Conditions Cx & Neck Flashcards
What treatment and diagnostic pathways can be used for neck pain?
Canadian C Spine Rule
NEXUS criteria
What are the red flags for acute onset neck pain?
Age over 50
Hx: trauma or malignancy
SSX and risk factors infection - fever, night sweats, systemic unwellness, immunosuppression, penetrating wound
CV risk factors
Neuro symptoms in limbs
unexplained weight loss
use of corticosteroids
failure to improve with treatment
What is the difference between radicular pain and radiculopathy?
Radiculopathy is compression or chemical irritation of the spinal nerve root. This can cause neurological SSX which may or may not include pain.
Radicular pain is pain associated with nerve root pathology, which can be caused by mechanical compression or chemical irritaiton of the nerve root.
Describe the dermatomes of the cervical spinal nerves
C3 - neck
C4 - shoulders
C5 - lateral arm
C6 - lateral forearm, thumb, index finger
C7 - middle finger, middle of hand
C8 - medial two fingers, medial hand, medial forearm
Describe cervical radiculopathy
Radiculopathy = compression or chemical irritation of spinal nerve roots
SSX:
neurological changes and/or radicular pain, usually in a dermatomal distribution.
Common causes:
disc pathology
chemical irritation of nerve root
cervical stenosis
Describe cervical artery dissection
a tear in carotid or vertebral artery walls which allows blood clots to develop, occluding the blood supply to the brain
risk factors:
- trauma within 5 days
- CV risk factors
- Cx manipulation
SSX:
- unilateral thunderclap headache
- unilateral neck or facial pain that is severe and new
- upper or lower limb neuro
- trouble with speech / tongue
- ataxia
- pulsating tinnitus
- Horners syndrome (miosis, one eyelid drooping, one side of face not sweating)
immediate medical referral - emergency
Describe the different types of disc pathology
Annular fissure - tear in annulus
Disc bulge - nucleus protrudes into annulus but is still contained
Prolapse / protrusion - annulus overlaps vertebral body, nucleus still contained
Extrusion - annulus overlaps vertebral body and nucleus breaches annulus
Sequestration - part of the nuclear body splits away from the disc and enters vertebral canal
What are the causes of disc pathology?
In younger populations - acute injuries, especially involving trauma or a combination of hyperflexion with rotation
In older populations - degenerative processes
What are some of the secondary pathologies that can be caused by disc herniation in the cervical spine?
Radiculopathy - compression of the nerve roots
Myelopathy - compression of the spinal cord
Describe the condition of whiplash including WAD
whiplash involves a rapid acceleration-deceleration mechanism at the neck, forcing the cervical spine into rapid hyperextension rapidly followed by hyperflexion.
WAD can be graded according to the Quebec Task Force classification system and managed using Canadian C Spine rule & NEXUS criteria
Common causes include MVAs, falling, diving, trauma in contact sports
SSX:
- neck pain: onset within 6 hours in neck and upper shoulders, can refer to suboccipital and interscapular regions
- neck stiffness, protective guarding of neck mm, very limited and painful Cx ROM
- maybe cervicogenic headache
- maybe radicular pain / radiculopathy if nerve roots compressed or chemically irritated
WAD:
- deafness
- tinnitus
- memory loss
- dizziness
- dysphagia
- TMJ pain
- psychological including PTSD
Describe the locations for referral of cervical facet injury
C2/3 - temporal & occipital C3/4 - lateral neck C4/5 - lateral neck, shoulder, upper back C5/6 - upper back & shoulder C6/7 - middle back
Describe a facet joint injury of the cervical spine
Most common cause of neck pain, can be caused by obvious trauma or repetitive microtrauma
SSX:
- neck pain
- referred pain
- pain aggravated by extension, ipsilateral SB, rotation
- limited Cx ROM
- locking sensation in certain movements
- hypertonicity paravertebral mm
- tenderness on joint palpation
Describe a cervicogenic headache
HA secondary to MSK disorder of Cx spine
SSX:
- pain in C1-3
- limited ROM upper Cx
- tissue tenderness upper Cx
Describe the condition of cervical spondylosis
Degenerative condition where IVDs shrink and spinal column becomes compressed. Can have associated growth of osteophytes (to stabilize vertebrae)
SSX:
- limited Cx ROM
- restriction in rotation and lateral flexion to painful side
- can cause radiculopathy
Describe the condition of burners / stingers in the cervical spine
Nerve injury to the upper trunk of brachial plexus or C5-6 nerve root
Injury caused by compression or traction of shoulder
Can be Grade 1 neurapraxia (most common, demyelination with axon not injured)
or Grade 2 axonotmesis (axonal damage & Wallerian degeneration)
SSX:
- transient burning pain in supraclavicular area
- sensory or motor abnormalities in UL
