Common Musculoskeletal Problems: Neck

Question 1

Name 4 areas involved in muscular-pattern neck pain

Answer 1

1. Trapezius muscle
2. C7 spinous process
3. Paracervical musculature (shoulder girdle pain)
4. Radiates to occiput (tension headaches)

Also seen in chronic widespread pain (fibromyalgia)

Question 2

What is acute torticollis?

Answer 2

Torticollis means ‘twisted neck’. The most common cause is acute torticollis, a.k.a. ‘wry neck’, which causes a self-limiting episode of neck pain and stiffness.

Question 3

List the common causes of pain in the neck and shoulder

Answer 3

V
I - inflammatory arthritis (e.g. AS, PMR)
T - trauma (e.g. fall, whiplash)
A - inflammatory arthritis
M - mechanical or muscular (e.g. acute torticollis, chronic work-related upper limb pain syndrome), rotator cuff tendonitis, calcific tendonitis or bursitis, impingement syndrome or rotator cuff tear, adhesive capsulitis (‘frozen’ shoulder)
I
N - tumour, disc prolapse (nerve root entrapment)
C
D - osteoarthritis (spondylosis)
E
F - fibromyalgia

Question 4

List 3 conservative measures to treat mechanical or muscular neck pain (shoulder girdle pain)

Answer 4

1. Short-course analgesic
2. Physiotherapy
3. Occupational therapist

Question 5

Name the 2 main causes of nerve root entrapment

Answer 5

1. Acute cervical disc prolapse

2. Cervical spondylosis with posterolateral osteophytes narrowing root canal

Question 6

How does acute cervical disc prolapse present? (4 neurological symptoms)

Answer 6

1. Unilateral neck pain
   - Radiates to interscapular and shoulder regions
   - Diffuse, aching dural pain followed by sharp electric shock-like pain down arm
   - Nerve root distribution
2. Paraesthesia
   - Pins & needles, numbness
3. Weakness
4. Loss of reflexes

Question 7

Describe the sensory and motor innervation of nerve root C5

Answer 7

Sensory: 
- Lateral arm
Motor: 
- Shoulder abduction
- Elbow flexion
Reflex loss:
- Biceps

Question 8

Describe the sensory and motor innervation of nerve root C6

Answer 8

Sensory: 
- Lateral forearm
- Thumb and index finger
Motor: 
- Elbow flexion
- Wrist extension
Reflex loss:
- Biceps
- Supinator

Question 9

Describe the sensory and motor innervation of nerve root C7

Answer 9

Sensory: 
- Middle finger
Motor: 
- Elbow extension
Reflex loss:
- Triceps

Question 10

Describe the sensory and motor innervation of nerve root C8

Answer 10

Sensory: 
- Medial forearm
- Little and ring finger
Motor: 
- Finger flexion
Reflex loss:
- None

Question 11

Describe the sensory and motor innervation of nerve root T1

Answer 11

Sensory: 
- Medial upper arm
Motor: 
- Finger ab/adduction
Reflex loss:
- None

Question 12

At which level are cervical spondylotic osteophytes commonly found?

Answer 12

C5/C6 or C6/C7 - seen on oblique radiographs of neck.

Question 13

Nerve root entrapment: What is the imaging method of choice if the diagnosis is unclear?

Answer 13

MRI: clearly distinguishes between facet joint OA, root canal narrowing and disc prolapse.

Question 14

List 3 conservative measures used to treat nerve root entrapment.

Answer 14

1. Support collar
2. Rest
3. Analgesia and sedation
   - Cervical root block under direct vision
   Also advised not to carry heavy items.

Question 15

What is the estimated spontaneous recovery time for nerve root entrapment? When would you refer to a neurosurgeon?

Answer 15

Usually recovers in 6-12 weeks.
Refer to neurosurgeon if:
A. Pain persists
B. Severe/bilateral signs of weakness/numbness

Question 16

Name 2 complications of posterior spondylotic osteophytes?

Answer 16

1. Spinal claudication

2. Cervical myelopathy

Question 17

True or false: bilateral root pain without long track symptoms is a neurosurgical emergency. Why?

Answer 17

True. Bilateral root pain with OR without long track symptoms is a neurosurgical emergency because a central disc prolapse may compress the cervical spinal cord.

Question 18

List 5 features of whiplash injury that may indicate serious bone injury

Answer 18

1. Midline cervical tenderness
2. Focal neurological deficit
3. Altered alertness
4. Intoxication
5. Other painful distracting injury

Question 19

True or false: MRI scans are reserved for those with bony injury. CT scans occasionally show soft tissue injury.

Answer 19

False - the opposite is true.

Question 20

What is the pattern of chronic pain in whiplash injury?

Answer 20

Pain in neck, shoulder, arm

Question 21

What symptoms may accompany chronic pain in whiplash injury?

Answer 21

1. Headache
2. Dizziness
3. Poor concentration

Question 22

True or false: a compensation process may delay recovery from whiplash injury.

Answer 22

True - non-conflictive means of compensation may lead to better prognosis

Question 23

List the 4 conservative measures used to treat whiplash injury

Answer 23

1. Reassurance
2. Analgesia
3. Short-term support collar
4. Physiotherapy
   Pain may take a few weeks or months to settle.