Approach to Cervical Spine Flashcards
What is the top cause of neck pain?
atraumatic MSK (followed by neurologic and non-spinal systemic or referred pain)
Traumatic neck pain DDX
myofascial injury (muscle strain) cervical fracture ligament injury disc injury cord or nerve root injury
Myofascial neck pain
may or may not be traumatic
symptoms: pain, spasm, loss of ROM in neck & headache (persistent pain w/ nothing on imaging)
Cervical fractures
3% of blunt trauma pts
MUST determine if stable or unstable (w/ imaging)
MUST document (initial presence & level of sensory & motor loss)
Spinal Cord Injury (w/o radiographic abnormality)
PT w/ normal CT of cervical spine but continues to have symptoms
MUST keep spine immobilized until MRI eval & consult w/ neurosurgeon
Nexus Criteria
determine if pt w/ neck pain needs imaging
if meet all then do NOT need imaging
What are the nexus criteria?
absence of posterior midline cervical tenderness normal level of alterness no evidence of intoxication no abnormal neurologic findings no painful distracting injuries
For atraumatic neck pain due to MSK, what should be on your mind?
Cervical spondylosis (degenerative changes)
For atraumatic neck pain due to non-spinal causes, what should be on your mind?
systemic disease or referred pain (need context, history & PE to eliminate DDX)
Cervical Spondylosis
degenerative changes in the spine (degenerative discs & osteophytes)
the MOST COMMON cause of acute & chronic neck pain in adults (general neck pain, radiculopathy & myelopathy)
Cervical Myelopathy
EMERGENT situation
any neuro deficit related to spinal cord
signs & SXs: bilateral or distal weakness/numbness, complain of clumsy hands, gait disturbances, bowel or bladder dysfunction
Cervical Radiculopathy
any neuro deficit occurring @ or near the nerve root
signs & SXs: sharp & burning pain radiating to shoulder or down arm, weakness or paresthesias develop weeks after pain onset
most common is C5-C6 followed by C6-C7
Meningitis
emergent situation
signs & SXs: fever, malaise, headache, neck pain & stiffness (nuchal rigidity, Kernigs & Brudzinki signs of meningeal inflammation)
diagnosed by lumbar puncture
Thoracic Outlet Syndrome
confined space between clavicle & 1st rib
compression of neurovascular bundle by various structures in area just above 1st rib & behind clavicle
TOS symptoms & management
Symptoms: arm pain, numbness & weakness (when hold up arms), reproducibly aggravated by any activity requiring elevation or sustained use of arms/hands above head
Vasculogenic (5%) & neurogenic (95%)
Imaging for atraumatic complaint
most pts w/ atraumatic neck pain w/o red flags do NOT require imaging
if pain for more than 6 weeks, use cervical spine radiography, CT or mRI
When to image for atraumatic pt?
w/ progressive neuro findings & pts w/ moderate to severe neck pain who do not respond to conservative management over 6 weeks
What are red flags in pts w/ neck pain?
recent major neck trauma neuro symptoms indicating spinal cord issue shock like paresthesia w/ neck flexion fever or chills history of IV drug use immunosuppression chronic glucocorticoid use unexplained weight loss history of cancer headache anterior neck pain (cardiac issue)
What do you palpate in cervical region?
LNs, thyroid gland, muscle, bone, CT, spinous processes, disc spaces
What is super important to document from PE of cervical neck region?
ROM (active v passive)
need to document + & - (no nuchal rigidity, no meningismus, negative NEXUS criteria)
Cervical sensory dermatomes
C6-lateral forearm & thumb
T4-nipples
T10-umbilicus
What will happen from spinal cord injury above C5?
respiratory paralysis b/c diaphragm innervated by C3-C5
What does the cervical spine PE look for?
carotid pulse
jugular venous distension
Special tests for cervical radiculopathy
Spurlings
Manual Distraction Test
