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PCM Final > Cervical Complaint > Flashcards

Cervical Complaint Flashcards

1
Q

Causes of Neck pain

A

1) Traumatic
2) Atrumatic
- MSK !!!!! (most)
- Neuro
- –> raducilo/myelopathy
- non-spinal
- > systemic disease or referred pain

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2
Q

Traumatic neck pain is us due to

A

1) MYOFASCIAL INJURY
2) cervical fracture
3) ligament injury
4) disc injury
5) cord/nerve root injury
6) SCIWORK

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3
Q

Myofascial Neck pain

A

MAY OR MAY NOT BE TRAUMATIC

1) pain, spasm, loss fo ROM in next
2) occipital headache

ex : whiplash, muscle strain

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4
Q

Cervical fractures

A
  • blunt trauma
  • most stable
  • neuro consult
  • det if stable via Nexus Criteria
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5
Q

Spinal Cord Injury w/o radiographic abnormality (SCIWORA)

A

-MUST KEEP SPINE IMBOLIZED UNTIL MRI AND EVAL/CONSULT WIRH A NEUROSURGEON

  • **more common in kids and elderly
  • > kids head large and elderly have spondylolysis
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6
Q

Nexus Criteria

A

HIGH SENSITIVITY

1) absence of posterior midline cervical tenderness
2) normal alertness
3) no intoxication
4) no abnormal neuro findings
5) no painful distracting injuries

IF ALL CRITERIA ARE MET PATIENT DOES NOT NEED IMAGING

IF NOT ALL ARE MET ; APPLYA CERVICAL COLLAR AND IMAGE THE PATIENT

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7
Q

Atraumatic Neck Pain Diff Diagnosis

A

1) MSK - cervical spondylosis = degenerative changes , whiplash, torticollis, etc
2) neuro = radicule/myelopathy
3) Nonspinal causes = systemic disease or referred pain (ie CAD, malignancy, referred shoulder pain, fibromyalgia, thoracic outlet syndrome)

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8
Q

Cervical Spondylosis

A
  • degenerative changes in spine

MOST COMMON CAUSE OF CHRONIC NECK PAIN IN ADULTS

(osteoarthritis; osteophytes)

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9
Q

Myelopathy vs Radiculopathy

A

Cervical Myelopathy = deficits related to the SC
—> bilateral or distal weakness/numbness, clumsy hands, gait disturbances, sex dysfunction, bowel bladder dysfunction
NEEDS EMERGENT MRI

CERVICAL RADICULOPATHY = nerve root issue
—-> share burning pain radiating to trap, periscapular area, or down arm
–> c5-c6 then c6-7 most common
URGENT WORKUP ,non-emergent MRI

DEGENERATIVE (SPONDYLITIC) CHANGES ARE THE MOST COMMON CAUSES OF BOTH

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10
Q

Meningitis

A

Sx : fever, malaise, photophobia, AMS, petechiae and purport,

-nuchal rigidity, kernig’s, brudzinskis

cause : bacterial , n. meningitidis, viral

dx : LUMBAR PUNCTURE

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11
Q

Thoracic Outlet syndrome

A

-compression of neurovasc bundle just above 1st rib and behind clavicle

sx : arm pain, numbness, weakness
-> agg. by activities done with arms and hands above the head

ROO’S/EAST TEST
adsons test

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12
Q

Most patients with atraumatic neck pain without red flags do not require imaging

A

image those who do not respond to conservative treatment over 6 weeks

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13
Q

Dermatomes

c3-c5? c6? t4? t10?

A

skin innv by sensory root of single spinal nerve

C3-5 = neck/clavicle/ diphragm

c6 = lateral forearm and thumb

t4 = nipple

t10 = umbilicus

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14
Q

ROM

trauma? neck stiffness?

A

trauma = NEVER unless have been cleared of cervical fracture and/or SC injury

never force ROM

neck stiffness = inability or I=unwillingness to move neck

  • -> check out immediately
  • -> causes of neck splinting/stiffness = c-spine fractures, cord injuries, ligament, muscle strain, SAH, meningitis
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15
Q

HVLA Contraindications

A

1) Rhumetoid Arthritis
- -> weak odontoid l. can rupture
2) Down syndrome
- -> weak odontoid l. can rupture
- ->incomplete or missing odontoid process
3) carotid disease, PVD
4) osteoarthritis or risk of
5) local metastases
6) pts on anticoags (cranial bleed)
7) osseous or l. disruption, apprehension

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16
Q

Red flags

1) neck trauma
2) SC issue
3) Lehrmitte’s phenom shock with neck flexion)
4) fever chills
5) injection drug use

A

1) cervical spine fracture
2) cervical cord compression
3) cervical cord compression / MS
4) infection
5) cervical spine or disc infection

17
Q

Red flags

6) immunosuppression
7) chronic glucocorticoid use
8) unexplained weightloss
9) history of cancer
10) headache, shoulder/ hip pain
11) anterior neck pain

A

6) infection
7) infection or cervical spine compression
8) malignancy
9) metastatic disease to cervical spine
10) rhumatic disease
11) non spinal (angina)

18
Q

Reflex testing

c4-5 disc = c5 root ?
c5-c6 disc = c6 root?
c6-c7 disc = c7 root?

A
  • biceps
  • brachioradialis
  • triceps
19
Q

Sensory exam

c4? c5? c6? c7? c8? t1?

A
  • lateral neck
  • lateral upper arm
  • lateral forearm/thumb
  • middle finger
  • medial wrist/forearm
  • medial elbow/upper arm
20
Q 
Strength testing
c1?
c2-4?
c5?
c6?
c7?
c8?
t1?
A 
c1 = resisted rotation ROM (main inn from spinal accessory)
c2-4 = scapular elevation
c5 = deltoid, shoulder abduction
c6 = biceps, wrist expension
c7 = triceps, wrist flexion
c8 = finger flexion
t1.= finger abduction
21
Q

Compression Test

A
  • head and neck in neutral position
  • place axial load loading force downward

+ UE pain, paresthesia, or numbness

22
Q

Spurling’s Test

A

goal : looking for nerve root compression

Apply axial force :

1) neutral
2) extension
3) SB/rotation toward or away

*if symptoms reproduced in one stage, do not proceed to the next stages

HIGH SPECIFICITY

INDICATED A CENTRAL NEUROPATHY

23
Q

Neck Distraction Test

A
  • place one hand under chin and other around occiput
  • slowly distract the head

+ = alleviation of symptoms
CENTRAL NEUROPATHY

24
Q

Adson’s Test

A
  • locate radial pulse on affected arm
  • abduct, extend, and externally rotate shoulder
  • while patients head is extended and rotated toward affected side and inhale and hold it
  • as exhale extend and rotate head away

+ = loss or change in pule; repro of symptoms

indication : THORACIC OUTLET SYNDROME. specifically subclavian b/w scalene when looking away OR 1st rid when looking toward affected side

25
Q

Roos/EAST Test

A

Abduct shoulder to 90s and externally rotate
-open and close posts for 3 min

+ = repro of symptoms (pain/parestheia)

indication = TOS, compression of subclavian a.

26
Q

Nuchal Rigidity

A

-patient supine, doctor flexes neck forward until chin touches chest

+ = neck stiffness/resistance to flexion

indication = INFLAMMATION IN SUBARACH SPACE (MENINGITIS OR SUBARACH HEM)

27
Q

Brudzinski’s Sign

A

-patient supine and flex neck forward

+ = flexion in hips and knees

indication : INFLAMM IN SUBARACH SPACE (men o r subarachnoid hem)

28
Q

Kernig’s Sign

A
  • patient supine
  • flex hip and knee to 90, attempt to passively extend the leg at the knee

+ = increased resistance to extension and pain behind the knee

indication : MENINGEAL/DURAL IRRITATION

29
Q

Jefferson fracture

A

axial compression -> c1 fracture

30
Q

wedge fracture

A

flexion and compression injury (flexion to 30 degrees = lordosis lost and protective soft tissue no longer protective)

PCM Final (4 decks)

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