Approach to Cervical Complaint Final Exam Flashcards
Causes of neck pain Atraumatic?
- MSK
- Neurologic
- Radiculopathy
- Myelopathy
- Non spinal
Traumatic neck pain?
- Myofascial injury (muscle strain, whiplash…)
- Cervical fracture
- lig injury
- disc injury
- cord or nerve root injury
- SCIWORA
Myofascial neck pain symptoms?
Very common!
- May/may not be traumatic
- symptoms are pain, spasm, loss of ROM, occipital headache
- pain can be persistent with little abnormalities seen on MRI CT or X ray
Cervical Fractures?
Spinal cord injury without r adiographic abonormality (SCIWORA)?
- Common in eldery and kids
- Patient presents with nonrmal films and CT but continues to have symptoms
- Must keep the spine immobilized until MRI and eval with a neurosurgeon
What is cervical spondylosis?
- Degenerative changes in the cervical spine
Nonspinal causes of atruaumatic neck pain?
- Systemic disease or referred pain
- Thoracic outlet syndrome
- CAD
- Malignancy
- RA
- Infection
What are the three types of torticollis?
- Congenital: muscular fibrosis of SCM
- Adult: acquired typically from SCM or traps muscle injury or inflammation
- Life threatening: retropharyngeal abscess, C spine injury, CNS tumor or spinal epidural hematoma
What is the most common cause of acute and chronic neck pain in adults?
- Cervical spondylosis
- osteophytes are seen on the vertebral bodies and disc spaces become more narrow
What is cervical myelopathy?
- Any neurologic deficit related to the spinal cord
- Signs: bilateral or distal weakness/numbeess, clumsy hands, gait disturbances, sex dysfunction, bowel/bladder dysfunction
- Needs emergent MRI
What is radiculopathy of cervical spine?
- Any neurologic deficit at or near nerve root
- Signs: sharp burning pain radiating to traps down arm or periscapular area. Weakness or paresthesias may develop
- C5-6 followed by C6-7 are most common
- Urgent work up, non emergent, MRI NSAIDS OMM PT
Meningitis symptoms diagnosis?
- Fever, malaise, headache, photophobia, neck pain stiffness rash
- Petechiae rash is near death
- Caused by:
- Bacterial: Hemophilus, Strep Pneumonia
- Nisseria Menigitidis: less prevalent since vaccine, gram - dipplococci
- Diagnosed by lumbar puncture
Gram - diplocci are meningicoccus important for Boards exam!
Thoracic outlet syndrome
Confined space between rib and clavicle
- Symptoms: arm pain, numbness, weakness
- Roo’s/EAST test
What portions of OLDCARTS are important for neck pain?
- Location, is it bilateral unilateral or diffuse
- Character, is is shtarp radicular
- Associated symptoms, weakness bowl or bladder dysfunction headache neck stiff
- ROS: Fever chills CP SOA history or recent trauma
- focused ROS: neurologic signs that suggest cord issues
- shock like paresthesia
What re the palpable structures in the neck?
- LN
- Thyroid
- Muscles and bones soft tissues
- Spinous processes
- disc space
ROM for the neck
- flexion
- ext
- rotation
- lateral bending
- passive and active
- Do NOT go through ROM with traumatic pain unless cleared by radiograph or clinically by Nexus criteria
C6 T4 and T10 are sensory dermatomes where?
- C6: lateral forearm and thumb
- T4: Nipples
- T10: umbilicus
What are the specialty tests for cervical radiculopathy?
- Spurlings test
- Manual distraction
Specialty test for meningeal irritation?
- Kernigs sign
- Brudzinski sign bring legs up and head flexed to relieve meninge stress
Neck stiffness is concerning due to possible …..
- C spine fracture
- cord injuries
- ligament injuries
- muscle strains and spasm
- SAH
- Meningitis
HVLA contraindication?
- RA
- Down syndrome
- Carotid disease
- OA
- Local metastases
- Anticoagulant
- Osseous or ligamentous disruption
