Differential Dx of Neck Pain part 2 Flashcards
What are the red flag for possible infection?
Age Over 50 Years Age Under 20 Years Fever or Chills Pain worse supine Recent Urinary Tract Infection IV Drug Abuse Immune Suppression
What are some red flags for cervical infection in the physical examination?
Fever
Spinous process percussive pain (only C2, C7, T1)
What are some red flags for cervical infection that could be seen in lab test?
Elevated WBC count
Elevated erythrocyte sedimentation rate
What are some infections that cause cervical neck pain?
Sinusitis Cervical Adenitis Parotitis Lyme Arthritis Osteomyelitis
What are the red flag for possible tumor in the cervical region?
Age over 50 years Age under 20 years Unexplained Weight Loss Pain worse when Supine Severe Nocturnal Pain History of cancer (has metastatic cancer until proven otherwise)
When doing the physical exam for circulatory disorders what should you look for and auscultate?
BP, Pulse Rate
Palpate Carotid Pulses (presence, character, thrill)
Heart (murmurs)
Carotid Arteries (bruits)
Vertebral Arteries at mastoid processes (bruits)
Ophthalmic Arteries over the eyeballs (bruits)
What are the red flags for vertebrobasiliar artery compromise?
Acute anxiety or panic on the part of the patient during any part of the examination or treatment (Ischemia)
Sitting pt look up toward the ceiling then turn the head to right
What test is NOT recommended for possible vertebrobasiliar artery compromise?
DeKleyn Test
What would ellict a wallenburg syndrome and what are its symptoms?
Vertebrobasiliar thrombosis
Homolateral face pain and paresthesia, contralateral loss of pain and temp sensation, vertigo w/ vomiting, unilateral paralysis of palate, pharynx and vocal cords
What is the history finding for mechanical abnormalities?
Insidious onset
What are some mechanical abnormalities of the cervical spine?
Somatic Dysfunction Kyphosis with Anterior Head Carriage Scoliosis Poor Posture Poor Muscle Tone Scapulo-Costal Syndrome Hypermobility
What constitutes about 30% of all neck and shoulder complaints in mid-life?
Scapulo-costal syndrome
Also called: fatigue postural paradox syndrome or levator scapulae syndrome
What does the posture look like in scapulo-costal syndrome?
Inc kyphosis with anterior head carriage with muscular neck, shoulder and back pain
Where does the pain localize to in scapulo-costal syndrome?
Superior medical corner of the scapula
What exacerbates the pain in scapulo-costal syndrome?
Elevation and adduction of the humerous
What sound could you hear if someone has scapulo-costal syndrome?
Crepitance due to facial scarring when circumducted
What is the treatment for scapulo-costal syndrome?
Correct Kyphosis Correct Scoliosis Correct Associated Cervical, Thoracic, Costal and Clavicular Somatic Dysfunctions Balance Shoulder muscle tension Trigger Point Treatment
What are some counterstrain treatments for scapulo-costal syndrome?
Counterstrain Muscle Energy Deep Inhibitory Pressure Spray & Stretch Injection of Lidocaine/Corticosteroids
What is intern’s neck and what is it caused by?
Neck and shoulder pain
Excessive Pull on the Suspensory Muscles of the shoulders
Due to overloading white coat pockets
How can you releive some of the pain in intern’s neck?
Transfer the weight off the shoulders onto pelvis
Where can hypermobility occur and what could cause it?
Anywhere
Laxity of ligaments due to genetic factors, degenerative discs, ligament trauma
What are the treatments for localized hypermobility?
OMT Exercise Bracing Prolotherapy Surgical fusion
What is Elhers-Danols syndrome?
A group of inherited disorders that affect connective tissue due to defects in collagen production
What type of Ehlers-Danols is hypermobility and what are the symptoms?
Type III
Loose connective tissue and chronic joint pain
Also called Benign Hypermobility Syndrome or Arthrochalasis Multiplex Congenita
What type of Ehlers-Danols is the classical case and what are the symptoms?
Type I and II
Highly Elastic, Velvety Skin
Fragile Skin that Bruises and Tears Easily
Slow and Poor Wound Healing Leading to Scarring
Non-cancerous fibrous growths on pressure areas such as elbows and knees
Fatty Growths on Shins & Forearms
Loose Joints, Prone to Dislocation, Delayed Development of Large-Motor Skills
What type of Ehlers-Danols is the vascular case and what are the symptoms?
Type IV
Fragile Blood Vessels and Organs that are Prone to Rupture
Thin, Fragile Skin that Bruises Easily
Veins Visible Beneath the Skin
Distinctive Facial Features Including Protruding Eyes, Thin Nose & Lips, Sunken Cheeks and Small Chin
Loose Joints Usually Limited to Fingers & Toes
What type of Ehlers-Danols is the Kyphoscoliosis case and what are the symptoms?
Type VI
Progressive Scoliosis
Fragile Eyes That are Easily Damaged
Severe, Progressive Muscle Weakness
What type of Ehlers-Danols is the Arthrochalasia case and what are the symptoms?
Type VII A and B Very loose joints and dislocations, involving hips, which may delay development of large motor skills Stretchy Skin that’s Prone to Bruising Early Onset Arthritis Increased Risk of Osteoporosis
What type of Ehlers-Danols is the Dermatosparaxis case and what are the symptoms?
Type VII C
Extremely fragile and sagging skin
Loose joints, may see large motor delay
How would you diagnose Ehlers-Danols?
Genetic tests
Skin biopsy
Cardiac ultrasound
What are some complications of Ehlers-Danols?
Prominent Scarring Difficulty with Surgical Wounds Healing Chronic Joint Pain Early Onset Arthritis Premature Aging with Sun Exposure Rupture of major blood vessels, intestines, uterus Eye problems Osteoporosis Premature delivery of fetus Premature rupture of fetal membranes
What are some causes that lead to temporomandibular joint dysfunction
Joint disease Dental malocculsion Dysfunction of muscles of mastication Head carriage Cranial somatic dysfunction Physiological issues
In the history of someone with degenerative diseases what should you look for?
Insidious onset
Age over 50
What are some causes of degenerative disease?
Cervical spondulosis
Diffuse idiopathic skeletal hyperostosis (DISH)
Osteoarthritis of the shoulder or TMJ
In cervical spondylosis what complaint is common and what accompanies that complaint?
Headache with cervical disc disease
Should you declare the etiology of headaches based on the X-rays?
No they must correlate with with the physical findings
What can DISH lead to?
Ossification of the posterior longitudinal ligament
When looking at a spine that has suffered from DISH what do you expect it to look like?
Candle wax osteophytes
What could DISH be heavily associated with?
Diabetes mellitus type II
What could be some causes of thoracic outlet syndrome?
Anterior scalene syndrome
Costo-clavicular syndrome
Pectroaliz minor syndrom
Somatic dysfunction of the cervical area, 1st or 2nd rib or clavicle
How could you test for toxic and metabolic disorders?
Lab screening of CBC, urinalysis, blood chemistries
What are the signs of hyperthyroidism?
Muscle weakness & Atrophy
What are the signs of hypothryroidism?
Brisk reflex contraction with slow relaxation
What are the signs of hypokalemia?
Muscle weakness, cramping, fasciculations
What are the signs of hypomagnesemia?
Weakness, tetany, carpopedal spasm, positive chvostek sign
What is chvostek sign?
Facial muscle involuntarily contract when the facial nerve is percussed
What causes refered pains to the breast?
C5/C6 nerve room (myotomal)
What causes refered percordial pain?
C5/C6 nerve room (myotomal)
What can cause face pain?
Trigeminal neuralgia
What are some causes of refered pain to the neck and head?
Cardiac pain Complex regional pain syndrom Dental pain Myfascial trigger points Occipital neuralgia Ocular pain
