NECK PAIN
The "Dubb-Jaffe"
Syndrome
reviewed
-
By Dr SeymourDubb
A prominent member of the faculty of General practice of the College of Medicine of South Africa, explains his experiences of Neck Pain in general practice.
For many yearsI have been seeingpatientscomplaining
of pain on one or otherside of the neck. The only positive
finding in all patientswas tendernessat the site of the
carotidbifurcation.In one month betweenone of my partnersand myself,we saw six such casesand, for want of a
better name, I ratherfacetiouslycalledit the Dubb-Jaffe
syndrome.
syndromeis probablydue to our
failure to recogniseit. We cannot recognise something of
which we are not already
aware."
W.H. Saunders6, of St. Louis
says: "The only difficulty in
diagnosingcarotid arteritis is in
thinking of it; no other condition
It was unusualto see such a years in one clinic.
causestendernesslimited to the
clusterof casesand months can
An analysis of these various
courseof the carotidartery."
go by with no casebeingseen,I reports shows the following
G.F. Green7, a generalpracticouldget no informationon this signs and symptoms:
tioner in Yorkshire,publisheda
condition either from textbooks
The condition occurs in both
series of 12 casesseen over a
or from the various physiciansI sexesand seemsto be confined
period of 2 years. He believes
discussedit with. We had now, to adults.
that the majority of episodesbehowever,seen enoughof these
All patientscomplainof pain
ing both mild and self limiting
casesto be able to reassureour in the neck. It can vary from mild
will tend to be acceptedin terms
patientsthat it was a self limiting discomfort to severe pain. The
of the patient'scomplaintof a
conditionand no causefor con- pain radiatesto the angle of the
jaw or to the ear. Some comsore throat, or swollenglands,
cern.
and that the remissionwill be atT h e b r e a k t h r o u g h c a m e plainof generalmalaise.
tributedto whatevertherapywas
about a year and a half ago
There is always marked
given.
when I found a letter in lhe
tenderness confined to the
From the experienceof this
L a n c e t h e a d e d : " l d i o p a t h i c carotid artery.
conditionin my practiceand the
There is sometimesa swelling
Carotiditis"by Dr Bank who had
review of the literature,there is
had the same experience as at the site of the bifurcation of
no doubt that this is a common
myself . seeingpatientswith this the carotidartery. There is often
condition that needs wider
condition,and unableto find any increased pulsation of the Aetiology
The variousauthorsspeculate recognition.
referenceto it in the literature. carotid artery on the affected
With this recognition of
He had seen 12 such cases.Dr side. Erthrocyte sedimentation as to the causeof this condition
Bank's publication produced a rate is usually normal or slightly but no firm aetiology has been carotid pain as a definite synresponsein the form of a letter raised.Leucocytecount is nor- found. The vessel cannot be drome, albeit of unknown
aetiology,one can then reassure
from Skrabanek,P.2 of Dublin. mal. There is no pyrexia. There biopsied
the patient that he or she is suf.
are:
Some suggestions
He quoted many referencesto is often an association with
this condition. The first descrip- migraine or psychoneuroticper- o Infection of the carotid feringfrom a benignselflimiting
illness,and so savemuch anxietion comes from the French sonality, but many of the pa- sheath.
literature,when in 1948 Truf- tients are healthy,well balanced o A u t o n o m i c d y s f u n c t i o n ty and unnecessaryinvestigation
and therapy.
closelyalliedto migraine.
fert, P.3 described the "Syn- people.
The durationof the pain can o The occuranceof an arteritis
dromedoloureauxde la Fourche
c a r o t i d i e n n e " . S k r a b a n e k be from days to months. The of the nature of a collagen
disorder.
References
ouotes four other references conditioncan be recurrent.
Why then has this fairly com- 1. Bank,H. Lancet1978 | 726
where authors describefrom 5
mon conditionnot found its way 2. Skrabanek,P. lbid 1978 I 823
to 12 cases.
Treatment:
3. Truffert,P. M€m Chir 1948,74,322
into
the textbooks, and why do 4. Lovshin,L.C. ClevelandCIinQuaft 1960,27 ,
Most authors recommend
The largestserieswasdescrib'
a
ed bv Lovshin of Cleveland analgesicsand firm reassurance. so few practitionersknow of it? 5. 5Davies,J. B.M.T. 1961 ii
1528
5
U.S.A.,who analysed1OOcase In the'moreresistantcasesBank Davies who describedsix cases 6. Saunders,W.H. Laryngoscope1962,72 481
says:"The apparentrarity of the 7. Creen,C.F. Practitioner1966. 146.562
prescribeda six day course of
histories of patients seen in 2
prednisone with striking improvemen| within 24 hoursthe
pain subsides.The regime is
3Omg/dayfor 2 days, 2Omg/day for 2 days, then 5mg/day
for 2 days. Other doctors have
also used steroidswith apparent
benefit.
In May 1979 | staited recording patientsseen by me and
collected 7 casesin the course
of eight months. There were 6
females, 2 males and ages
variedfrom 26 to 53, the mean
age was 40. All had pain in the
over
neckand all hadtenderness
the rightor left carotid.I couldn't
find a swellingin any of the patients. There was increased
pulsation in two. Three of the
patients had been treated for
anxietyand/or depression.They
were all treated with nonsteroidal anti-inflammatory
drugs, explanation and
reassurance.
FamilyPractice- February1981