Approach To Cervical Spine Complaint Flashcards
What are atraumatic causes of neck pain?
Musculoskeletal, neurologic (radiculopathy or myelopathy) or non-spinal (systemic disease or referred pain)
What are some causes for traumatic neck pain?
Myofascial injury (strain, whiplash, etc), cervical fracture, ligamentous injury, disc injury, cord or nerve root injury, SCIWORA (SC injury without radiographic abnormality)
Describe myofascial neck pain
Very common
May or may not be traumatic
Sx: pain, spasm, loss of ROM in the neck, occipital HA
Pain can be persistent with little identifiable abnormality seen on imaging
Ex: whiplash, muscle strain, etc
Describe cervical fractures
Most are stable
All require neuro consultation
Must determine if stable or unstable (done with imaging)
Document any neuro complaint in the history and initial presence + level of sensory and motor loss, rectal tone during PE
Describe SCIWORA
Need a high degree of suspicion to dx
Pt has normal plain fils and normal CT of C spine but continues to have neuro signs and sx
Must keep spine immobilized until MRI and evaluation/consultation with a neurosurgeon
More common in kids (more flexible neck with large head) and elderly
What accounts for the vast majority of atraumatic neck pain?
Musculoskeletal
Ex. Cervical spondylosis (degenerative changes)
What is an example of a non spinal cause of atraumatic neck pain?
Thoracic outlet syndrome
What is congenital torticollis?
Arises from muscular fibrosis of the SCM and less commonly from neuro or bony abnormalities
What are the classifications for torticollis?
Congenital, adult and life threatening causes of torticollis
What are life threatening causes of torticollis?
Retropharyngeal abscess, C spine injury, CNS tumor
Spinal epidural hematoma
Describe cervical spondylosis
Most common cause of acute and chronic neck pain in adults
Often asymptomatic
Can cause general neck pain, radiculopathy, myelopathy
Incidence increases with age
What is cervical myelopathy?*
Any neurologic deficit related to the SC
Signs and sx: bilateral or distal sx (weakness/numbness), may complain of clumsy hands, gait disturbances, sexual dysfunction, bowel or bladder dysfunction
Needs emergent MRI
What is cervical radiculopathy?*
Any neurologic deficit occurring at or near the nerve root
Signs and sx: sharp, burning pain radiating to the trapezius, periscapular area or down the arm; weakness or paresthesia may develop weeks after pain onset
C5-6 followed by C6-7 are the most common
Urgent work up, non-emergent MRI, NSAIDs, OMM, PT
Describe meningitis
Sx: fever, malaise, HA, photophobia, neck pain and stiffness, AMS, rash (petechiae and purpura) and meningismus
Nuchal rigidity, Kernig’s and Brudzinski’s sign of meningeal inflammation
Causes: bacterial, neisseria meningitidis (gram neg dipplocci), viral, other
Diagnosed by lumbar puncture*
Describe thoracic outlet syndrome
The thoracic outlet is a confined space between the clavicle and 1st rib*
Compression of the neurovascular bundle by various structures in the area above the 1st rib and behind the clavicle
Sx: arm pain, numbness and weakness (reproduced by activity that requires elevation or sustained use of the arms above the head)
Roo’s/EAST test
Most patients with atraumatic neck pain without red flags do not require what?
Imaging
Describe a focused ROS for neck pain
Recent major neck trauma
Neuro sx or sings that suggest spinal cord issue (weakness, gait difficulty, bowel or bladder dysfunction)
Shock like paresthesia (Lhermitte’s phenomena) with neck flexion
What discriminators and life threats should be evaluated?
Fever, chills, CP, SOA, history of recent trauma
What are red flags for pts with neck pain?
Recent major neck trauma, neuro sx that suggest SC issue, shock like paresthesia with neck flexion, fever or chills, hx of injection drug use, immunosuppression, chronic steroid use, unexplained weight loss, history of cancer, HA shoulder or hip pain, visual sx in older patient, anterior neck pain
Do not check ROM on patients with traumatic neck pain unless they have what?
Been cleared radiographically or clinically by Nexus criteria
What are the special tests for cervical radiculopathy?
Spurling’s test
Manual distraction test
What special tests are used for meningeal irritation?
Kernig’s sign
Brudzinski’s sign
What specialty tests are used for thoracic outlet syndrome?
Roo’s or east test
Neck stiffness (inability or unwillingness) to move the neck is what?
Concerning
Causes include C spine fractures, cord injuries, ligamentous injury, muscle strains, muscle spasm, SAH and meningitis
