Approach to cervical spine complaint Flashcards
Where do back and neck pain fall under the scale of disabilities in the US?
Back pain is the number one cause
Neck pain is the 4th cause of disability
What are the causes of neck pain?
Traumatic
Atraumatic (muscles, neurologic, non-spinal)
***most are multifactorial and musculoskeletal is the NUMBER ONE Cause
What is NEXUS?
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
What are the causes for traumatic neck pain?
- Myofascial injury (most common)
- Cervical fracture
- ligamentous issue
- Disc injury
- Cord or root injury
- SCIWORA (spinal cord injury without radiographic abnormality)
Describe myofascial neck pain
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
______ _______ occur in 3% of blunt trauma patients, most being stable, and require further neurological work ups
Cervical fractures
How do you determine whether or not a cervical fracture is stable or non stable?
With imaging!!!! Must record rectal tone, sensory, and motor findings
What is SCIWORA and how do you diagnose it?
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
What age populations are most susceptible to SCIWORA? Why?
Kids- because their spines are flexible and they have big heads
Elderly: because they typically have arthritic changes
What are the NEXUS criteria?
Criteria:
- absence of posterior midline cervical tenderness
- Normal levels of alertness
- No evidence of intoxication
- no abnormal neurological findings
- No painful distracting injuries
What if all of the NEXUS are not met?
Place the patient in a C-collar and order imaging
What are the broad based differentials for atraumatic neck pain?
- Musculoskeletal: vast majority of neck pain; can be caused by spondylosis, discogenic pain, myofascial pain, whiplash, etc
- neurologic- radiology
- Nonspinal causes: systemic diseases or referred pain; CAD, Malignancy, neurological conditions, referred shoulder pain, infection, etc
Describe cervical spondylosis
Degenerative changes in the spine that causes chronic neck pain and increases with age
*** most common cause of neck pain in adults
______ _______ 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
Cervical myelopathy
______ _______ 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
Cervical radiculopathy
What is the most common vertebral levels affected by cervical radiculopathy?
C5-C6 followed by C6-C7
What are the symptoms of meningitis?
fever, malaise, headache, photophobia, neck pain and stiffness, AMS, rash
What are the clinical signs that indicate meningitis? How is it diagnosed?
Nuchal rigidity
Kernigs and Brudzinskis signs
Diagnosed with a lumbar puncture
What are the causes of meningitis?
Bacterial
Neisseria meningitis
Viral
What is the thoracic outlet?
Confined space between the clavicle and the first rib
nerves (brachial plexus), subclavian artery, and the subclavian vein pass through here
_____ ______ _______ 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
Thoracic outlet syndrome
What are the symptoms of thoracic outlet syndrome?
Arm pain, numbness, and weakness that is reproduced with activity that requires elevation or sustained use of the arms or hands above the head
If a patient has a recent major neck trauma, what would you be suspicious of?
Cervical spine fracture
If a patient presents with neurologic symptoms including weakness, bladder or bowel dysfunction, or gait issues, what are you suspecting
Concern for a cervical cord compression
If a patient presents with shock like parasthesia with neck flexion, what are you suspicious of clinically?
Cervical cord compression or multiple sclerosis
What do fever and chills indicate clinically?
Infections
When a patient presents with a history of injection drug use, what are you suspecting clinically?
cervical spine or disc infection
When a patient is on immunosuppressive drugs, what should you be suspicious of clinically?
Concern for infection
Unexplained weight loss can be indicative of what??
Malignancy
When a patient has anterior neck pain, what should you be suspicious of clinically?
non-spinal causes
What is HVLA?
High Velocity, Low amplitude technique for neck pain treatment?
What are the contradictions of HVLA?
Rheumatoid arthritis (weak odontoid ligament)
Down syndrome (weak odontoid ligament)
Carotid disease. PVD
Osteoporosis
What is an OA joint?
Occiptoatlanto joint; flexion and extension with minimal side bending
OCCIPUT ROATES AND SIDE BENDS TO OPPOSITE SIDES
What is the primary motion of the AA joint?
Rotation
For the vertebral levels of C2-C7, how do you diagnose a rotation and side bending issue?
Rotation and SB are typically on the same side
What are the lymph nodes that are present in the cervical region?
superficial, deep, and posterior chains…
occipital
pre/post auricular
submandibular
submental
tonsillar
supraclavicular
What is LAD (lymphadenopathy) indicative of?
viral infections, HIV/AIDS, lymphoma, leukemia
______ ______ can be due to a neck mass, mediastinal mass, atelectasis, or a pneumothorax
Trachea deviation
How do you palpate the thyroid?
Have the patient slightly flex their neck and place both fingers below the cricoid cartilage and have the patient swallow
What is a wedge fracture?
Flexion and compression injury
