#Middlebury #ToYourGoodHealth
By Keith Roach, M.D.
DEAR DR. ROACH: One day, I woke up and my neck was bent forward. Now my chin almost touches my chest. How much worse can this get? One doctor said he may have to break my neck and reset it. I can’t look people in the face anymore; I’m looking at their belt buckle. – R.W.
ANSWER: I can think of several reasons why your neck may be bent forward. One is a muscle problem. A severe muscle spasm in the neck can force the neck into an unnatural position, often very painful to move. This can go on for weeks. However, most people can force their neck into a normal position.
The second is a nerve problem. Cervical dystonia is the most important of these. Dystonia can present itself with the neck pointing to the side, forward or backward. It typically gets better and then worse, and is associated with sustained muscle contractions.
What the doctor said about “breaking your neck” doesn’t make sense to me. However, since your doctor has suggested a possible spine surgery, the third, and most likely cause, is a skeletal problem. Kyphosis is the term for an abnormal forward deformity of the spine (as opposed to scoliosis, which is to the side). There are numerous causes, but in older men, the most likely is osteoporosis, which can cause very severe kyphosis, especially when in conjunction with vertebral fractures. I wonder if you had a vertebral compression fracture that made things suddenly worse.
Unfortunately, surgery for kyphosis has a very high complication rate and shouldn’t be considered unless you are facing serious impediments, such as difficulty breathing or intractable pain. The best treatment is an exercise program. An orthopedic surgeon or physiatrist could make precise recommendations for your physical therapist.
DEAR DR. ROACH: I am a 75-year-old male on Coumadin who recently took a fall. I badly bruised my shin. Initially, it swelled up the size of half a grapefruit but now, two weeks later, it’s still very tender and the size of half an orange. I first iced and elevated it. Lately I have tried heat, an elastic wrap and even my TENS unit, but nothing seems to reduce the swelling and sensitivity. Any suggestions? – B.N.
ANSWER: A bone bruise, called a periosteal hematoma, happens when small blood vessels are broken in the lining of the bone, called the periosteum. The blood collects and forms a tender lump at the site of injury. It can happen at any bone, but the shin is very common due to its being very superficial.
Warfarin (Coumadin) works by preventing the liver from making blood-clotting proteins, making for a larger blood collection, which takes longer to heal. As long as your INR is in range, though, it will eventually heal.
READERS: Worried about the strength of your bones? The osteoporosis pamphlet explains how to prevent this universal condition. Readers can obtain a copy by writing to Dr. Roach – No. 1104W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name address. Please allow four weeks for delivery.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to P.O. Box 536475, Orlando, FL 32853-6475.
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