Approach to Cervical Spine Complaint Flashcards

1
Q

Neck pain is the #__ cause of disability in the US

A

4

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2
Q

Red Flags of Neck Pain

A
  • recent trauma
  • neurologic sxs (ex. weakness, gait difficulty, bladder dysfunction)
  • shock-like paresthesia with neck flexion
  • fever or chills
  • Hx of injection drug use
  • Immunosuppression
  • Chronic glucocorticoid use
  • unexplained weight loss
  • Hx of cancer
  • HA, shoulder ache, hip girdle pain
  • anterior neck pain
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3
Q

Special tests for Cervical Radiculopathy

A
  • Spurlings Test
  • Manual Distraction Test
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4
Q

Special Tests for Meningeal Irritation

A
  • Kernigs Sign
  • Brudzinskis Sign (nuchal rigidity)
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5
Q

Special Tests for Thoracic Outlet

A
  • Roos Test
  • Adsons Test
  • East Test
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6
Q

Causes of neck splinting or stiffness:

A
  • c-spine fxs
  • cord injuries
  • ligamentous injuries
  • muscle strains
  • muscle spasm
  • SAH
  • meningitis
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7
Q

Contraindications to HVLA

A
  • Rheumatoid Arthritis: weak odontoid ligament is susceptible to rupture
  • Downs Syndrome: weak odontoid ligament susceptible to rupture, may have incomplete or missing odontoid process
  • Carotid Disease or PVD
  • Osteoporosis
  • Local metastases
  • Patients on anticoagulants: sheer stress –> intracranial bleed
  • Osseous or ligamentous disruption
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8
Q

Traumatic Neck Pain Differential

A
  • Myofascial injury (muscle strains, whiplash, etc)
  • Cervical fx
  • Ligamentous injury
  • Disc injury
  • Cord or nerve root injury
  • Spinal cord injury w/o radiographic abnormality (SCIWORA)
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9
Q

SCIWORA

A
  • patient has normal plain films and normal CT of cervical spine but continues to have neurologic signs or sxs
  • must keep spine immobilized until MRI and evaluation/consultation with neurosurgeon
  • more common in kids and elderly
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10
Q

Atraumatic Intrinsic Neck Pain

A

within the neck
- MSK (majority of atraumatic neck pain; includes cervical spondylosis, degenerative changes)
- Neurologic (radiculopathy, myelopathy)

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11
Q

Atraumatic Extrinsic Neck Pain

A

outside the neck
- systemic disease
- neurologic conditions
- referred pain
- thoracic outlet syndrome

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12
Q

Examples of Atraumatic Extrinsic Neck Pain

A
  • thoracic outlet syndrome
  • coronary artery disease
  • metastatic disease
  • neurological conditions
  • referred shoulder pain
  • rheumatologic conditions
  • fibromyalgia
  • visceral etiologies
  • infection (meningitis)
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13
Q

Torticollis

A

“twisted neck”

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14
Q

Congenital Torticollis

A

usually arises from muscular fibrosis of the SCM muscle and less commonly from neurologic or bony abnormalities

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15
Q

Adult Torticollis

A
  • acquired
  • typically results from SCM or trapezius muscle injury or inflammation
  • wide variety of conditions can also cause this due to cervical muscle spasm or cervical nerve irritation
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16
Q

Life-threatening causes of Torticollis:

A
  • retropharyngeal abscess
  • C-spine injury
  • CNS tumor
  • spinal epidural hematoma
17
Q

What is the most common cause of acute and chronic neck pain in adults?

A

Cervical Spondylosis

18
Q

Cervical Myelopathy

A
  • any neurological deficit related to the spinal cord
  • signs and sxs: weakness, numbness, clumsy hands, gait disturbances, sexual dysfunction, bowel or bladder dysfunction, sxs cross multiple dermatomes
  • associated with UMN findings (muscle spasticity, hyperreflexia, increased muscle tension)
  • needs emergent MRI
19
Q

Cervical Radiculopathy

A
  • any neurological deficit occurring at or near the nerve root
  • signs and sxs: sharp, burning pain radiating to the trapezius, periscapular area or down the arm; weakness or paresthesias may develop weeks after onset; radiation is dermatomal
  • C5-C6 followed by C6-C7 are the most common
  • needs urgent workup, non-emergent MRI, NSAIDS, OMM, PT
20
Q

Meningitis

A
  • signs and sxs: fever, malaise, HA, photophobia, neck pain and stiffness, AMS, rash, meningismus
  • caused by bacteria (Hemophilus, strep, pneumonia), neiserria menigitidis, viral
21
Q

How is meningitis diagnosed?

A

Lumbar Puncture

22
Q

Thoracic Outlet

A
  • confined space between the clavicle and first rib
  • structure located here: nerves of brachial plexus, subclavian artery and vein
23
Q

Thoracic Outlet Syndrome

A

Compression of the neurovascular bundle by various structures in the area just above the first rib and behind the clavicle, within the confined region of the thoracic outlet

24
Q

Symptoms of Thoracic Outlet Syndrome

A
  • arm pain
  • arm numbness
  • arm weakness
  • reproducibly aggravated by any activity that requires elevation or sustained use of the arms or hands above the head
25
Q

Do most patients with atraumatic neck pain require imagining?

A

No, not if there aren’t any red flags

26
Q

Patients with atraumatic neck pain that should be imaged:

A
  • progressive neurological findings
  • moderate to severe neck pain (affects sleep, daily activity, occupation)
  • do not respond to conservative management over six weeks
27
Q

What test is used for Cervical Myelopathy?

A

Hoffmann Reflex

28
Q

Hoffmann Reflex

A
  • Indicates: UMN damage due to cervical cord compression, stroke, encephalitis, etc
  • Steps: physician quickly releases distal middle finger from extension
  • (+) Test = involuntary flexion of the terminal phalanx of the thumb and the 2nd and 3rd phalanx of some other finger
29
Q

What tests are used for Cervical Radiculopathy?

A
  • Neck Compression Test
  • Neck Distraction Test
  • Spurling Test