C-Spine Complaint

Question 1

Causes of Neck Pain

Answer 1

• traumatic

- atraumatic: MSK, neurologic, Non-spinal

Question 2

C-Spine Fractures

Answer 2

• most stable
• need neurosurgical consult and imagining
• Need to document: initial presence and level of sensory and motor loss, rectal tone

Question 3

Spinal Cord Injury W/O Radiographic Abnormality (SCIWORA)

Answer 3

• need to keep spine immobilized until MRI

- more common with kids and elderly

Question 4

Nexus Criteria

Answer 4

-Determines need for radiographic imaging
NEED all criteria met for no imaging if not met C-collar and image
Criteria:
1. Absence of posterior midline cervical tenderness
2. Normal level of alertness
3. No evidence of intoxication
4. No abnormal neuro findings
5. No painful distracting injuries

Question 5

Atraumatic Neck Pain (DD)

• MSK
• Neurologic
• Nonspinal

Answer 5

-MSK most common
cervical spondylosis, whiplash, myofascial pain
-Neuro
radiculopathy or myelopathy
-Nonspinal:
malignancy, thoracic outlet syndrome, MI, infection

Question 6

Cervical Spondylosis

Answer 6

• degenerative
• common cause of acute and chronic neck pain
• pain increases with age

Question 7

Myelopathy versus Radiculopathy

Answer 7

Myelopathy–> EMERGENT MRI
-related to SC
-bilateral or distal sxs (weakness or numbness), bowel dysfunction, gait, clumsy hands
Radiculopathy–> non-emergent MRI, urgent workup
-at or near nerve root
-sharp, burning pain radiating and weakness or paralysis can develop after
-C5-C6 then C6-C7 most common

Question 8

Meningitis

Answer 8

-fever, malaise, headache, photobia, neck stiffness
-Nuchal rigidity, Kernings, Brudinskis
Causes: bacterial or viral
Diagnosis: lumbar puncture
treatment right away

Question 9

Thoracic Outlet Syndrome

Answer 9

-compression of brachial plexus and subclavian by scalenes or 1st rib
-Symptoms: arm pain, numbness, weakness
Roos, adsons test

Question 10

Atraumatic Diagnostic workup Imagining time

Answer 10

-progressive findings who dont respond to treatment over 6 weeks

Question 11

Red Flags with Neck Pain

Answer 11

Recent trauma: C-spine fracture
SC issues: Cervical cord compression
Shock-like paresthesia: Cervical cord compression or MS
Fever or Chills: infection 
IV drug use: infection
Immunosuppression: infection
Glucocorticoid use: infection 
history of cancer: metastatic disease
headache, shoulder, visual symptoms in older pt: Rheumatoid disease
Ant. neck pain: non spinal cause

Question 12

HVLA Contraindications

Answer 12

• RA
• Down Syndrome
• Carotid Disease
• Osteoporosis
• Ligament damage