H A Smythe1. 1. University of Toronto Rheumatic Disease Unit, ON, Canada.
Abstract
OBJECTIVES: (1) To confirm association of marked tenderness at the coracoid tip, lateral pectoral and medial elbow sites, with tenderness at the C6-7 level in the cervical spine. This had been observed in subjects with prior neck pain, who lost tenderness at C5-6 and standard upper body sites with neck support during sleep, but remained symptomatic; (2) to document apparent risk and prognostic factors; (3) to observe the effects of a modified treatment strategy. METHODS: A protocol including possible risk and prognostic factors was developed, and a case series assembled. Findings on entry tested the hypothesized pattern of linked tender sites. Subjects consenting to followup became a cohort in which outcomes were studied. RESULTS: In 151 subjects, there were associations among the tenderness scores (mean r value of 0.59, p < 0.001) of points in the 6-7 group on the same side, an intermediate level of association with contralateral but homologous points (mean r value of 0.31), but weak associations (mean r value 0.07) with contralateral and different points. During followup, 47% obtained marked or complete relief at their first followup visit, and a final followup (median 18 months), 84% of those without previous fibromyalgia (FM) achieved this satisfactory outcome, and 63% of those with prior FM. CONCLUSION: This experience supports the hypothesis that mechanical factors determine patterns of symptoms and tenderness in many subjects with regional and general pain syndromes, and points to new strategies of diagnosis and treatment which may be critical for success.
OBJECTIVES: (1) To confirm association of marked tenderness at the coracoid tip, lateral pectoral and medial elbow sites, with tenderness at the C6-7 level in the cervical spine. This had been observed in subjects with prior neck pain, who lost tenderness at C5-6 and standard upper body sites with neck support during sleep, but remained symptomatic; (2) to document apparent risk and prognostic factors; (3) to observe the effects of a modified treatment strategy. METHODS: A protocol including possible risk and prognostic factors was developed, and a case series assembled. Findings on entry tested the hypothesized pattern of linked tender sites. Subjects consenting to followup became a cohort in which outcomes were studied. RESULTS: In 151 subjects, there were associations among the tenderness scores (mean r value of 0.59, p < 0.001) of points in the 6-7 group on the same side, an intermediate level of association with contralateral but homologous points (mean r value of 0.31), but weak associations (mean r value 0.07) with contralateral and different points. During followup, 47% obtained marked or complete relief at their first followup visit, and a final followup (median 18 months), 84% of those without previous fibromyalgia (FM) achieved this satisfactory outcome, and 63% of those with prior FM. CONCLUSION: This experience supports the hypothesis that mechanical factors determine patterns of symptoms and tenderness in many subjects with regional and general pain syndromes, and points to new strategies of diagnosis and treatment which may be critical for success.