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Plain x-rays of the shoulder may be normal or show a calcium deposit in the supraspinatus tendon or subacromial bursa; MRI is able to demonstrate more subtle abnormalities, such as muscle and tendon tears of the rotator cuff or a labral tear of the joint capsule In most patients the pain subsides gradually with immobilization and analgesics, followed by a program of increasing shoulder mobilization If it does not, the injection of small amounts of corticosteroids into the bursa, or the site of major pain indicated by passive shoulder movement in the case of rotator cuff injuries, is often temporarily effective and allows the patient to mobilize the shoulder Osteoarthritis and osteophytic spur formation of the cervical spine may cause pain that radiates into the back of the head, shoulders, and arm on one or both sides.

Coincident compression of nerve roots is manifest by paresthesias, sensory loss, weakness and atrophy, and tendon re ex changes in the arms and hands Pain in the neck may project into and cause numbness or burning of one half the tongue (the neck-tongue syndrome ; see page 165) Should bony ridges form in the spinal canal, as described in detail in Chap 44, the spinal cord may be compressed, with resulting spastic weakness, ataxia, and loss of vibratory and position sense in the legs (cervical spondylosis) The bony changes are evident on plain lms but are better seen by CT There may be dif culty in distinguishing cervical spondylosis with root and spinal cord compression from a primary neurologic disease (syringomyelia, amyotrophic lateral sclerosis, or tumor) with an unrelated cervical osteoarthritis, particularly at the C5-C6 and C6-C7 levels.

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Here the CT-myelogram and MRI are of particular value in revealing compression of the spinal cord, generally with narrowing of the spinal canal to less than 10 to 11 mm in the anteroposterior diameter (see also pages 1073 1076) A combination of osteoarthritis of the cervical spine with injury to ligaments and muscles when the neck has been forcibly extended and exed (eg, the acceleration or whiplash injury in rear-end automobile collisions) can create a number of dif cult clinical problems The injury ranges from a minor sprain of muscles and ligaments to severe tearing of these structures, to avulsion of muscle and tendon from vertebral body, and even to vertebral and intervertebral disc damage The latter lesions can be seen with MRI and, if severe, can result in root or spinal cord compression or, occasionally, in cartilagenous embolization of the spinal cord (see page 1072).

Milder degrees of whiplash injury are often complicated by psychologic and compensation factors (see LaRocca for a review of this subject) Spinal rheumatoid arthritis may be restricted to the cervical apophysial (facet) joints and the atlantoaxial articulation The usual manifestations are pain, stiffness, and limitation of motion in the neck and pain in the back of the head In contrast to ankylosing spondylitis, rheumatoid arthritis is rarely con ned to the spine Because of major affection of other joints, the diagnosis is relatively easy to make, but signi cant involvement of the cervical spine may be overlooked in patients with diffuse disease In the advanced.

goes to the hole marked (E) on the circuit board Finally locate the 9 volt snap battery terminal stip and connect it to the battery terminals on the far left marked BATT Now that your 6N2 receiver has been completed, it is time to test out your receiver to see if it is going to work Connect up the 9 volt battery clip to the 9 volt battery Connect an antenna to the antenna terminal For testing purposes you can simply connect a 19 piece of wire to the antenna terminals, or if you have an outdoor antenna you can connect it up to the receiver Position the band switch to the 2-meter band position Now adjust the volume control to the mid-way position, and adjust the squelch control counterclockwise so that you just break the squelch and you should hear the receiver noise coming from the speaker.

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