Imaging of the cervical spine has been a topic of considerable debate in the athlete. The favorable natural history of neck pain and the high incidence of false-positive findings should temper the use of advanced imaging. Gore et al13 demonstrated that
95% of asymptomatic male and 75% of asymptomatic female subjects had evidence of degenerative changes on plain films by the age of 65. Friedenberg and Miller14 showed that 25% of men andwomen have degenerative changes of the cervical spine by the fifth decade of life increasing to 75% by the seventh decade. Healy et al15 demonstrated that 15 of 19 asymptomatic lifelong noncontact sport athletes had abnormalities on cervical magnetic resonance imaging (MRI). Berge et al16 demonstrated a higher incidence of degenerative changes of the cervical spine by MRI in high-level front-line rugby players than in age-matched controls.
The radiographic evaluation of neck pain should begin with plain radiographs including anteroposterior, lateral, and oblique views. Evaluation should include a check of overall alignment (lordosis 21 ± 13 degrees) as well as for instability (>3mm translation, >11-degree kyphosis), fracture, spondylosis, congenital malformations, or ankylosed segments. Radiographic clues to potential stenosis include canal diameter less than 17 mm, Pavlov ratio greater than 0.85 (sagittal canal diameter to sagittal vertebral body width), and encroachment of the facet joints on the spinolaminar line (Fig. 15-2). If plain films demonstrate fracture, computed tomography is recommended to improve detail of the extent of bony injury.17
MRI is indicated if the patient has a neurologic deficit, disabling weakness, persistent radiculopathy, or long tract signs.18 MRI may demonstrate acute soft disk herniations, edema, central or foraminal stenosis, syringomyelia, hematoma, or spinal cord edema. However, one must interpret findings in light of the clinical picture. Boden et al19 demonstrated that 14% of asymptomatic subjects younger than 40 years old had abnormalities as well as 28% of those older than 40 years of age.
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Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.