痛强度、采用Lovett量表评估肌肉力量、评估反射、斯普林试验、评估活动性触发点（TRP）以及浅感觉。神经生理学测试包括静息时（rEMG）和最大收缩时（mcEMG）的表面肌电图以及神经电图（ENG）。 结果：椎间盘神经根冲突患者出现了最强烈的疼痛及其分散现象。在肌筋膜疼痛综合征亚组中，检测到斜方肌肌力显著下降。椎间盘神经根冲突患者的拇短展肌无力使其与肌筋膜疼痛综合征患者有所不同（P = 0.05）。椎间盘神经根冲突和脊柱退行性疾病患者在肱三头肌诱发的反射方面存在差异（P = 0.03）。斯普林试验阳性症状在椎间盘神经根冲突亚组中最为常见（56.7%）。在所有肌筋膜疼痛综合征患者中均发现斜方肌存在TRP。rEMG振幅测量结果在患者之间存在差异，P = 0.05。只有拇短展肌的mcEMG记录能够实现对它们的明确区分。ENG研究显示椎间盘神经根冲突和脊柱退行性疾病患者存在异常（P值从0.05至0.02）。发现VAS、TRP和rEMG以及Lovett评分、mcEMG和ENG结果之间存在正相关。 结论：只有同时应用多种临床和神经生理学测试，才有可能区分颈椎疼痛病因不同的患者。 证据等级：4级。
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