Approach To Cervical Spine Complaint Flashcards
A traumatic Neck Pains splits up to
Musculoskeletal
Neurologic (Radiculopathy and Myelopathy)
Non-Spinal
Atraumatic -INTRINSIC
-EXTRINSIC
- Musculoskeletal (cervical spondylosis, torticollis, osteoarthritis, myofascial pain) or
Neurologic (Radiculopathy and Myelopathy) or
Nonspinal cause (referred pain or systemic disease, Thoracic Outlet Syn, infection)
-Systemic Disease, Neurologic, Referred Shoulder Pain, Thoracic Outlet
Traumatic Neck Pain
Myofascial Injury (muscle strain, whiplash)
Cervical fracture
Ligaments injury
Disc Injury
Cord/nerve injury
SCIWORA (SC Injury Without Radiographic Abnormality)
Myofascial Neck Pain
Both T and AT
Pain, spasm, loss of ROM, occipital headache
Hard to see on MRI or CT or radiography
EX: Whiplash, muscle strain
Cervical Fracture
DO CT AND MRI
SCIWORA
Does not show up on the CT
MUST DO MRI (to see cord and disc) and keep spine immobilized
Kids and elderly more common
Cervical Spondylosis (degenerative disc and osteophytes)
Most common neck pain in adults
Torticollis
Congenital, Adult, Life threatening
- Muscular fibrosis or SCM
- Inflammation or injury of SCM, cervical muscle spasm or cervical nerve irritation
- Retropharyngeal abscess(if fever), C-Spine injury, CNS tumor, Spinal Epidural Hematoma)
Cervical Myelopathy
CORD PROBLEM (trunk of the tree) Related to spinal cord NEED MRI Bilateral or distal weakness/numbness), may have clumsy hands, gait problems, sexual disturbance, and bladder dysfunction
Cervical Radiculopathy
NERVE ROOT PROBLEM
Sharp, burning, pain radiating to the trapezius, or down the arm
Weakness, paresthesia happens weeks after onset of pain.
C5/C6 and C6/C7 most common
DO MRI, NSAIDS, OMM, PT
Spurling’s Test
Manual Distraction Test
Meningitis
Fever, malaise, headache, photophobia, neck pain and stiffness, rash (petechiae and purpura)
GRAM 1 DIPLOCOCCI = menigococcus
DO LUMBAR PUNCTURE
Caused by Bacteria- hemophilus, Strep, Pneumonia
-Neiserria menigitidis
Kernigs and Brudzinski’s Sign
Thoracic Outlet Syndrome
Between clavicle and 1st rib Numbness, pain, weakness Work above the head Vascular, and neurological (95%) Roo’s Test and EAST Test and Adson’s Test
When to image Neck pain
- Patient with progressive or moderate to sever neck pain that effecting sleep, daily activity, occupation, for more then 6 weeks with conservative Tx not helping
- Patient with RED FLAGS
Red Flags
- Recent Major Neck Trauma
- Neurological symptoms that suggest SC issue (weakness, gait, bladder)
- Shock like paresthesia with flexed neck= Lhemitt’s Phenomenon
- Cervical Spine Fracture
- Cervical Cord Compression
- Cervical Cord Compression or MS
Red Flags
- Fever and chills
- History on Injection Drug use
- Immunosuppression
- Chronic Steroid or glucocorticoid use
- Infection
- Cervical spine or disc infection
- Infection
- Infection or cervical spine compression fracture
Red Flags
- Unexplained weigh loss
- Cancer history
- Headache, shoulder or hip pain, visual symptoms
- Anterior Neck Pain
- Malignancy
- Metastatic disease to cervical spine
- RA
- Non-Spinal Cause (Angina Pectoris)
ROM on Neck pain when to not do it
TRAUMATIC Neck pain, unless cleared radiographically or by clinically by NEXUS CRITERIA
Big EJV
Can mean lower EXTR edema and listen also for crackles in the base of the lungs
Spurlings test
Manual Distraction Test
Pull up on the head= should reduce pain
Kernigs Sign
Brudzinskis Sign
Raise leg up to 90 and that makes the neck flex up due to pain (Meningitis or spinal subarachnoid hemorrhage)
Raise neck in flexion and that causes leg knees and hips to flex due to pain
Roo’s
EAST
Put arms up in like a touchdown sign and open and close palms while holding arms up in elbow flexed 90 shoulder abducted 90 and flexed 90
HVLA contraindications
RA Down’s syndrome Carotid disease Osteoporosis Anticoagulant patients Ligamentous disrupiton
26yo Hispanic athlete left neck and shoulder pain
Pain going down arm electric pain
No SOB, bladder problems, no weakness in lower EXTR
Numbness and weakness in hands (thumb and lateral forearm)
Positive Spurlings test
Cervical Radiculopathy at C6
Image MRI,
86yo former medical school professor female diffuse posterior neck pain
Aching pain and worse when she moves the head
No weakness, pain, numbness
DM, CAD, HTN
Osteoarthritis or Cervical Spondylosis
Don’t do HVLA
18yo female, 3mo of progressive worsening pain and numbness and weakness in the right upper extremities
Worse when she works above her head
Atrophy of her thenar eminence
Positive Roo’s and EAST
Thoracic Outlet Syndrome
MRI and CT of cervical spine= -
CXR= she has extra cervical rib
Brachial plexus compression
58yo M intoxicated confused wearing nothing only fishnet with posterior neck pain and wear arms bilaterally cervical collar applied by EMS PTA
CT normal , keep them in cervical collar in case of SCWARA
MRI- contusion and edema with no fracture = central cord syndrome = SCIWRA
