Approach to Cervical Spine Complaint Flashcards
What percent of the adult general population has neck pain at any time?
10-20%
What are the causes of neck pain?
Traumatic or atraumatic (MSK, radiculopathy, myelopathy, or systemic disease or referred pain)
For traumatic neck pain, what diagnoses should you consider?
Myofascial injury, cervical fracture, ligamentous injury, disc injury, cord or nerve root injury
What are the symptoms of myofascial neck pain?
Pain, spasm, loss of ROM, occipital headache
How do you determine if a neck fracture is stable or unstable?
CT or MRI with a radiological and neurosurgical consultation
What is a SCIWORA?
Spinal Cord Injury without Radiographic Abnormality; patient has normal plain films and normal CT but with neurological signs or symptoms; must keep spine immobilized until MRI and evaluation/consultation with a neurosurgeon
What are the nexus criteria?
Used to determine which patients presenting with neck pain after trauma need radiographic imaging
Criteria: absence of posterior midline cervical tenderness, normal level of alertness, no evidence of intoxication, no abnormal neurologic findings, no painful distracting injuries
If all criteria are met, patient doesn’t need imaging; if all are not met, apply cervical collar and image patient
What makes up the majority of atraumatic neck pain?
MSK
What are some diagnoses of atraumatic neck pain with non-spinal causes?
Coronary artery disease, malignancy, neurologic conditions, referred shoulder pain, rheumatic conditions, fibromyalgia, thoracic outlet, visceral etiologies, infection (meningitis)
What is spondylosis?
Degenerative discs and osteophytes; most common cause of acute and chronic pain in adults; incidence increases with age and is often asymptomatic
What is cervical myelopathy? What are the signs and symptoms?
Any neurologic deficit related to the spinal cord
Signs/SX: bilateral or distal weakness/numbness, clumsy hands, gait disturbances, sexual dysfunction, bowel/bladder dysfunction
Needs emergent MRI
What is cervical radiculopathy? What are the signs and symptoms?
Any neurologic deficit occurring at or near the nerve root
Signs/SX: sharp, burning pain radiating to the traps, periscapular area or down the arm, weakness or paresthesia may develop weeks after pain onset
C5-C6 followed by C6-C7 are most common; urgent workup, non-emergent MRI, NSAIDS, OMM, PT
What are the signs and symptoms of meningitis?
Fever, malaise, headache, photophobia, neck pain and stiffness, AMS, rash, meningismus
Nuchal rigidity, Kernig’s and Brudzinski’s signs of meningeal inflammation
What are the causes of meningitis?
Bacterial: hemophilus, strep, pneumonia
Neiserria menigitidis (gram negative dipplococci) is now less prevalent since the vaccine; can also be viral
How do you diagnose meningitis?
Lumbar puncture; treatment depends on etiology
What is thoracic outlet syndrome?
Compression of the neurovascular bundle by various structures in the area just above the first rib and behind the clavicle, within the confined space of the thoracic outlet
What are the symptoms of thoracic outlet syndrome?
SX: arm pain, numbness, weakness; reproducibly aggravated by any activity that requires elevation or sustained use of the arms or hands above the head
When should patients with atraumatic neck pain be sent for imaging?
Progressive neurological findings, moderate to severe neck pain affecting sleep, daily activities, occupation; those who do not respond to conservative management over 6 weeks
What are some red flags in patients with neck pain?
Recent major neck trauma, neurologic symptoms or signs that suggest spinal cord issue, shock-like paresthesia with neck flexion, fever or chills, history of injection use, immunosuppression, chronic glucocorticoid use, unexplained weight loss, history of cancer, headache, anterior neck pain
What structures are you palpating for when palpating the neck?
Lymph nodes, thyroid gland, muscle, bone, connective tissues, soft tissues, spinous processes, disc spaces
For the vascular portion of the neck exam, what are you feeling for?
Carotid pulse and jugular venous distention
For cervical radiculopathy, what special tests should you do?
Spurling’s or manual distraction
For meningeal irritation, what special tests should you do?
Kernig’s sign or Brudzinski’s sign
For thoracic outlet syndrome, what special tests should you do?
Roo’s or EAST test
In terms of ROM of the neck, what are some things to keep in mind?
1) Never check ROM in a trauma patient unless they have been cleared of cervical fracture/spinal cord injury clinically or radiographically
2) Never force ROM; be cautious when performing spurling maneuver
3) Neck stiffness (inability or unwillingness) to move the neck is concerning
What are some causes of neck splinting or stiffness?
C-spine fractures, cord injuries, ligamentous injuries, muscle strains, muscle spasms, meningitis
What are some contraindications for using HVLA (high velocity low amplitude)?
Rheumatoid arthritis, down syndrome, carotid disease, osteoporosis, local metastases, patients on anticoagulants, osseous or ligamentous disruption
