PDF(Pubmed)
Abstract：
Patients presenting with chest pain to the emergency department constitute a diagnostic challenge as 77% of the patients\' symptoms are not cardiac. Diagnostic uncertainty is a pervasive issue in primary care. A 56-year-old man presented with non-traumatic chest pain and chronic neck pain for 2 years, as well as numbness in his right third and fourth fingers for 6 months. It was not associated with palpitation, orthopnea or pedal edema. Except for hyperglycemia, no abnormal findings were found in diagnostic tests. At that time, he was being treated for type 2 diabetes using glucose-lowering drugs in order to lower his blood glucose and lessen his risk of heart disease. The cause of his chest pain remained unknown. Following a second opinion from an orthopedist, the patient was diagnosed with cervical radiculopathy and was treated with analgesics and physical therapy. Because the treatments had only provided temporary pain relief for the previous 6 months, he sought chiropractic care for pain relief. The patient\'s vital signs were stable and within normal limits during the assessment. A restricted neck movement, a positive Spurling test, and hypoesthesia in the right C7 dermatome were seen. Cervical radiographs revealed degenerative spondylosis with right C5/C6 neuroforaminal stenoses and bilateral C6/C7 neuroforaminal stenoses. A provisional diagnosis of cervical spondylotic radiculopathy associated with cervicogenic angina (CA) was made. Chiropractic procedures, including cervical manipulation, instrumented soft tissue mobilization, and motorized intermittent neck traction, were performed two to three times per week. After 3 months, the patient reported that the chest pain, neck pain, and radicular symptoms had completely resolved. Repeated radiographs taken during the 11th month follow-up revealed a comparable improvement in the increased spacing of the restricted neuroforamina, which could signify a beneficial alteration related to cervical function retrieval. CA is an angina-like chest pain caused by cervical spine disorders. This study adds to our understanding of the biomechanical impact of cervical radiculopathy on chest pain, which has largely been overlooked during diagnostic workups. Once cervical radiculopathy has been identified, CA symptoms can be eased by alleviating the noxious input stemming from the pinched nerve roots.
摘要：
到急诊科出现胸痛的患者构成了诊断挑战，因为77%的患者症状不是心脏症状。诊断不确定性是初级保健中普遍存在的问题。一名56岁的男子出现了2年的非创伤性胸痛和慢性颈部疼痛，以及他右手第三和第四个手指麻木了6个月。它与心悸无关，端坐呼吸或踏板水肿。除了高血糖,在诊断测试中未发现异常结果.当时,他正在使用降糖药物治疗2型糖尿病，以降低他的血糖，降低他患心脏病的风险。他胸痛的原因仍然未知。根据骨科医生的第二种意见，患者被诊断为神经根型颈椎病，并接受了镇痛药和物理治疗。因为治疗仅在前6个月提供了暂时的疼痛缓解，他寻求脊椎治疗以缓解疼痛。评估期间患者的生命体征稳定且在正常范围内。颈部活动受限，一个积极的喘振测试,并在右侧C7皮刀中观察到感觉减退。颈椎X线片显示退行性脊柱病伴右侧C5/C6神经间孔狭窄和双侧C6/C7神经间孔狭窄。对与颈源性心绞痛（CA）相关的神经根型颈椎病进行了临时诊断。整脊手术，包括子宫颈操纵，器械化软组织动员，和电动间歇性颈部牵引，每周进行两到三次。三个月后,病人报告说胸痛，颈部疼痛,神经根症状完全消退。在第11个月随访期间拍摄的重复X光片显示，限制性神经孔的间距增加有相当的改善，这可能意味着与宫颈功能恢复有关的有益改变。CA是由颈椎疾病引起的心绞痛样胸痛。这项研究增加了我们对神经根性颈椎病对胸痛的生物力学影响的理解，这在诊断检查中很大程度上被忽视了。一旦确定了颈神经根病，CA症状可以通过减轻源自挤压神经根的有害输入来缓解。
