Approach To Cervical Spine Complaint

Question 1

A traumatic Neck Pains splits up to

Answer 1

Musculoskeletal
Neurologic (Radiculopathy and Myelopathy)
Non-Spinal

Question 2

Atraumatic -INTRINSIC

-EXTRINSIC

Answer 2

• 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

Question 3

Traumatic Neck Pain

Answer 3

Myofascial Injury (muscle strain, whiplash)
Cervical fracture
Ligaments injury
Disc Injury
Cord/nerve injury
SCIWORA (SC Injury Without Radiographic Abnormality)

Question 4

Myofascial Neck Pain

Answer 4

Both T and AT
Pain, spasm, loss of ROM, occipital headache
Hard to see on MRI or CT or radiography
EX: Whiplash, muscle strain

Question 5

Cervical Fracture

Answer 5

DO CT AND MRI

Question 6

SCIWORA

Answer 6

Does not show up on the CT
MUST DO MRI (to see cord and disc) and keep spine immobilized
Kids and elderly more common

Question 7

Cervical Spondylosis (degenerative disc and osteophytes)

Answer 7

Most common neck pain in adults

Question 8

Torticollis

Congenital, Adult, Life threatening

Answer 8

1. Muscular fibrosis or SCM
2. Inflammation or injury of SCM, cervical muscle spasm or cervical nerve irritation
3. Retropharyngeal abscess(if fever), C-Spine injury, CNS tumor, Spinal Epidural Hematoma)

Question 9

Cervical Myelopathy

Answer 9

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

Question 10

Cervical Radiculopathy

Answer 10

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

Question 11

Meningitis

Answer 11

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

Question 12

Thoracic Outlet Syndrome

Answer 12

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

Question 13

When to image Neck pain

Answer 13

1. 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
2. Patient with RED FLAGS

Question 14

Red Flags

1. Recent Major Neck Trauma
2. Neurological symptoms that suggest SC issue (weakness, gait, bladder)
3. Shock like paresthesia with flexed neck= Lhemitt’s Phenomenon

Answer 14

1. Cervical Spine Fracture
2. Cervical Cord Compression
3. Cervical Cord Compression or MS

Question 15

Red Flags

4. Fever and chills
5. History on Injection Drug use
6. Immunosuppression
7. Chronic Steroid or glucocorticoid use

Answer 15

4. Infection
5. Cervical spine or disc infection
6. Infection
7. Infection or cervical spine compression fracture

Question 16

Red Flags

8. Unexplained weigh loss
9. Cancer history
10. Headache, shoulder or hip pain, visual symptoms
11. Anterior Neck Pain

Answer 16

8. Malignancy
9. Metastatic disease to cervical spine
10. RA
11. Non-Spinal Cause (Angina Pectoris)

Question 17

ROM on Neck pain when to not do it

Answer 17

TRAUMATIC Neck pain, unless cleared radiographically or by clinically by NEXUS CRITERIA

Question 18

Big EJV

Answer 18

Can mean lower EXTR edema and listen also for crackles in the base of the lungs

Question 19

Spurlings test

Manual Distraction Test

Answer 19

Pull up on the head= should reduce pain

Question 20

Kernigs Sign

Brudzinskis Sign

Answer 20

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

Question 21

Roo’s

EAST

Answer 21

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

Question 22

HVLA contraindications

Answer 22

RA
Down’s syndrome 
Carotid disease
Osteoporosis
Anticoagulant patients 
Ligamentous disrupiton

Question 23

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

Answer 23

Cervical Radiculopathy at C6

Image MRI,

Question 24

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

Answer 24

Osteoarthritis or Cervical Spondylosis

Don’t do HVLA

Question 25

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

Answer 25

Thoracic Outlet Syndrome
MRI and CT of cervical spine= -
CXR= she has extra cervical rib
Brachial plexus compression

Question 26

58yo M intoxicated confused wearing nothing only fishnet with posterior neck pain and wear arms bilaterally cervical collar applied by EMS PTA

Answer 26

CT normal , keep them in cervical collar in case of SCWARA

MRI- contusion and edema with no fracture = central cord syndrome = SCIWRA