Approach to Cervical Spine Complaint Flashcards
Neck pain is the #__ cause of disability in the US
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Red Flags of Neck Pain
- 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
Special tests for Cervical Radiculopathy
- Spurlings Test
- Manual Distraction Test
Special Tests for Meningeal Irritation
- Kernigs Sign
- Brudzinskis Sign (nuchal rigidity)
Special Tests for Thoracic Outlet
- Roos Test
- Adsons Test
- East Test
Causes of neck splinting or stiffness:
- c-spine fxs
- cord injuries
- ligamentous injuries
- muscle strains
- muscle spasm
- SAH
- meningitis
Contraindications to HVLA
- 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
Traumatic Neck Pain Differential
- 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)
SCIWORA
- 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
Atraumatic Intrinsic Neck Pain
within the neck
- MSK (majority of atraumatic neck pain; includes cervical spondylosis, degenerative changes)
- Neurologic (radiculopathy, myelopathy)
Atraumatic Extrinsic Neck Pain
outside the neck
- systemic disease
- neurologic conditions
- referred pain
- thoracic outlet syndrome
Examples of Atraumatic Extrinsic Neck Pain
- thoracic outlet syndrome
- coronary artery disease
- metastatic disease
- neurological conditions
- referred shoulder pain
- rheumatologic conditions
- fibromyalgia
- visceral etiologies
- infection (meningitis)
Torticollis
“twisted neck”
Congenital Torticollis
usually arises from muscular fibrosis of the SCM muscle and less commonly from neurologic or bony abnormalities
Adult Torticollis
- 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