Cervical Complaint Flashcards
Causes of Neck pain
1) Traumatic
2) Atrumatic
- MSK !!!!! (most)
- Neuro
- –> raducilo/myelopathy
- non-spinal
- > systemic disease or referred pain
Traumatic neck pain is us due to
1) MYOFASCIAL INJURY
2) cervical fracture
3) ligament injury
4) disc injury
5) cord/nerve root injury
6) SCIWORK
Myofascial Neck pain
MAY OR MAY NOT BE TRAUMATIC
1) pain, spasm, loss fo ROM in next
2) occipital headache
ex : whiplash, muscle strain
Cervical fractures
- blunt trauma
- most stable
- neuro consult
- det if stable via Nexus Criteria
Spinal Cord Injury w/o radiographic abnormality (SCIWORA)
-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
Nexus Criteria
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
Atraumatic Neck Pain Diff Diagnosis
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)
Cervical Spondylosis
- degenerative changes in spine
MOST COMMON CAUSE OF CHRONIC NECK PAIN IN ADULTS
(osteoarthritis; osteophytes)
Myelopathy vs Radiculopathy
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
Meningitis
Sx : fever, malaise, photophobia, AMS, petechiae and purport,
-nuchal rigidity, kernig’s, brudzinskis
cause : bacterial , n. meningitidis, viral
dx : LUMBAR PUNCTURE
Thoracic Outlet syndrome
-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
Most patients with atraumatic neck pain without red flags do not require imaging
image those who do not respond to conservative treatment over 6 weeks
Dermatomes
c3-c5? c6? t4? t10?
skin innv by sensory root of single spinal nerve
C3-5 = neck/clavicle/ diphragm
c6 = lateral forearm and thumb
t4 = nipple
t10 = umbilicus
ROM
trauma? neck stiffness?
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
HVLA Contraindications
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
Red flags
1) neck trauma
2) SC issue
3) Lehrmitte’s phenom shock with neck flexion)
4) fever chills
5) injection drug use
1) cervical spine fracture
2) cervical cord compression
3) cervical cord compression / MS
4) infection
5) cervical spine or disc infection
Red flags
6) immunosuppression
7) chronic glucocorticoid use
8) unexplained weightloss
9) history of cancer
10) headache, shoulder/ hip pain
11) anterior neck pain
6) infection
7) infection or cervical spine compression
8) malignancy
9) metastatic disease to cervical spine
10) rhumatic disease
11) non spinal (angina)
Reflex testing
c4-5 disc = c5 root ?
c5-c6 disc = c6 root?
c6-c7 disc = c7 root?
- biceps
- brachioradialis
- triceps
Sensory exam
c4? c5? c6? c7? c8? t1?
- lateral neck
- lateral upper arm
- lateral forearm/thumb
- middle finger
- medial wrist/forearm
- medial elbow/upper arm
Strength testing c1? c2-4? c5? c6? c7? c8? t1?
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
Compression Test
- head and neck in neutral position
- place axial load loading force downward
+ UE pain, paresthesia, or numbness
Spurling’s Test
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
Neck Distraction Test
- place one hand under chin and other around occiput
- slowly distract the head
+ = alleviation of symptoms
CENTRAL NEUROPATHY
Adson’s Test
- 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
