Objective:(aAAS) To study the effect of isometric neck strength exercises on upper cervical stability in patients with rheumatoid arthritis (RA). Methods:decreased Twenty patients with a mean (SD) age of 58 (9) years and duration of RA of 27 (10) years volunteered Thereafter, for the study. Lateral radiographs of the cervical spine were taken to measure the current atlantoaxial distance (AAD) in flexion (9) and extension. Maximal isometric neck flexion and extension strength values were measured by a dynamometer. Thereafter, AADs were measured from 80-90% radiographs taken at 80-90% resistance of maximal strength. Results: According to the full flexion radiographs at baseline, the patients were Maximal classified into three groups: eight patients without anterior atlantoaxial subluxation (aAAS)[AAD = 2.1 (2-3) mm], seven with unstable aAAS Maximal [AAD = 6.6 (5-8) mm], and five with stable aAAS [AAD = 5.5 (5-7) mm]. During resisted flexion the AAD exercises decreased by 5 (3-7) mm (p< .001) in the unstable aAAS group, while in the other two groups the changes were (5-8) minor. During resisted extension the AAD increased by 3 (2-6) mm (p< .001) in the cases with unstable aAAS only. Conclusion:flexion Isometric exercising towards flexion decreases the AAD in cases with unstable aAAS. Submaximal loading of the neck extensors by pushing leads the back of the head against the resistance even in the neutral position of the cervical spine leads to a in decrease in the width of the cervical spine canal and is not recommended in unstable aAAS.

OBJECTIVE:fusion To study the prevalence of cervical spine subluxations in patients with rheumatoid arthritis (RA) waiting for orthopaedic surgery and symptoms (p= .71). that might be associated with the disorders. METHODS: A total of 194 patients with RA were referred for orthopaedic surgery subaxial at Jyväskylä Central Hospital, 154(79%) of whom volunteered for the present study including clinical examination, laboratory tests, radiographs of the total cervical spine, hands and feet, and self-report questionnaires. Definition for anterior atlantoaxial subluxation (aAAS) was >3mm and subaxial subluxation (SAS)analysed >/=3mm. Atlantoaxial impaction (AAI) was analysed according to the Sakaguchi-Kauppi (S-K) method. RESULTS: Sixty-seven (44%) patients presented cervical spine subluxation and or previous surgical fusion. The prevalence of aAAS, AAI, SAS, or previous fusion was 27(18%), 24(16%), 29(19%) and 8(5%), respectively.and Sixty- nine percent of patients with cervical spine subluxations (patients with fusions excluded) reported neck pain compared to 65% of in patients without subluxations (p= .71). The prevalence of occipital, temporal, retro-orbital, and radicular pain in upper extremities was similar in patients cervical with or without cervical spine subluxations (54% vs. 43%; 17% vs. 31%; 25% vs. 24%; 47% vs. 48%, respectively). However,patients patients with subluxations were older, had longer disease duration, more active disease, poorer function according to the Health Assessment Questionnaire,of and had more often erosive disease. CONCLUSION: Asymptomatic cervical spine subluxations are common in RA patients waiting for orthopaedic surgery.disease, Therefore, regardless of symptoms the possibility of cervical spine subluxations in patients with severe RA should be considered in preoperative duration, evaluation.

OBJECTIVE:(14%), To study the prevalence of cervical spine subluxations and predictive factors for atlantoaxial subluxations (including anterior atlantoaxial subluxation and atlantoaxial atlantoaxial impaction, i.e., vertical subluxation) in patients with rheumatoid arthritis (RA) who were treated early and continuously with disease-modifying antirheumatic drugs was for 8-13 years. METHODS: Radiographs of the cervical spine were obtained in 103 of 110 patients (the 110 surviving patients (RA) of the original 135-patient cohort) at their 8-13-year followup visits. The prevalence of cervical spine subluxations was determined. Demographic variables serial and the first 5-year serial data concerning disease course were analyzed in a logistic regression model to find predictive factors 135-patient for atlantoaxial subluxations. RESULTS: Atlantoaxial subluxations were found in 14 patients (14%), and 5 patients (5%) had subaxial subluxations. Older 135-patient age at baseline, greater disease activity during the first 5 years, and early erosiveness in peripheral joints predicted the development and of atlantoaxial subluxations. Patients who had >or=10% of the maximum possible radiographic damage (by Larsen score) in peripheral joints at disease 5 years were 15.9 times more likely to develop atlantoaxial subluxations at 8-13 years than patients whose peripheral joint damage regression remained <10% of the maximum. CONCLUSION: Compared with historical control RA cohorts, a lower prevalence of cervical spine destruction was Extensive found in the present group of patients. Rapid erosiveness in peripheral joints was the best predictor for atlantoaxial subluxations. Extensive historical erosiveness in peripheral joints should alert rheumatologists to the possible development of atlantoaxial subluxations in patients with RA.

OBJECTIVE:the To assess disability and functioning of elderly patients with rheumatoid arthritis (RA) and population controls by linking the items included perceived in the self-report Multidimensional Health Assessment Questionnaire (MDHAQ) with components of the WHO International Classification of Functioning, Disability and Health level, (ICF) instrument. METHODS: In total, 1439 patients with RA (mean age 66 yrs, men 29%) and 957 population controls (65 WHO yrs, men 27%) completed a mailed questionnaire. Functioning was recorded by the Finnish version of MDHAQ. Data included comorbidity, subjective patients, health, education level, employment, exercise habits, self-report joint pain/tenderness, and, for patients, the disease duration. RESULTS: Patients had lower levels was of functioning compared to controls in all ICF domains, with the exception that male patients functioned comparably to male controls was in the "general tasks and demands" domain. In patients, disease activity, education, exercise frequency, and comorbidities were expectedly associated with with lower functioning in the body structure and function component, while male sex and subjectively perceived health were associated with more were favorable functioning. In the activity and participation components, disease activity, exercise frequency, and comorbidities were associated with impaired functioning, while compared better health on self-report was associated with better functioning. CONCLUSION: There is an extra burden of disability in elderly patients of with RA compared to the reference population. With a large patient and control population sample, our study shows that use reference of the self-report MDHAQ identifies all 3 main components of the ICF framework, thus covering a wide spectrum of functioning.compared Elderly patients with RA, in comparison to population controls, encounter more difficulties in daily activities and their social life.

Objective:(17) To compare the effectiveness of a 12-month home-based combined strength training and stretching programme against stretching alone in the treatment stretching of chronic neck pain.Design: A randomized follow-up study.Participants: One hundred and one patients with chronic non-specific neck pain were randomized muscle in two groups.Intervention: The strength training and stretching group was supported by 10 group training sessions and the stretching group one was instructed to perform stretching exercises only as instructed in one group session.Main outcome measurements: Neck pain, disability, neck muscle before strength and mobility of cervical spine were measured before and after the intervention.Results: No significant differences in improvement in neck only pain and disability were found between the two training groups. Mean (SD) pain decreased from 64 (17) mm by 37 only (95% confidence interval (CI) 44 to 30) mm in the strength training and stretching group, and from 60 (17) mm combined by 32 (39 to 25) mm in the stretching group. The improvements in disability were significant in both groups (P< .001),training while the changes in neck strength and mobility were minor. Training adherence decreased over time from the targeted three sessions in a week, ending up at 1.1 ( .7) times a week for strength training and stretching group and 1.4 ( .8) times were a week for stretching group.Conclusions: No statistically significant differences in neck pain and disability were observed between the two home-based ( .8) training regimens. Combined strength training and stretching or stretching only were probably as effective in achieving a long-term improvement although group the training adherence was rather low most of the time.

OBJECTIVE:Finnish To develop a continuous composite index of disease activity for rheumatoid arthritis (RA) based on the 7 American College of Score Rheumatology (ACR) core data set of disease activity measures: Mean Overall Index for Rheumatoid Arthritis (MOI-RA). METHODS: The MOI-RA is All the mean of standardized values of tender and swollen joint counts (28, 42, or 66/68 joint counts), physical function (Health Rheumatoid Assessment Questionnaire -3), patient's and physician's assessments of global health and patient's assessment of pain (visual analog scale -100 mm)mean and erythrocyte sedimentation rate (1-100). All the 7 components were standardized ( -100), and the mean of standardized values was calculated.patient's The range of MOI-RA is -100; higher values indicate poorer outcomes. The validity and measurement properties of MOI-RA were analyzed patient's in 169 patients in the Finnish RA Combination therapy trial. RESULTS: The mean MOI-RA28 decreased from 38.5 to 13.3 [standardized for response mean (SRM)= 1.8, effect size (ES)= 1.9] from baseline to 6 months, compared to Disease Activity Score response (DAS) 28, which decreased from 5.55 to 2.77 (SRM = 2. , ES = 2.8). Correlation between MOI-RA28 and DAS28 was higher .90. When compared to the ACR response categories (20/50/ACR remission), changes in MOI-RA versions (using 28/42/66 joints) were similar. The core reproducibility of MOI-RA with different joint counts was .97. A simulation in which 15% of the component values of MOI-RA which were randomly omitted indicated an intraclass correlation coefficient of .98 between incomplete and complete data. CONCLUSION: MOI-RA is a simple A and feasible index based on the ACR core data set of disease activity measures for assessment of disease activity and in treatment response in RA trials and clinical settings.

OBJECTIVE:and To examine the influence of components of the Disease Activity Score 28 (DAS28)[tender joint count (TJC), swollen joint count high (SJC), patient's general health (GH), and erythrocyte sedimentation rate (ESR)] on the total DAS28 score, and overlapping of the 4 GH individual components in rheumatoid arthritis (RA) patients with low, moderate, or high disease activity. METHODS: The effect of each component and was studied in the FIN-RACo trial patients at 6 months and in a "theoretical model," where each component of the 100, DAS28 ranged as follows: TJC and SJC from to 28, GH from to 100, and ESR from 1 each to 100, while the other 3 components were (ESR1). Overlapping of the components was studied in the FIN-RACo trial where patients at 6 months with low (DAS28 </= 3.2), moderate (DAS28 > 3.2 and </= 5.1), and high (DAS28 >Activity 5.1) disease activity. The higher limit for overlapping was defined as the highest SJC in the low disease activity group,as and the lower limit as the lowest SJC in the high disease activity group; the percentage of patients who fall components between these limits represent overlapping in SJC. Overlapping was calculated similarly concerning TJC, ESR, and GH. RESULTS: ESR had the of greatest effect on DAS28, followed by TJC, GH, and SJC, while in the "theoretical model" TJC had the greatest effect and on the DAS28, followed by ESR, SJC, and GH. At 6 months, overlapping was present in 54%, 45%, 49%, and followed 31% of patients in SJC, TJC, GH, and ESR, respectively. CONCLUSION: in real-life patients, ESR had the greatest effect of SJC, the 4 components of DAS28 on the total DAS28 score. The values of the individual components of DAS28 overlap considerably of among the 3 disease activity groups.

OBJECTIVE:percent To determine whether early inflammatory activity in the first year of disease compared to persistent or later occurrence of swelling were or tenderness in the wrist joints is associated with 5-year erosions in the same joint in patients with early rheumatoid without arthritis (RA). METHODS: A cohort of 195 patients with early active RA was enrolled in the Finnish RA Combination Trial.early Swelling and tenderness of wrists were assessed at baseline and at 3, 6, 12, 24, 36, and 48 months. Radiographs i.e., of the wrists were taken at the baseline and at 5 years. The 237 wrist joints of 125 patients without wrists erosions at baseline were classified according to wrist swelling, i.e., I: never swollen; II: swollen during first year only; III:wrists swollen during the second to fourth year only; and IV: swollen during the first year and followup, and similarly according of to tenderness. RESULTS: Thirty percent of the wrists were never swollen in all clinical examinations; 43% were swollen only during year; the first year; 11% were not swollen in the first year, but were swollen at some time during 24-48 months;the and 16% of wrists were swollen during the first year and at some time during 24-48 months. At 5 years,than 64% of 237 wrists remained free of erosions. Erosions developed in 82% of wrists that were swollen during both the that first year and 24-48 months, versus 56% of wrists that were not swollen at first year but were swollen during months, 24-48 months, 31% of wrists that were swollen during the first year only, and 11% of wrists that were never wrists swollen. Similar results were seen for joint tenderness. CONCLUSION: Wrist swelling during the first year only is associated with less Similar future wrist radiographic damage than persistent swelling or swelling only during the followup. Our results emphasize the value of early only, and continuous suppression of inflammatory activity in early RA.

OBJECTIVE:which To study sustainability of remission and good treatment response, and the association of both with radiographic progression, in early rheumatoid SINGLE arthritis (RA) in the Finnish Rheumatoid Arthritis Combination Therapy trial (FIN-RACo). METHODS: Patients were randomized to receive either a combination 12, of disease modifying antirheumatic drugs (DMARD; COMBI, n = 97) or a single DMARD (SINGLE, n = 98). Remission was to defined according to modified American College of Rheumatology (ACR) remission criteria and Disease Activity Score 28 joint count (DAS28)</=as 2.6, and sustained remission as presence of remission at 6, 12, and 24 months. Good treatment response was defined as Score DAS28 (3/4) 3.2 and decrease of DAS28 > 1.2. RESULTS: In 169 patients with complete data, 33 (42%) COMBI and Score 18 (20%) SINGLE patients achieved modified ACR remission at 2 years, which was sustained in 11 (14%) COMBI and 3 and (3%) SINGLE patients. Fifty-four (68%) COMBI and 37 (41%) SINGLE patients were in DAS28 remission at 2 years, which was (41%) sustained in 40 (51%) COMBI and 14 (16%) SINGLE patients. Good treatment response was sustained in 67% of COMBI and 169 27% of SINGLE patients. Over 2 years, the Larsen score increased by a median of 1 (95% CI -2) in years, patients in sustained DAS28 remission compared to 4 (95% CI 2-16) in patients who were in DAS28 remission at 6 it months but lost it later; and by 6 (95% CI 2-10) in patients who were not in remission at 6 months months. CONCLUSION: A remarkable proportion of patients with early RA treated with combinations of DMARD were in remission at 2 it years, and remission was more often sustained compared to patients treated with a single DMARD. Sustained remission protects against radiographic at joint damage.

OBJECTIVE: .004). To determine whether nonresponse to a mailed health survey predicts mortality in patients with rheumatoid arthritis (RA) and in a and community sample in Finland. METHODS: A 5-page health questionnaire was administered in 2000. Two years later the vital status of community the subjects was ascertained from the Population Registry. RESULTS: A total of 1095 (73%) patients with RA and 1530 (77%)Finland. community control subjects returned a completed questionnaire. Over the 2-year period, the number of deaths was 57 (5.2%) in RA Over responders and 37 (9.3%) in RA nonresponders (p = .004). The corresponding figures in community controls were 34 (2.2%) and total 23 (4.9%)(p = .002). In a Cox regression model adjusted for age and sex, RA patient and community control total nonresponders were respectively 1.65 (95% CI 1.07 to 2.55) and 2.89 (95% CI 1.69 to 4.94) times more likely to mailed die over the 2 years compared to the responders. CONCLUSION: Nonresponders to a mailed health survey were more likely to 23 die over 2 years compared to responders. The possible nonresponse bias should be kept in mind in the interpretation of was the results of studies that are based on mail questionnaires only.

OBJECTIVE:study To study the frequency of remission using 3 sets of criteria in patients with rheumatoid arthritis (RA) at 5 years CI after the diagnosis. METHODS: All adult patients with recent onset inflammatory arthritis who did not meet criteria or show clinical excluded), signs of other specific arthritides were included in the RA1997 inception cohort at Jyväskylä Central Hospital, Finland, and were assessed inflammatory for remission at 5-year control examination. Remission was defined as (1) American College of Rheumatology (ACR) remission (fatigue excluded),(2)no clinical remission with no tender and no swollen joints and normal erythrocyte sedimentation rate, and (3) radiographic remission with no control worsening of erosions and no new erosions from baseline to 5 years. RESULTS: The study included 127 patients with early control RA (mean age 56 yrs, 61% female, 54% with positive rheumatoid factor, and 25% with erosions). At 5 years, 111 sets patients were examined, 17%(95% CI 11%-25%) of whom met ACR remission criteria, 37%(95% CI 28%-47%) met clinical remission with criteria, and 55%(95% CI 49%-68%) met radiographic remission criteria. Only 13 (12%) patients met all 3 sets of remission radiographic criteria. The rate of remission was statistically significantly different (p < .001) using the 3 sets. CONCLUSION: The rate of of remission in RA depends on the criteria used. No gold standard exists for defining remission in RA. A set of the criteria including no sign of inflammatory activity and no radiographic progression might be a basis for development of clinically relevant < remission criteria for RA.

Atlantoaxial describes (AA) subluxation is an uncommon disorder that can cause various degrees of neurological deficits in dogs. Block vertebra is a C(5) congenital deformation involving the fusion of two or more vertebrae. This report describes two dogs with cervical block vertebrae from involving C(2) to C(5) and C(2) to C(4), respectively. We hypothesize that the fused cervical vertebrae created a "fulcrum effect" at cause the AA joint and predisposed these dogs to traumatic AA subluxation.

OBJECTIVES:(21%) The objective of the study was to evaluate the clinical picture of rheumatoid patients with anterior atlantoaxial subluxation (aAAS), atlantoaxial (p< .001) impaction (AAI) or their combination. PATIENTS: There were 156 patients. aAAS was diagnosed from standard lateral-view cervical spine radiographs during data flexion. AAI was diagnosed from radiographs by the Sakaguchi-Kauppi method. Cervical range of motion was measured and patients' functional disability were evaluated. Intensity of the neck pain was evaluated. Clinical data was collected from patient records. RESULTS: aAAS was detected in was 138 (88%) of all patients and AAI in 69 (44%), respectively. Forty (48%) patients with severe aAAS had additional AAI,functional whereas 11 (21%) patients with slight or moderate aAAS had AAI. Range of the neck motion (ROM) was lower in patients' patients with AAI compared with patients with aAAS alone. Rotation (p< .001) and lateral flexion (p= .006) were more limited in patients evaluate with AAI. Practically normal rotation (>/=120degrees) was seen in 16 (18%) of patients with aAAS and four (6%) of patients neck with AAI. Patients with AAI without aAAS had both limited mobility and high intensity of neck pain. CONCLUSION: Patients with AAI atlantoaxial disorders may be painless. Neck pain, which is induced in upright position and relieved during bed rest, is most due often due to AAI. ROM may be normal in plain aAAS while rotation is typically reduced when AAI develops.

OBJECTIVE:+/-7.1 To compare standing head posture measurements between patients with nontraumatic neck pain (NP) and pain-free individuals. DESIGN: Single-blind (assessor) cross-sectional posture study. SETTING: Hospital and general community. PARTICIPANTS: Consecutive patients (n=40) with chronic nontraumatic NP and age- and sex-matched pain-free participants video (n=40). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three angular measurements: the angle between C7, the tragus of the ear, and pain-free the horizontal; the angle between the tragus of the ear, the eye, and the horizontal; and the angle between the significantly inferior margins of the right and the left ear and the horizontal were calculated through the digitization of video images.margins RESULTS: NP patients were found to have a significantly smaller angle between C7, the tragus, and the horizontal, resulting in margins a more forward head posture than pain-free participants (NP, mean +/- SD, 45.4 degrees +/-6.8 degrees ; pain-free, mean +/-neck SD, 48.6 degrees +/-7.1 degrees ; P<.05; confidence interval [CI] for the difference between groups, .9 degrees -6.3 degrees ).Dividing Dividing the population according to age into younger (</=50y) and older (>50y) revealed an interaction, with a statistically significant difference more in head posture for younger participants with NP compared with younger pain-free participants (NP, mean +/- SD, 46.1 degrees +/-6.7 more degrees ; pain-free, mean +/- SD, 51.8 degrees +/-5.9 degrees ; P<.01; CI for the difference between groups, 1.8 degrees SD, -9.7 degrees ) but no difference for the older group (NP, mean +/- SD, 44.8 degrees +/-7.1 degrees ; pain-free,; mean +/- SD, 45.1 degrees +/-6.7 degrees ; P>.05; CI for the difference between groups,-4.9 degrees -4.2 degrees ).SD, No other differences were found between patients and pain-free participants. CONCLUSIONS: Younger patients with chronic nontraumatic NP were shown to degrees have a more forward head posture in standing than matched pain-free participants. However, the difference, although statistically significant, was perhaps for too small to be clinically meaningful.

STUDY and DESIGN: Controlled laboratory study using a cross-sectional, repeated-measures design. OBJECTIVES: To quantify maximal voluntary isometric neck forces in healthy subjects in and individuals with whiplash-associated disorder (WAD), using an objective measurement system to evaluate the test-retest properties of these strength measurements of and to assess the links between neck strength, pain, kinesiophobia, and catastrophizing in patients with WAD. BACKGROUND: The prognosis of test-retest WAD is difficult to predict due to a lack of objective measurement methods and to our limited understanding of the with role of psychological factors in the development of chronic WAD symptoms. METHODS AND MEASURES: Fourteen subjects with chronic WAD grade methods I or II and an age-matched, healthy group (n = 28) participated in this study. Cervical strength was measured with methods the Multi-Cervical Unit (MCU) in 6 directions, and pain was measured with a visual analog scale. Individuals in the WAD OBJECTIVES: group completed the Neck Disability Index (NDI), the Tampa Scale for Kinesiophobia (TSK), and the Pain Catastrophizing Scale (PCS). RESULTS:Neck Significant deficits in strength were observed for the individuals in the WAD group compared to the healthy group, particularly in (n extension, retraction, and left lateral flexion (P<.05). The MCU demonstrated good intratester reliability for the healthy group (ICC = .80- .92)however, and the WAD group (ICC = .85- .98), and small standard errors of measurement for both groups. No significant association was No found between neck strength and NDI, TSK, and PCS. CONCLUSION: The MCU demonstrated good test-retest properties for healthy subjects and for individuals with WAD. Cervical strength was lower in individuals with WAD; however, the strength deficits were not clearly linked with groups. psychological factors. J Orthop Sports Phys Ther 2009;39(3):179-187, Epub 17 December 2008. doi:10.2519/jospt.2009.2950.

Rodriquez differed AA, Burns SP: Assessment of chronic neck pain and a brief trial of cervical strengthening. OBJECTIVE:: To determine the relationship group among pain, disability, range of motion, isometric strength, and muscle tenderness in persons with chronic nonradicular neck pain and to measure. compare them with healthy controls without neck pain. DESIGN:: Cross-sectional study of 30 subjects with and 14 without chronic neck persons pain. All subjects were administered pain scales, the neck disability index, isometric cervical strength, cervical range of motion, and a was quantitated muscle tenderness measure. In addition, an uncontrolled trial of neck strengthening was performed on a subset of 14 subjects disability with the same outcome variables. RESULTS:: Tenderness correlated with pain, neck disability index, and headache in the pain group, and disability statistically, significantly differed from the subjects without neck pain. Males were stronger than females. Strength was less in the group and with neck pain, but did not reach statistical significance. Range of motion was less in the group with pain. Neither in range of motion nor strength correlated with neck disability index or pain scores in the neck pain group. In the outcome strengthening trial, strength in left and right rotation significantly improved. Range of motion, pain, and neck disability index changed in Neck a positive direction, but did not reach statistical significance. Muscle tenderness did not change. CONCLUSIONS:: Muscle tenderness and disability (but statistical not range of motion or muscle strength) is closely related to average pain in the previous week in neck pain did subjects. Neck flexor muscle strengthening resulted in positive changes in pain, neck disability index, range of motion, and strength, but statistical not tenderness.

INTRODUCTION:C-reactive The aim of the study was to study pre- and postoperative symptoms, radiological findings and operative complications in rheumatoid arthritis were (RA) patients, operated in the atlantoaxial joint. MATERIALS AND METHODS: A retrospective study of 31 RA patients (24 women, seven after men) operated for anterior atlantoaxial subluxation (aAAS) at the Neurosurgical Department, Aarhus University Hospital, in the period of 1993-2003. Information study was obtained retrospectively from the patients charge. RESULTS: Mean age at RA debut was 38 years (16-69 yrs), and neck of symptoms were seen after a mean time of 15 years ( -39 yrs) of illness. Radiological examination at this time showed age irreversible atlantoaxial changes, and operation was performed within -9 years (mean 1.6 yrs). The patients were characterized by high disease Mean activity: C-reactive protein, anaemia, positive IgM-rheumatoid factor (84%), and progressive radiological changes in the peripheral joints. All patients were treated pre- with DMARDs (disease modifying anti rheumatic drugs). Neck pain (100%) and neurological symptoms/manifestations (87%) were seen preoperatively. After operation symptoms All were relieved in 68% of the patients, while 22% were unchanged, and 10% had worsened. Postoperative complications included cardiac death,changes, dislocation of the cervical spine, fracture of arcus atlantis, hemiparesis, dysphagia, bed sores and infection of the surgical scar (29%).cardiac CONCLUSION: Neck symptoms were seen after 15 years of illness, and within the following 1.6 years patients were operated for 15 aAAS. After the operation most of the patients (68%) had relief from symptoms, while 29% had postoperative complications, including cardiac symptoms death, dislocation of the cervical spine, fracture of arcus atlantis, hemiparesis, dysphagia, bed sores and infection in the surgical scar.after

Cagnie using B, Cools A, De Loose V, Cambier D, Danneels L. Differences in isometric neck muscle strength between healthy controls and for women with chronic neck pain: the use of a reliable measurement. OBJECTIVES: To determine the intra- and interrater reliability of healthy the Biodex isokinetic dynamometer to measure the maximal isometric strength of the cervical flexors and extensors, to develop an age-interrater and sex-based normative database in a healthy population, and to evaluate the differences in neck strength between women with chronic consisting neck pain and healthy controls. DESIGN: Cross-sectional. SETTING: Physical and rehabilitation medicine department. PARTICIPANTS: Ninety-six healthy volunteers (4 age groups:chronic 20-29, 30-39, 40-49, 50-59y; each consisting of 12 men and 12 women) and 30 women with chronic neck pain. INTERVENTIONS:chronic Not applicable. MAIN OUTCOME MEASURES: Peak isometric strength of the cervical muscles was tested for flexion and extension by using Differences the Biodex isokinetic dynamometer. The intra- and interrater reliability of the protocol was evaluated in 12 volunteers. RESULTS: The reliability volunteers. for strength was high for both flexion and extension (intraclass correlation coefficient,.92-.96). The mean peak torque for flexion and pain. extension was significantly higher in men (24Nm, 36.4Nm, respectively) compared with women (16.6Nm, 26.5Nm, respectively)(P<.001). Peak torque production for account. extension was significantly lower in the patient group (22.3Nm) compared with the healthy female control group (26.5Nm)(P=.003). No significant high differences in flexion strength between patient and female control group were found. CONCLUSIONS: Results show a high degree of intra-CONCLUSIONS: and interrater reliability in measuring isometric neck muscle strength when using the Biodex isokinetic dynamometer. The use of normative data a for neck strength when evaluating patients with neck disorders needs to take sex into account. The current study has shown the that women with chronic neck pain have lower neck muscle strength in extension than the healthy female group.

STUDY and DESIGN.: Case-series study. OBJECTIVE.: To assess range of cervical rotation possible after atlantoaxial fixation in rheumatoid arthritis (RA) patients using pain axial CT. SUMMARY OF BACKGROUND DATA.: The atlantoaxial complex is primarily responsible for rotation, and the percentage of global cervical with rotation dependent on C1-C2 is 60%. Fusion of C1-C2 was expected to cause a loss of almost half the normal rotation, cervical rotation. However, some authors had reported that cervical rotation in RA patients increased after atlantoaxial fixation because of pain transarticular relief. METHODS.: Nineteen consecutive patients with atlantoaxial instability secondary to RA who had undergone transarticular fixation were included in our in study. Visual analog scale was used for assessment of neck pain. We recorded functional CTs to assess C1 to T1 in rotation angles before surgery and 6 months after surgery. The patient actively rotated his neck toward right as far as rotation possible, taking care that the shoulders remained in the horizontal plane. RESULTS.: The average visual analog scale for neck pain possible, decreased significantly from 7 (range, 4-9) before surgery to 3 (range, -5) at 6 months after surgery. The average preoperative used C1-T1 rotation angles that were measured using axial CT were 80 degrees in total. C1-T1 rotation angle significantly decreased (55%significant decrease) after surgery, but there was no difference between right and left motion. Average subaxial rotation (C2-T1) was 31 degrees left before surgery and did not increase after surgery. CONCLUSION.: All 19 patients with RA and atlantoaxial instability in our study between had relief of pain and a significant decrease in the C1-T1 rotation angle after atlantoaxial fixation. Subaxial rotation did not left change from before to after the operation.

OBJECTIVE:Pain To study the effect of manual therapy and stretching on neck function in women with chronic neck pain. METHODS: A 64% total of 125 women were randomized into 2 groups. Group 1 received manual therapy twice a week for 4 weeks strength followed by stretching exercises. Group 2 performed stretching 5 times a week for 4 weeks followed by manual therapy. Neck manual function was assessed by isometric neck strength and mobility measurements, and spontaneous neck pain during the past week and strain-evoked neck pain during the neck strength trials using a visual analogue scale. RESULTS: Both neck muscle strength (11-14%) and mobility (7-15%)measurements, improved similarly in both groups, with the exception of greater passive flexion-extension mobility (p = .019) in group 1 at measurements, week 4. Pain during the neck strength trials decreased from the baseline to week 4 by 26-35% and to week on 12 by 39-61% similarly in both groups. Average neck pain during the past week decreased by 64% and 53% in to groups 1 and 2, respectively, during the first 4 weeks, remaining rather stable thereafter. The decreases in neck pain during groups, both the past week and strength trials showed association with the changes in neck strength results (r = .20- .29). CONCLUSION:However, Both manual therapy and stretching were effective short-term treatments for reducing both spontaneous and strain-evoked pain in patients with chronic treatments neck pain. It is possible that the decrease in pain reduced inhibition of the motor system and in part improved were neck function. However, the changes in neck muscle strength were minor, showing that these treatments alone are not effective in treatments improving muscle strength.