Saturday, October 16, 2010

TwistedSister Wins first Hey Clinic Clinical Puzzle!!

Well, ladies and gentleman, we have our first winner of the Hey Clinic Challenge Question.
Yesterday we received this answer from “TwistedSister” via the Hey Clinic Blog:

“I suspect that her neck pain may be attributed to her trying to hold her neck in a normal vertically straight upright position. Thus, her neck musculature is competing against the "natural" gravitational force caused by the scoliotic curvature...just my guess (unfortunately deduced from personal experience). “

Posted by  twistedsister  to  The Hey Clinic for Scoliosis and Spine Surgery <>  at  October 15, 2010 1:23 PM

Twisted Sister is absolutely correct!!!
If you look carefully at the X-Ray, you’ll notice that I actually drew an angular measurement in the upper thoracic spine, showing 14 degree “lean” to one side.  This gives the neck a tilted “foundation”, so that in order for her to keep her head level, she has to bend her neck back about 14 degrees or so to get her eyes level.  This puts extra strain on the neck.  As we all get older, and our neck gets more arthritis / degeneration in the facet joints and discs, it is harder and more painful to compensate for this.  

This particular patient will be having surgery with us, and we’ll straighten that up for her along with the rest of the deformity, which should help her posture as well as pain and functioning for a better quality of life for the long run.  That unbalanced gravitational force is what also can cause scoliosis to progress more rapidly in later years, as the discs and facets break down, and the “moment arm” or lateral force becomes stronger.  That’s why they had to fix the Leaning Tower of Pisa before that unbalanced loading would have caused the 500+ year old tower to come crashing down to the ground if it had gone beyond the critical few degree threshold.

Patients who have kyphosis also have trouble with neck pain.
Years ago I saw a 50 woman from Chicago who had a normal neck MRI with severe neck pain.
It turned out that she also had a 90 degree thoracic kyphosis, which meant that she had to hyperextend her neck all the time in order to just look straight ahead.
I fixed her kyphosis, and her neck pain went away!  
She also told me that she no longer looked like a “Turtle” --- a posture she never liked since she was a teenager.
Here’s web link to her interview with me after surgery:

TwistedSister — strong work on the quiz.  Sorry to hear you had to learn it through your own painful experience.  If you send in a web request with your correct email through, Tiffany in my office will send you out an official Hey Clinic T-Shirt this coming week, in white, or pink (our breast cancer walk color).

Hope you are all having a great weekend.
If you like the clinical puzzles, let me know and I’ll come up with some more.
Gotta get you thinkin’ and learning even more.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

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