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PCM EX 2 > 2a. Approach to Cervical Complaint > Flashcards

2a. Approach to Cervical Complaint Flashcards

1
Q

4 cause of disability in the US

10-20% of adult general population has this at any given time

A

neck pain

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2
Q

atraumatic causes of neck pain

A
  • musculoskeletal (most common)
  • neurologic
  • non-spinal causes
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3
Q

broad based differential for traumatic neck pain

A
  • myofascial injury
  • cervical fracture
  • ligamentous injury
  • disc injury
  • cord or nerve root inury
  • SCIWORA
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4
Q

pain, spasm, loss of neck ROM, occipital headache

persist with little abnormality on MRI, CT, radiograh, or bone scan imaging

may or may not be traumatic

ex: whiplash, muscle strain, etc.

A

myofascial neck pain

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5
Q

occur in 3% of blunt trauma

most stable

all require neurosx consult

determine if stable or unstable via imaging or consultation

document: initial presence, leel of sensory/motor, rectal tone

A

cervical fractures

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6
Q

What would you document in patients presenting with possible cervical fracture?

A
  • initial presence
  • initial level of sensory/motor loss
  • rectal tone
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7
Q

SCIWORA

A

spinal cord injury without radiographic abnormality

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8
Q

What should you do with patients presenting with SCIWORA?

A

If patienthas normal plain films and cervical CT but continues to have neurologic signs/symptoms, must keep spine immobilized until MRI and evaluation/consult with a neurosurgeon.

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9
Q

Nexus criteria

A
  • absence of posterior midline C-spine tenderness
  • normal level of alertness
  • no intoxication
  • no abnormal neurologic findings
  • no painful distracting injuries
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10
Q

When is Nexus criteria used?

A

patient presents with neck pain after trauma

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11
Q

What happens if patient has (+) Nexus?

A
  1. Apply C-collar
  2. Obtain imaging
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12
Q

most common cause of musculoskeletal atraumatic neck pain

A

cervical spondylosis (degenerative changes)

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13
Q

musculoskeletal atraumatic neck pain

A
  • cervical spondylosis
  • discogenic pain
  • myofascial spain
  • whiplash
  • torticollis
  • facet osteoarthritis
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14
Q

neurologic atraumatic neck pain

A

radiculoapthy and/or myelopathy

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15
Q

non-spinal causes musculoskeletal atraumatic neck pain

A
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16
Q

most common cause of acute and chronic neck pain in adults

degeneraive changes in spine: degenerative discs and osteophytes

incidence increases with age

often asymptomatic

causes general neck pain, radiculopathy, and myelopathy

A

cervical spondylosis (degenerative changes)

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17
Q

cervical myelopathy vs. cervical radiculopathy

A

cervical myelopathy: neurologic deficit related to SC

cervical radicuopathy: neurologic deficit at or near nerve root

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18
Q

symptoms of cervical myelopathy

A

bilateral or distal symptoms (weakness/numbness)

clumsy hands

gait disturbances

sexual dysfunction

bowel/bladder dysfunction

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19
Q

symptoms of cervical radiculopathy

A

sharp, burning pain radiating to the trapezius, periscapular area, down the arm

weakness or paresthesias may develop weeks after pain onset

most common at C5-C6 followed by C6-C7

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20
Q

Is cervical myelopathy or radiculopathy more emergent?

A

Cervical myelopathy requires emergent MRI.

Cervical radiculopathy requires urgent work-up.

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21
Q

symptoms/signs of meningitis

A

fever, malaise, headache, photophobia, neck pain/stiffness, AMS, rash (petechiae and purpura), and meningismus

22
Q

tests for meningitis

A
  • nuchal rigidity
  • Kernig’s
  • Brudzinski’s
23
Q

When would you likely see a rash with meningitis?

A

Neisseria meningitidis

(has been less prevalent since vaccine; Gram neg dipplococci)

24
Q

How do you diagnose meningitis?

A

perofrm a lumbar puncture

25
Q

bacterial causes of meningitis

A

hemophilus, strep pneumonia, and neisseria menigitidis

26
Q

compression of NV bundle by various structures in the area just above first rib and behind the clavicle, within the confined space of the thoracic outlet

A

thoracic outlet syndrome

27
Q

symptoms of thoracic outlet yndrome

A

arm pain, numbness, and weakness

reproducibly aggravated by any activity requiring elevation or sustained use of arms or hands above the head

28
Q

What is more common: vasculogenic or neurogenic TOS?

A

neurogenic (95%)

vascular: arterial or venous (5%)

29
Q

tests for thoracic outlet syndrome

A
  • Roo’s EAST test
  • Adson’s test
30
Q

When would you consider imaging work-up for patients with atraumatic neck pain?

A

patients with progressive neurologic findings and moderate-to-severe neck pain who do not respond to conservative management for >6 weeks

most patients with atraumatic neck pain w/o red flags do not require imaging

31
Q

clinical significance of major neck trauma

A

concern for C-spine fracture

32
Q

clinical significance of neurologic symptoms/signs such as weakness, gait difficulty, bowel/bladder dysfunction

A

concern for cervical cord compression

33
Q

clinical significance of shock-like paresthesia (Lhermitte’s phenomenon) w/ neck flexion

A

suggestive of cervical cord compression or MS

34
Q

clinical significance of fever or chills with neck pain

A

suggestive of infection

35
Q

clinical significance of history of injection drug use

A

raises concern for C-spine or disc infection

36
Q

clinical significance of immunosuppression

A

raises concern for infection

37
Q

clinical significance of chronic glucocorticoid use

A

concern for infection or C-spine compression fracture

38
Q

clinical significnce of unexplained weight loss

A

suggestive of malignancy

39
Q

clinical significance of history of cancer with neck pain

A

raises concern for mestastatic disease to cervical spine

40
Q

clinical significance of headache, shoulder/hip girdle pain, or visual symptoms in older patients with neck pain

A

suggestive of rheumatic disease (polymyalgia rheumatica, giant cell arteritis)

41
Q

clinical significance of anterior neck pain

A

suggestive of non-spinal cause (e.g. angina pectoris)

42
Q

important structures to palpate in the neck

A

lymph nodes

thyroid gland

muscle

bone

connective tissues

soft tissues

spinous processes

disc spaces

43
Q

dermatome of lateral neck

A

C4

44
Q

dermatome of lateral upper arm

A

C5

45
Q

dermatome of lateral forearm and thumb

A

C6

46
Q

dermatome of middle finger

A

C7

47
Q

dermatome of medial wrist/forearm

A

C8

48
Q

dermatome of medial elbow/upper arm

A

T1

49
Q

specialty testing for cervical radiculopathy

A
  • Spurling’s test
  • manual distraction test
50
Q

When would you check ROM in a trauma patient?

A

Never check ROM in a trauma patient unless they have been cleared of cervical fracure and/or SC injury clinically or radiographically

51
Q

Why is “neck stifness” (inability or unwillingness) to move the neck concerning?

A

causes of splinting or stiffness include: C-spine fx, cord injuries, ligament injuries, muscle stains, muscle spasm, SAH, meningitis

52
Q

contraindications for HVLA

A

PCM EX 2 (11 decks)

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