APPROACH TO NECK PAIN

Question 1

DDx

Answer 1

Whiplash
Fractures
Torticollis
Spinal tumor
Spinal infection
Aneurysm
OA
DDD
Angina/MI
Tendonitis
RA
Reiter’s syndrome
PMR

Question 2

Red Flags

Answer 2

Kernigs sign
Headache (aneurysm)
lack of rottion
No physical aggracating factors
B symptoms
Infectious symtoms
Hx of malignancy

Question 3

Relevant Physical Exam Maneuvers

Answer 3

General Inspection
Palpation
ROM
Kernigs
Spurlings

Question 4

Canadian C spine rules exclusion criteria

Answer 4

Unstable patient
Known vertebral disease or surgery
GSC<15
Age <16
Pregnancy

Question 5

C-Spine Rules

Answer 5

Image if:
>65
Dangerous mechanism
Paresthesias
More than a simple rear end collision
Not sitting in the ER
Not ambulatory at any time
Delayed onset of the pain
Not able to rotate neck 45 degrees bilaterally

Question 6

Nexus Criteria

Answer 6

<16 years old

If any of:
Neuro deficit
Midline tenderness
Intoxication
GCS<15
Distracting injuries

Question 7

5 unstable neck fractures

Answer 7

Jeffersons (C1 compression)
Hangmans (C2 bilateral pars)
Bilateral cervical facet dislocations
Clay-shovelers (spinous process of C6 or C7)
Odontoid fracture
Atlanto-Occipital dislocation
Flexion teardrop (anterior inferior vertebral body)