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PCM Exam 2 > Approach to cervical spine complaint > Flashcards

Approach to cervical spine complaint Flashcards

1
Q

Where do back and neck pain fall under the scale of disabilities in the US?

A

Back pain is the number one cause

Neck pain is the 4th cause of disability

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2
Q

What are the causes of neck pain?

A

Traumatic

Atraumatic (muscles, neurologic, non-spinal)

***most are multifactorial and musculoskeletal is the NUMBER ONE Cause

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3
Q

What is NEXUS?

A

The criteria for clearing a patient clinically for cervical injuries following a traumatic event

Determines who needs radiologic studies done… IF THE PATIENT MEETS ALL OF THE CRITERIA THEY DO NOT NEED IMAGING

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4
Q

What are the causes for traumatic neck pain?

A
  1. Myofascial injury (most common)
  2. Cervical fracture
  3. ligamentous issue
  4. Disc injury
  5. Cord or root injury
  6. SCIWORA (spinal cord injury without radiographic abnormality)
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5
Q

Describe myofascial neck pain

A

VERY COMMON

may or may not be traumatic (whiplash, muscle strain)

symptoms: pain, spasm, loss of range of motion in the neck, occipital headache

sometimes abnormalities can be seen on MRI, CT, Xray

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6
Q

______ _______ occur in 3% of blunt trauma patients, most being stable, and require further neurological work ups

A

Cervical fractures

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7
Q

How do you determine whether or not a cervical fracture is stable or non stable?

A

With imaging!!!! Must record rectal tone, sensory, and motor findings

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8
Q

What is SCIWORA and how do you diagnose it?

A

Spinal cord injury without radiographic abnormality

Hard to diagnose but if the patient is continuing to have symptoms, then you need to keep the spine immobilized until an MRI or neuro consult

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9
Q

What age populations are most susceptible to SCIWORA? Why?

A

Kids- because their spines are flexible and they have big heads

Elderly: because they typically have arthritic changes

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10
Q

What are the NEXUS criteria?

A

Criteria:

  1. absence of posterior midline cervical tenderness
  2. Normal levels of alertness
  3. No evidence of intoxication
  4. no abnormal neurological findings
  5. No painful distracting injuries
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11
Q

What if all of the NEXUS are not met?

A

Place the patient in a C-collar and order imaging

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12
Q

What are the broad based differentials for atraumatic neck pain?

A
  1. Musculoskeletal: vast majority of neck pain; can be caused by spondylosis, discogenic pain, myofascial pain, whiplash, etc
  2. neurologic- radiology
  3. Nonspinal causes: systemic diseases or referred pain; CAD, Malignancy, neurological conditions, referred shoulder pain, infection, etc
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13
Q

Describe cervical spondylosis

A

Degenerative changes in the spine that causes chronic neck pain and increases with age

*** most common cause of neck pain in adults

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14
Q

______ _______ is any neurological deficit that is related to the spinal cord

symptoms include bilateral weakness, numbness, clumsy hands, bladder or bowel disfunction and requires EMERGENT MRI

A

Cervical myelopathy

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15
Q

______ _______ is any neurological deficit that occurs at or near the nerve root

symptoms include a sharp, burning pain that radiates into the trapezius or scapular area

A

Cervical radiculopathy

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16
Q

What is the most common vertebral levels affected by cervical radiculopathy?

A

C5-C6 followed by C6-C7

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17
Q

What are the symptoms of meningitis?

A

fever, malaise, headache, photophobia, neck pain and stiffness, AMS, rash

18
Q

What are the clinical signs that indicate meningitis? How is it diagnosed?

A

Nuchal rigidity
Kernigs and Brudzinskis signs

Diagnosed with a lumbar puncture

19
Q

What are the causes of meningitis?

A

Bacterial
Neisseria meningitis
Viral

20
Q

What is the thoracic outlet?

A

Confined space between the clavicle and the first rib

nerves (brachial plexus), subclavian artery, and the subclavian vein pass through here

21
Q

_____ ______ _______ is the compression of the neuromuscular bundle by various structures in the area above the first rib and behind the clavicle, within the thoracic outlet

A

Thoracic outlet syndrome

22
Q

What are the symptoms of thoracic outlet syndrome?

A

Arm pain, numbness, and weakness that is reproduced with activity that requires elevation or sustained use of the arms or hands above the head

23
Q

If a patient has a recent major neck trauma, what would you be suspicious of?

A

Cervical spine fracture

24
Q

If a patient presents with neurologic symptoms including weakness, bladder or bowel dysfunction, or gait issues, what are you suspecting

A

Concern for a cervical cord compression

25
Q

If a patient presents with shock like parasthesia with neck flexion, what are you suspicious of clinically?

A

Cervical cord compression or multiple sclerosis

26
Q

What do fever and chills indicate clinically?

A

Infections

27
Q

When a patient presents with a history of injection drug use, what are you suspecting clinically?

A

cervical spine or disc infection

28
Q

When a patient is on immunosuppressive drugs, what should you be suspicious of clinically?

A

Concern for infection

29
Q

Unexplained weight loss can be indicative of what??

A

Malignancy

30
Q

When a patient has anterior neck pain, what should you be suspicious of clinically?

A

non-spinal causes

31
Q

What is HVLA?

A

High Velocity, Low amplitude technique for neck pain treatment?

32
Q

What are the contradictions of HVLA?

A

Rheumatoid arthritis (weak odontoid ligament)

Down syndrome (weak odontoid ligament)

Carotid disease. PVD

Osteoporosis

33
Q

What is an OA joint?

A

Occiptoatlanto joint; flexion and extension with minimal side bending

OCCIPUT ROATES AND SIDE BENDS TO OPPOSITE SIDES

34
Q

What is the primary motion of the AA joint?

A

Rotation

35
Q

For the vertebral levels of C2-C7, how do you diagnose a rotation and side bending issue?

A

Rotation and SB are typically on the same side

36
Q

What are the lymph nodes that are present in the cervical region?

A

superficial, deep, and posterior chains…

occipital

pre/post auricular

submandibular

submental

tonsillar

supraclavicular

37
Q

What is LAD (lymphadenopathy) indicative of?

A

viral infections, HIV/AIDS, lymphoma, leukemia

38
Q

______ ______ can be due to a neck mass, mediastinal mass, atelectasis, or a pneumothorax

A

Trachea deviation

39
Q

How do you palpate the thyroid?

A

Have the patient slightly flex their neck and place both fingers below the cricoid cartilage and have the patient swallow

40
Q

What is a wedge fracture?

A

Flexion and compression injury

PCM Exam 2 (10 decks)

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