Abstract
The pain with cervicothoracic interspinous busritis is localized to the interspinous region between C7 and T1 and does not radiate. It is constant, dull, and aching. The patient may attempt to relieve the constant ache by assuming a posture of dorsal kyphosis with a thrusting forward of the neck. In contrast to the pain of cervical strain, the pain of cervicothoracic interspinous bursitis often lessens with activity and worsens with rest. Pain syndromes that may mimic cervicothoracic bursitis include cervical strain, cervical fibromyositis, inflammatory arthritis, and disorders of the cervical spinal cord, roots, plexus, and nerves. Congenital abnormalities such as Arnold-Chiari malformation and Klippel-Feil syndrome may also manifest similarly to cervicothoracic bursitis. Correction of the functional abnormalities responsible for the development of cervicothoracic interspinous bursitis is mandatory if long-lasting relief is to be achieved.
Keywords
bursitis, interspinous ligament, neck pain, cervicalgia, cervical facet syndrome, Arnold-Chiari malformation, cervical strain
ICD-10 CODE M71.50
The Clinical Syndrome
The interspinous ligaments of the lower cervical and upper thoracic spine and their associated muscles are susceptible to the development of acute and chronic pain symptoms following overuse. Bursitis is thought to be responsible for this pain. Frequently, the patient presents with midline pain after prolonged activity requiring hyperextension of the neck, such as painting a ceiling, or following prolonged use of a computer monitor with too high a focal point.
Signs and Symptoms
The pain is localized to the interspinous region between C7 and T1 and does not radiate. It is constant, dull, and aching. The patient may attempt to relieve the constant ache by assuming a posture of dorsal kyphosis with a thrusting forward of the neck ( Fig. 21.1 ). In contrast to the pain of cervical strain, the pain of cervicothoracic interspinous bursitis often lessens with activity and worsens with rest. On physical examination, tenderness is elicited on deep palpation of the C7-T1 region, often with reflex spasm of the associated paraspinous musculature. Decreased range of motion is invariably present, and pain increases with extension of the lower cervical and upper thoracic spine.
Testing
No specific test exists for cervicothoracic bursitis, although magnetic resonance imaging (MRI) may reveal inflammation of interspinous bursae ( Fig. 21.2 ). Testing is aimed primarily at identifying an occult pathologic process or other diseases that may mimic cervicothoracic bursitis (see “ Differential Diagnosis ”). Plain radiographs can delineate any bony abnormality of the cervical spine, including arthritis, fracture, congenital abnormality (e.g., Arnold-Chiari malformation), and tumor. All patients with the recent onset of cervicothoracic bursitis should undergo MRI of the cervical spine and, if significant occipital or headache symptoms are present, of the brain ( Fig. 21.3 ). Ultrasound imaging may also be useful in further distinguishing solid from cystic interspinous masses ( Fig. 21.4 ) Screening laboratory tests consisting of a complete blood count, erythrocyte sedimentation rate, antinuclear antibody testing, and automated blood chemistry should be performed to rule out occult inflammatory arthritis, infection, and tumor.
