Approach to Cervical Spine Complaint

Question 1

In the US, neck pain is the fourth highest cause of?

Answer 1

Disability

Question 2

What type of neck pain is very common, may or may not be traumatic, and may present with spasms, and loss of ROM?

Answer 2

Myofascial neck pain

Question 3

What is an important aspect of SCIWORA (spinal cord injury without radiographic abnormality)?

Answer 3

Must keep spine immobilized until MRI and eval with neuro

Question 4

What is used to determine which patients presenting with neck pain after trauma need radiographic imaging and has sensitivity of 99.6%?

Answer 4

Nexus Criteria

Question 5

What are the Nexus Criteria?

Answer 5

1) Absence of posterior midline cervical tenderness
2) Normal level of alertness
3) No abnormal neurological findings
4) No painful distracting injuries

Question 6

If all points of the Nexus Criteria are met, what type of imaging does the patient need?

Answer 6

No need for any imaging

Question 7

If the Nexus Criteria are NOT met, what should be done?

Answer 7

Apply a cervical collar and use imaging

Question 8

What is a general term used to describe degenerative changes in the spine and is the most common cause of acute and chronic neck pain in adults?

Answer 8

Spondylosis

Question 9

What is a condition that deals with any neurological deficit related to the spinal cord, bilateral or distal weakness/numbness, clumsy, gait disturbances, and bladder/bowel dysfunctions?

Answer 9

Myelopathy

Question 10

What should be done first when dealing with myelopathy?

Answer 10

Emergent MRI

Question 11

What is a condition that deals with any neurological deficit occurring at or near the nerve root?

Answer 11

Cervical radiculopathy

Question 12

What is the most common symptom of meningitis?

Answer 12

Fever

Question 13

What are the specialty tests for meningitis?

Answer 13

1) Nuchal rigidity
2) Kernig’s
3) Brudzinski’s

Question 14

What is meningitis diagnosed by?

Answer 14

Lumbar puncture

Question 15

What condition deals with compression of the neurovascular bundle by various structures in the area just above the first rib and behind the clavicle?

Answer 15

Thoracic Outlet Syndrome (TOS)

Question 16

What are some common symptoms of Thoracic Outlet Syndrome (TOS)?

Answer 16

Arm pain, numbness, and weakness

Question 17

What test can be used for patients with TOS?

Answer 17

Roos

Question 18

What are some contraindications for HVLA?

Answer 18

1) Rheumatoid arthritis
2) Down syndrome
3) Carotid disease
4) Osteoporosis
5) Local metastases
6) Patients on anticoagulants
7) Osseous or ligamentous disruption

Question 19

What specialty test has patients supine with the physician hands behind patients head and flexes the neck forward until the chin touches the chest?

Answer 19

Nuchal rigidity

Question 20

What is considered a positive neck distraction test?

Answer 20

Relief of symptoms with distraction

Question 21

What is the most appropriate test when assessing for vascular compression?

Answer 21

Roos