One of the most common issues affecting the neck and spine is cervical subluxation. This condition occurs when the vertebrae in the cervical (neck) region become misaligned, leading to a range of symptoms and discomfort. Cervical subluxation can be caused by various factors, such as trauma, poor posture, or degenerative changes in the spine.
When the vertebrae in the neck are not properly aligned, it can result in nerve irritation and decreased mobility. This can lead to symptoms such as neck pain, stiffness, headaches, and even radiating pain or numbness in the arms or hands. Cervical subluxation can also affect the function of surrounding muscles, leading to muscle weakness or spasms.
Treating cervical subluxation often involves chiropractic care, as chiropractors specialize in the diagnosis and treatment of conditions related to the spine. Chiropractors use manual techniques to gently manipulate the vertebrae back into alignment, relieving pressure on the nerves and restoring proper function to the neck. In addition to spinal adjustments, chiropractors may also recommend stretching exercises, massage therapy, or lifestyle modifications to support the healing process and prevent future subluxations.
Cervical Subluxation: Causes, Symptoms, and Treatment
Cervical subluxation refers to the misalignment of the vertebrae in the neck, specifically the cervical spine. This condition can cause discomfort and a range of symptoms. Understanding the causes and symptoms of cervical subluxation is crucial in seeking appropriate treatment.
Causes of Cervical Subluxation
Cervical subluxation can be caused by various factors, including:
| Causes | Description |
|---|---|
| Trauma | Any injury or impact to the neck can lead to misalignment of the cervical vertebrae. |
| Poor posture | Long periods of sitting or standing with incorrect posture can gradually cause cervical subluxation. |
| Degenerative conditions | Conditions like arthritis or disc degeneration can contribute to the development of cervical subluxation. |
Symptoms of Cervical Subluxation
The symptoms of cervical subluxation can vary depending on the severity of the misalignment and the affected nerves. Common symptoms include:
- Neck pain or stiffness
- Headaches
- Shoulder or arm pain
- Tingling or numbness in the arms or hands
- Weakness in the arms or hands
Treatment for Cervical Subluxation
Treatment for cervical subluxation aims to alleviate symptoms, restore proper alignment, and improve overall spinal health. Options for treatment may include:
- Chiropractic adjustments: Manual manipulation techniques performed by a chiropractor to realign the vertebrae.
- Physical therapy: Exercises and stretches to strengthen the neck muscles and improve posture.
- Pain management: Medications or injections to reduce pain and inflammation.
- Surgical intervention: In severe cases, surgery may be necessary to correct the misalignment.
If you suspect you have cervical subluxation, it is important to seek professional medical advice for an accurate diagnosis and appropriate treatment plan. Timely treatment can help prevent further complications and improve quality of life.
Causes of Cervical Subluxation
Cervical subluxation, also known as cervical misalignment or a subluxated vertebrae, can be caused by various factors. The cervical spine, which consists of the seven vertebrae in the neck, can become misaligned due to injury, poor posture, or repetitive strain.
Injury
An injury to the neck, such as whiplash from a car accident or a fall, can cause cervical subluxation. The sudden jolt or impact can force the vertebrae out of their proper alignment, leading to discomfort and restricted movement.
Poor Posture
Poor posture, especially when sitting or standing for extended periods, can contribute to cervical subluxation. Slouching or hunching forward puts strain on the neck and causes the vertebrae to shift out of place. This can result in pain and stiffness in the neck and shoulders.
Repetitive Strain
Engaging in repetitive activities that strain the neck, such as excessive computer use or constantly looking down at a phone or tablet, can lead to cervical subluxation. The constant stress placed on the neck can cause the vertebrae to gradually shift out of alignment, resulting in discomfort and reduced range of motion.
If left untreated, cervical subluxation can lead to further complications and chronic pain. Chiropractic treatment, involving gentle adjustments to realign the vertebrae, is a common and effective approach to managing cervical subluxation and relieving associated symptoms.
Symptoms of Cervical Subluxation
Cervical subluxation refers to the misalignment of the cervical spine, which is the neck region of the spine. This condition can lead to various symptoms that can cause discomfort and impact an individual’s quality of life.
1. Neck Pain
One of the most common symptoms of cervical subluxation is neck pain. The misalignment of the cervical spine can put pressure on the surrounding nerves and tissues, causing pain and stiffness in the neck. This pain may be persistent or occur intermittently, making it difficult to perform daily activities.
2. Headaches
Cervical subluxation can also contribute to headaches. As the misaligned vertebrae put pressure on the nerves in the neck, it can lead to tension headaches or migraines. These headaches can range from mild to severe and may be accompanied by other symptoms such as sensitivity to light or sound.
Other symptoms of cervical subluxation may include:
- Shoulder pain
- Arm pain or numbness
- Decreased range of motion in the neck
- Muscle weakness
- Tingling or burning sensation in the neck or arms
If you are experiencing any of these symptoms, it is important to seek chiropractic treatment for cervical subluxation. A chiropractor can assess your condition and provide appropriate adjustments to realign the cervical spine, relieving discomfort and improving overall spinal health.
Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment options.
Diagnosis of Cervical Subluxation
Diagnosing cervical subluxation is essential to determine the appropriate treatment plan for patients experiencing neck discomfort. Cervical subluxation occurs when the vertebrae in the spine are misaligned, causing pain and limited range of motion.
During the diagnosis process, a healthcare professional will carefully assess the patient’s symptoms and medical history. They will inquire about any recent accidents or traumas that may have contributed to the development of cervical subluxation.
Physical examinations, such as range of motion tests and palpation of the neck, are also conducted to evaluate the extent of the misalignment. These tests help to identify any tender areas or abnormalities in the cervical spine.
Imaging tests, including X-rays, CT scans, or MRIs, may be ordered to provide a more detailed view of the cervical spine. These diagnostic tools allow healthcare providers to assess the alignment of the vertebrae and identify any other underlying conditions that may be contributing to the subluxation.
Once a diagnosis of cervical subluxation is confirmed, the healthcare provider can develop an appropriate treatment plan tailored to the patient’s needs. This may include chiropractic adjustments, physical therapy exercises, pain medication, or other interventions to help restore proper alignment and alleviate discomfort.
Regular follow-up appointments and re-evaluations are crucial to monitor the progress of the treatment and make any necessary adjustments to the plan. By actively managing cervical subluxation, patients can experience improved neck function and overall well-being.
Types of Cervical Subluxation
Cervical subluxation refers to the partial misalignment or displacement of the vertebrae in the cervical spine, which is located in the neck area. This condition can cause discomfort and limited neck mobility. Understanding the different types of cervical subluxation can help in determining the appropriate treatment.
Anterior Subluxation:
Anterior subluxation occurs when a vertebrae in the cervical spine slips forward and becomes misaligned with the one below it. This type of subluxation can result from trauma or injury to the neck, such as whiplash.
Posterior Subluxation:
Posterior subluxation refers to the backward displacement of a vertebrae in the cervical spine. It can be caused by factors such as poor posture, degenerative changes in the spine, or repetitive stress injuries.
Treatment for cervical subluxation often involves chiropractic care. Chiropractors use manual adjustment techniques to correct the misalignment and restore proper function to the spine. These adjustments can help alleviate discomfort, improve range of motion, and promote overall neck health.
Prevention of Cervical Subluxation
Preventing cervical subluxation is essential to maintain proper spinal health and prevent discomfort. Here are a few measures and practices that can help prevent cervical subluxation:
1. Maintain good posture:
Proper posture plays a crucial role in preventing cervical subluxation. Maintain an upright position while sitting or standing, and avoid prolonged slouching or hunching. Use ergonomic chairs and adjustable desks to support your spine’s natural curvature.
2. Exercise regularly:
Regular exercise not only improves overall strength and flexibility but also helps strengthen the muscles supporting the cervical spine. Incorporate exercises that focus on strengthening the neck and back muscles to maintain proper alignment and reduce the risk of subluxation.
3. Avoid repetitive movements:
Avoid repeated motions that strain the neck and spine, such as excessive head tilting or twisting. Be mindful of your movements during activities like using electronic devices or carrying heavy objects, and try to minimize repetitive stressing on the cervical vertebrae.
4. Take breaks while working:
If you have a sedentary job that involves sitting for long hours, make sure to take short breaks and stretch periodically. Changing positions and moving around helps relieve stress on the cervical spine and prevents subluxation caused by extended periods of immobility.
5. Maintain a healthy weight:
Excess weight can put additional strain on the cervical spine, increasing the risk of subluxation. Maintain a healthy weight through a balanced diet and regular physical activity to reduce the load on your neck and spine.
6. Seek chiropractic care:
Regular chiropractic check-ups and adjustments can help maintain proper alignment of the cervical vertebrae and prevent subluxation. Chiropractors specialize in diagnosing and treating spinal misalignments, providing targeted treatment and guidance for optimal spinal health.
By following these preventive measures and seeking appropriate treatment when necessary, individuals can reduce the risk of cervical subluxation and maintain a healthy neck and spine.
Treatment Options for Cervical Subluxation
When facing cervical subluxation, it is important to seek appropriate treatment to alleviate discomfort and prevent further complications. The cervical spine, consisting of seven vertebrae, plays a crucial role in supporting the neck and head. When misalignment or subluxation occurs, it can cause pain, restricted movement, and even nerve impingement.
Chiropractic Care
Chiropractic care is a non-invasive treatment option that focuses on realigning the cervical spine to relieve subluxation. Chiropractors use manual adjustment techniques to gently manipulate the vertebrae back into their proper position. This helps reduce pressure on the surrounding nerves and tissues, alleviating pain and restoring proper function.
Physical Therapy
Physical therapy exercises can also be beneficial in the treatment of cervical subluxation. A licensed physical therapist can develop a personalized plan to improve strength, flexibility, and range of motion in the neck. These exercises can help stabilize the cervical spine and prevent future subluxation episodes.
Traction
Traction therapy may be recommended for severe cases of cervical subluxation. This involves using a device or specialized table to gently stretch the neck and relieve pressure on the vertebrae. Traction can help restore proper alignment and relieve symptoms associated with cervical subluxation.
Medication
In some cases, medication may be prescribed to manage pain and reduce inflammation associated with cervical subluxation. Non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants can be effective in providing temporary relief. However, it is important to note that medication alone does not address the underlying cause of subluxation and should be used in conjunction with other treatment approaches.
When seeking treatment for cervical subluxation, it is important to consult with a healthcare professional experienced in treating spine-related conditions. They can provide an accurate diagnosis and develop a personalized treatment plan to address the specific needs of each patient.
Chiropractic Care for Cervical Subluxation
Chiropractic care offers a non-invasive and drug-free approach to treating cervical subluxation, a condition characterized by a misalignment of the vertebrae in the neck region. This misalignment can result in nerve interference, muscle tension, and decreased range of motion.
How Does Chiropractic Care Help?
When you visit a chiropractor for cervical subluxation, they will conduct a thorough examination to determine the extent of the misalignment and any associated symptoms. Using various manual adjustment techniques, such as spinal manipulation and mobilization, the chiropractor will work to restore proper alignment of the vertebrae in the cervical spine.
Chiropractic adjustments are gentle and precise. By applying controlled force to the affected area, the chiropractor can gradually move the misaligned vertebrae back into their correct position. This helps alleviate nerve compression, reduce muscle tension, and improve overall spinal function.
Benefits of Chiropractic Treatment
Chiropractic treatment for cervical subluxation offers several benefits, including:
- Relief from neck pain and stiffness
- Reduced muscle spasms and tension
- Improved range of motion in the neck
- Enhanced nerve function
- Increased overall well-being
Chiropractic care also focuses on addressing the underlying causes of cervical subluxation, such as poor posture, repetitive movements, or trauma. By identifying and addressing these factors, chiropractors can help prevent future subluxations and promote long-term spinal health.
If you are experiencing symptoms of cervical subluxation, such as neck pain, headaches, or restricted movement, consider seeking chiropractic care for a natural and effective treatment option. A qualified chiropractor can provide personalized care to help alleviate your symptoms and restore proper alignment to your cervical spine.
Physical Therapy for Cervical Subluxation
Physical therapy is a non-invasive treatment option for cervical subluxation, a condition characterized by misalignment of the vertebrae in the neck. This misalignment can cause discomfort and interfere with the normal functioning of the spine.
Benefits of Physical Therapy
Physical therapy aims to restore proper alignment and function to the cervical spine. It can help reduce pain, improve range of motion, and strengthen the muscles supporting the neck. By addressing the root cause of the subluxation, physical therapy can provide long-term relief and prevent future episodes of discomfort.
Treatment Approaches
In physical therapy, various techniques may be utilized to treat cervical subluxation. These include:
- Manual Therapy: The therapist may use hands-on techniques to mobilize and manipulate the vertebrae, bringing them back into proper alignment.
- Therapeutic Exercises: Specific exercises can be prescribed to stretch and strengthen the muscles surrounding the cervical spine. These exercises can improve stability and promote proper alignment.
- Traction: This technique involves applying a gentle pulling force to the neck to separate the vertebrae and relieve pressure on the nerves.
- Posture Correction: Physical therapists can provide guidance on maintaining proper posture to prevent further strain on the neck and spine.
During a physical therapy session, the therapist will assess the individual’s condition and develop a customized treatment plan. The frequency and duration of sessions will vary depending on the severity of the subluxation and the individual’s response to treatment.
In addition to physical therapy, chiropractic care may also be recommended for cervical subluxation. Chiropractors focus on manual adjustments and spinal manipulations to restore proper alignment and function of the spine.
If you are experiencing discomfort or suspect cervical subluxation, it is important to consult with a healthcare professional. They can diagnose the condition and recommend appropriate treatment options, which may include physical therapy.
Medications for Cervical Subluxation
When it comes to treating cervical subluxation, medications may play a role in managing the discomfort and pain associated with this condition. While medication alone is not typically considered a primary treatment for cervical subluxation, it can be used in conjunction with other forms of therapy to help provide relief.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to reduce inflammation and discomfort in the neck. These medications work by blocking certain enzymes in the body that cause pain and swelling.
In some cases, muscle relaxants may be prescribed to help reduce muscle spasms and tension in the neck. These medications can help alleviate discomfort and improve mobility in the affected area.
For individuals experiencing severe pain or inflammation, corticosteroids may be used. These medications work by suppressing the immune system’s response to inflammation, reducing pain and swelling.
It’s important to note that medications should always be used under the guidance and supervision of a healthcare professional. They should be used as a part of a comprehensive treatment plan that may include chiropractic adjustments, physical therapy, and other forms of therapy to address the underlying cause of cervical subluxation and promote healing in the spine and neck.
If you are experiencing symptoms of cervical subluxation, such as pain, stiffness, or limited range of motion in the neck, it is essential to consult with a healthcare provider for an accurate diagnosis and appropriate treatment approach. They can recommend the most suitable medication options based on your individual condition and overall health.
Surgical Interventions for Cervical Subluxation
When non-surgical treatments fail to provide relief, surgical interventions may be considered for cervical subluxation. Surgical interventions aim to correct the misalignment of the cervical spine and alleviate the symptoms associated with subluxation.
Anterior Cervical Discectomy and Fusion (ACDF)
One common surgical procedure for cervical subluxation is anterior cervical discectomy and fusion (ACDF). This procedure involves removing the herniated or damaged disc that may be causing the subluxation and fusing the adjacent vertebrae together. ACDF helps to stabilize the neck and relieve pain and discomfort.
Posterior Cervical Fusion
Another surgical option is posterior cervical fusion. This procedure involves fusing the vertebrae in the cervical spine from the back of the neck. It helps to stabilize the spine and reduce subluxation. Posterior cervical fusion may also be performed alongside decompression surgery to relieve pressure on nerves that may be affected by the subluxation.
Both ACDF and posterior cervical fusion surgeries require a period of recovery and rehabilitation. Patients may need to wear a neck brace or collar to limit movement and support the healing process. Physical therapy may also be recommended to improve strength and flexibility in the neck.
| Pros | Cons |
|---|---|
| – Provides long-term stability | – Invasive procedure |
| – Alleviates neck pain and discomfort | – Potential risks and complications |
| – Improves overall neck function | – Longer recovery time |
It is important to note that surgical interventions for cervical subluxation are generally considered as a last resort, when conservative treatments have failed to provide relief. It is always recommended to consult with a healthcare professional, such as a chiropractor or orthopedic surgeon, to determine the best course of action based on individual circumstances and symptoms.
Alternative Therapies for Cervical Subluxation
While conventional medical treatment is often the primary approach for cervical subluxation, there are alternative therapies that can also be considered. These therapies focus on addressing the underlying causes of subluxation and providing relief from symptoms and discomfort.
Chiropractic Care
Chiropractic care is a popular alternative therapy for cervical subluxation. Chiropractors are trained to detect and treat spinal misalignments, including subluxations in the cervical vertebrae. Through manual adjustments, chiropractors aim to realign the spine, alleviate pressure on the nerves, and improve overall spinal function. This can help alleviate pain and discomfort associated with cervical subluxation.
Physical Therapy
Physical therapy can be an effective alternative treatment for cervical subluxation. Physical therapists use various techniques, including exercises, stretches, and manual therapy, to improve the strength, flexibility, and stability of the neck muscles and spine. This can help correct imbalances, reduce strain on the cervical vertebrae, and promote proper alignment, reducing the risk of subluxation and relieving associated discomfort.
In addition to chiropractic care and physical therapy, other alternative therapies that can be considered for cervical subluxation include acupuncture, massage therapy, and yoga. These therapies focus on improving overall well-being, reducing muscle tension, promoting relaxation, and restoring balance to the body. While there may be limited scientific evidence supporting the effectiveness of these alternative therapies for cervical subluxation, many individuals find them helpful in managing their symptoms and improving their quality of life.
It is important to consult with a healthcare professional before undergoing any alternative therapy for cervical subluxation. They can provide guidance and recommendations based on individual needs and medical history.
Exercises for Cervical Subluxation
Cervical subluxation is a common condition characterized by the misalignment of the cervical vertebrae in the neck. This misalignment can cause discomfort, pain, and limited mobility. Fortunately, there are exercises that can help to relieve these symptoms and improve the overall condition of the cervical spine.
1. Neck Range of Motion Exercises
Neck range of motion exercises can help to increase flexibility and strengthen the muscles surrounding the cervical spine. These exercises involve moving the neck in various directions, such as flexion (forward), extension (backward), lateral flexion (side bending), and rotation.
Here are some examples of neck range of motion exercises:
- Chin Tucks: Sit or stand with your back straight. Gently retract your chin, bringing it back towards your neck. Hold for a few seconds and then relax. Repeat 10 times.
- Neck Retraction: Sit or stand with your back straight. Keeping your eyes level, gently pull your head back, creating a double chin. Hold for a few seconds and then relax. Repeat 10 times.
- Side Bends: Sit or stand with your back straight. Gently tilt your head towards one shoulder, trying to touch your ear to your shoulder. Hold for a few seconds and then tilt your head towards the other shoulder. Repeat 10 times on each side.
- Neck Rotation: Sit or stand with your back straight. Gently rotate your head to one side, trying to look over your shoulder. Hold for a few seconds and then rotate to the other side. Repeat 10 times on each side.
2. Isometric Neck Exercises
Isometric neck exercises involve contracting the muscles without moving the neck. These exercises can help to improve muscle strength and stability in the cervical spine.
Here are some examples of isometric neck exercises:
- Neck Extension: Place your hands on the back of your head and apply light pressure, while simultaneously pushing your head back against your hands. Hold for a few seconds and then relax. Repeat 10 times.
- Neck Flexion: Place your hands on your forehead and apply light pressure, while simultaneously pushing your head forward against your hands. Hold for a few seconds and then relax. Repeat 10 times.
- Side Resistance: Place one hand on the side of your head and apply light pressure, while simultaneously pushing your head against your hand. Hold for a few seconds and then repeat on the other side. Repeat 10 times on each side.
It is important to consult with a healthcare professional, such as a chiropractor, before starting any exercise program for cervical subluxation. They can provide guidance on the most appropriate exercises for your specific condition and ensure that you are performing them correctly.
Lifestyle Changes for Cervical Subluxation
Living with cervical subluxation can be challenging, but there are lifestyle changes that can help manage and prevent this condition. Cervical subluxation refers to the misalignment of the vertebrae in the neck, which can cause pain, discomfort, and limited range of motion. By making certain adjustments to your daily routine, you can reduce the risk of cervical subluxation and support the effectiveness of chiropractic treatment.
Here are some lifestyle changes that may benefit those with cervical subluxation:
| 1. | Avoid prolonged sitting or standing |
| 2. | Use ergonomic furniture and equipment, such as an adjustable chair or desk |
| 3. | Practice good posture by keeping your head aligned with your spine |
| 4. | Take frequent breaks when working on a computer or engaging in other activities that strain the neck |
| 5. | Engage in regular exercise to strengthen the neck muscles and improve overall posture |
| 6. | Stretch the neck muscles regularly to improve flexibility and reduce tension |
| 7. | Avoid carrying heavy bags or backpacks that put strain on the neck and shoulders |
| 8. | Invest in a supportive pillow and mattress that promote proper alignment of the spine |
| 9. | Manage stress levels through relaxation techniques, such as deep breathing or meditation |
| 10. | Seek regular chiropractic adjustments to correct spinal misalignments and relieve symptoms |
By making these lifestyle changes, you can reduce the risk of cervical subluxation and improve the effectiveness of chiropractic treatment. Remember to consult with a healthcare professional before making any major changes to your routine, as they can provide personalized advice based on your specific condition.
Complications of Cervical Subluxation
Cervical subluxation refers to the misalignment of the vertebrae in the neck, which can lead to various complications if left untreated. This condition can cause several problems affecting the spine and surrounding structures.
One of the main complications of cervical subluxation is the compression of the spinal cord and nerve roots. When the vertebrae become misaligned, they can put pressure on the spinal cord, leading to a range of symptoms such as numbness, tingling, muscle weakness, and pain. In severe cases, cervical subluxation can even result in paralysis.
Another complication is the disruption of the normal biomechanics of the neck. The subluxation can interfere with the proper movement and function of the spine, leading to stiffness, reduced range of motion, and muscle imbalances. This can result in chronic pain and discomfort in the neck and surrounding areas.
Chiropractic treatment is often recommended for cervical subluxation to restore proper alignment and alleviate the complications associated with it. Chiropractors use various techniques to gently adjust the affected vertebrae, reducing the pressure on the spinal cord and allowing it to function optimally. This can help relieve pain, improve mobility, and restore overall health and well-being.
It is important to note that cervical subluxation can have serious consequences if left untreated. Therefore, early detection and treatment are essential. If you experience any symptoms or suspect that you may have cervical subluxation, it is advisable to consult a healthcare professional or chiropractor for evaluation and appropriate management.
| Complications of Cervical Subluxation |
|---|
| Compression of spinal cord and nerve roots |
| Disruption of normal biomechanics of the neck |
| Stiffness and reduced range of motion |
| Muscle imbalances |
| Chronic pain and discomfort |
| Paralysis (in severe cases) |
Question-answer:
What is cervical subluxation?
Cervical subluxation is a condition that occurs when the vertebrae in the neck become misaligned or move out of their normal position.
What are the causes of cervical subluxation?
The causes of cervical subluxation can vary and may include trauma, poor posture, degenerative conditions, repetitive motion, and abnormal spinal curvatures.
What are the symptoms of cervical subluxation?
The symptoms of cervical subluxation may include neck pain, stiffness, headaches, dizziness, numbness or tingling in the arms or hands, muscle weakness, and limited range of motion in the neck.
How is cervical subluxation diagnosed?
Cervical subluxation can be diagnosed through a combination of physical examination, medical history, and imaging tests such as X-rays or MRIs.
What are the treatment options for cervical subluxation?
Treatment options for cervical subluxation may include chiropractic manipulation, physical therapy, exercises to improve posture and strengthen neck muscles, pain medications, and in some cases, surgery.
What is cervical subluxation?
Cervical subluxation is a condition where there is an abnormal movement of the vertebrae in the neck, resulting in misalignment.
What are the causes of cervical subluxation?
Cervical subluxation can be caused by various factors such as trauma or injury to the neck, repetitive stress or strain on the neck, poor posture, and degenerative conditions like arthritis.
What are the symptoms of cervical subluxation?
The symptoms of cervical subluxation can vary but commonly include neck pain, stiffness, headaches, radiating pain to the shoulders or arms, numbness or tingling sensation in the hands or fingers, and limited range of motion in the neck.
How is cervical subluxation treated?
The treatment for cervical subluxation usually involves a combination of chiropractic adjustments, physical therapy, exercises to strengthen the neck muscles, and lifestyle changes. In severe cases, surgery may be required.