12: Neck Pain Flashcards
What test is used to assess nerve root irritation or spinal cord compromise?
Electromyography
T/F In torticollis, spasms are usually sporadic and uncontrollable.
False. They are usually uncontrollable and continuous.
When is an x-ray useful in neck pain?
If there is trauma. No trauma, no x-ray.
With cervical disc dz, when do you order an x-ray?
No need, as it won’t show disc issues. It only shows bony changes. May see DJD or narrowing of foramina of vertebrae. Can be useful in trauma, if a bone injury is suspected.
When is a CAT scan used instead of MRI?
CAT scans are used more for acute injury, in ERs, or if the patient has metal in their body.
Is this an acute cervical strain or chronic?
Burning or aching, with or without radiation to the arm or hand.
Chronic
What can be a sign of nerve or disc involvement in cervical disc dz?
Pain that is relieved by lifting an arm above the head.
What x-ray view looks at C1-T1 (alignment and disc space)?
Cross table lateral
How do you evaluate ROM?
- Evaluate degree of ROM and pain with movement
- Some people have full ROM (forward flexing of neck) but cannot extend neck at all
With neck pain, the majority of pts will want an MRI. When should this be considered?
If neurological, or pain persists or worsens after conservative treatment (4–6 weeks), order an MRI or CAT scan.
How much time should pass before referring to physical therapy?
No improvement within 3 days
Usually an abrupt onset of pain. Danger signs include radiculopathy in only 1 arm. Look for pain, weakness, numbness, and tingling.
Cervical Disc Dz
What is the compression test and what does it show?
Compress downward on head to reproduce radicular symptoms if herniated disc is present.
In neurological testing, what vertebra does the triceps reflex test?
- C7
- Triceps, wrist flexors, and finger extensors
In neurological testing, what vertebra is associated with the interossei muscles (not assessed via a reflex)?
T1
In neurological testing, what vertebra does the biceps reflex test?
- C5
- Biceps and deltoid
In neurological testing, what spinal nerve does abducting and adducting fingers test (not assessed via a reflex)?
- C8
- Finger flexors, interossei muscles
In neurological testing, what vertebra does the radial reflex test?
- C6
- Biceps and wrist extensors
What is the PE for neck pain?
- Palpate C-spine
- Range of motion
- Resisted range of motion
- Grip strength
- Special maneuvers
If a person has neck pain, evaluate for _____ problems.
If a person has neck pain, evaluate for neurological problems.
If patients with carpal tunnel are unable to resolve, look to the neck. Frequently, a _____ nerve involvement presents similarly to carpal tunnel.
If patients with carpal tunnel are unable to resolve, look to the neck. Frequently, a C6 nerve involvement presents similarly to carpal tunnel.
What is the management for neck pain?
- Typical, conservative treatment:
- Anti-inflammatories
- Ice
- Muscle relaxants
- PT for soft tissue mobilization and sometimes traction to release pressure on spine
- U/S
- Stimulation
- Cervical exercises
- Discuss work and sleep positions
- Typically sleep on a pillow that does not support neck
- Cervical pillow has valley that supports neck while keeping spine aligned
What direction does the pain take if there is a herniated disc and you perform the compression test?
Pain doesn’t go down to the lower back. It will go out if there is a herniated disc.
If distraction alleviates radicular pain, what does this indicate?
There is probably some nerve involvement or a herniated disc that’s compressed.
When evaluating a pt for cervical disc dz, what might alleviate the pain?
Raising arm above head. This alleviates the stress and pull on the herniated disc.
If a person has _____ pain, but didn’t injure themselves, look to the neck.
If a person has shoulder pain, but didn’t injure themselves, look to the neck.
When do you refer for neck pain?
- Cervical fracture
- Intractable pain with neurological deficit (weakness, numbness, tingling, and unremitting neurological types of pain)
- If no relief after 4-6 weeks
What is the congenital form of torticollis called?
Wry Neck
Why do you check the pulse while performing adson’s test?
It checks for a thoracic outlet problem.
What is adson’s test and what does it test?
- Abduct and externally rotate shoulder while turning head toward arm being tested.
- C5-T1
When will electromyography be useful?
6-8 weeks after onset of radicular pain
What is it called when you elevate a person’s neck by lifting up the head a little bit?
Distraction
What x-ray view looks at C1 and C2 (atlas and axis of spine)?
Odontoid view (through mouth)
What does a muscle spasm feel like on exam?
Ropy type of nodule that goes along muscle fibers.
Contraction or spasm of neck muscles causing head to be lifted and tilted to one side; usually accompanied by rotation of chin upward.
Torticollis
What is the cause of torticollis?
Unknown, but possible infx.
T/F If a plain x-ray suggests a fracture, CT or MRI are indicated.
True
How do you palpate the C-spine?
- Check alignment
- Assess tenderness over vertebral processes
- Feel for abnormal masses and point tenderness, especially with trauma
Is this an acute cervical strain or chronic?
Sharp neck pain with radiation to head, shoulder, or hand.
Acute
_____ stems from overuse, whiplash (usually mechanical).
Cervical strain stems from overuse, whiplash (usually mechanical).
What test looks at alignment, disc space, and facets?
X-ray
T/F 10% of people have degenerative joint disease (DJD), arthritis, or a herniated disc in their neck or back, with no symptoms.
True. Once identified, evaluate further.
Neck pain can be either _____ or _____.
Neck pain can be either neurological or mechanical.
When is neck pain chronic?
3+ months
What is the treatment for cervical disc dz?
- Anti-inflammatories (pain control)
- ROM exercises
What is the treatment for torticollis?
- Physical therapy
- Pain control (anti-inflammatories)
- Muscle relaxants
- Possibly neck braces (if prolonged)
What single vertebra are these muscles associated with?
Interossei muscles
T1
What single vertebra are these muscles associated with?
Triceps, wrist flexors, and finger extensors
C7
What single vertebra are these muscles associated with?
Biceps and wrist extensors
C6
What single vertebra are these muscles associated with?
Biceps and deltoid
C5
What single spinal nerve are these muscles associated with?
Finger flexors, interossei muscles
C8
