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OMM M1 CB > E4: Differential Diagnosis of Neck Pain > Flashcards

E4: Differential Diagnosis of Neck Pain Flashcards

1
Q

What are some congenital etiologies of torticollis?

A 
Trauma at birth
Klippel-Feil syndrome
Basilar impression
Atlanto-occipital fusion
Pterygium colli (web neck)
Odontoid abnormalities
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2
Q

What is Klippel Feil syndrome?

A

Cervical spine anomaly consisting of multiple fused vertebrae, possible hemivertebrae or other anomalies

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3
Q

On physical exam, what signals Klippel Feil syndrome?

A

Segmental motion testing demonstrates total motion loss, not just restriction.

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4
Q

What are some inflammatory etiologies of torticollis?

A

Lymphadenitis in the neck
Tuberculosis
Typhoid
Rheumatoid arthritis *most common - causes spontaneous Atlanto-axial rotatory subluxation

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5
Q

How does rheumatoid arthritis induce torticollis?

A

It erodes away the transverse odontoid ligament with subluxation of the dens posteriorly into the spinal canal

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6
Q

If a patient presents with neck pain and has RA elsewhere in the body, what should be done before taking a manipulative approach?

A

Perform flexion/extension films of the odontoid

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7
Q

What are some neurologic etiologies of torticollis?

A 
Ocular dysfunction
Syringomyelia
Spinal cord tumor
Cerebellar tumor
Bulbar palsies
Spasmodic torticollis
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8
Q

What is syringomyelia?

A

Central cavitation (dilation) of the spinal cord

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9
Q

When do symptoms of syringomyelia typically appear?

A

Second/third decade of life

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10
Q

Which demographic is more affected by syringomyelia?

A

Men

M:F - 7:3

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11
Q

What is the calling card of syringomyelia?

A

Awkwardness/weakness in the extremities
“Claw hand”
Radicular pain is UNUSUAL

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12
Q

What are the red flags for possible infection with neck pain?

A 
Age: >50 years or <20 years
Fever or chills
Pain worse supine
Recent UTI
IV drug abuse
Immune suppression
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13
Q

What are common infectious causes of neck pain?

A 
Sinusitis
Cervical adenitis
Parotitis
Lyme arthritis
Osteomyelitis
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14
Q

What are the red flags for possible tumor with neck pain?

A

Age: >50 years or under <20 years
Unexplained weight loss
Pain worse when supine
Severe nocturnal pain

**NO fever

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15
Q

What Beighton score do most people with Ehlers-Danlos have?

A

7

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16
Q

What is the most common sub-type of Ehlers Danlos?

A

Type III - Hypermobility Type

1 in 10-15,000 people

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17
Q

What are hypermobile Ehlers Danlos patients prone to?

A

Chronic joint pain

18
Q

What is Classical Type Ehlers Danlos and what are the symptoms?

A

Types 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

19
Q

What is a major implication of Type IV Ehlers Danlos?

A

Type IV = Vascular Type

Fragile blood vessels and organs are prone to rupture

20
Q

Percussive pain is present with which conditions?

A 
Fracture
Tumor
Osteomyelitis
Infectious discitis
Facet joint synovitis
21
Q

Neck pain that radiates into shoulder, arm, forearm, wrist, or hand indicates which condition?

A

Herniated cervical disc

22
Q

This technique will make the symptoms of any space-occupying lesion in the spinal canal worse.

A

Valsalva maneuver

23
Q

What aspects of patient’s history would indicate herniated cervical disc?

A

Pain that radiates into a dermatomal distribution

Numbness/paresthesias in a dermatomal distribution

24
Q

PE findings that indicate herniated cervical disc

A

Abnormal head carriage

Loss or reversal of cervical lordosis

25
Q

What is Lhermitte sign?

A

Electrical shock paresthesia down back, arms, or legs with flexion of the neck

26
Q

When does Lhermitte sign occur?

A

With any cause of spinal cord compression

Occurs with many causes of spinal cord inflammation

27
Q

Nerve root compression results in reflex _____. Spinal cord compression results in reflex _____.

A

Loss

Abnormality

28
Q

Hoffman test

A

Support the middle finger and then flick it

Positive sign: thumb and pointer finger move

29
Q

Hypoplastic dens may be present in which demographic?

A

Dwarfism

Down Syndrome

30
Q

Syringomyelia patients typically do not have _____.

A

Pain

31
Q

If patient has rheumatoid arthritis elsewhere in the body, what should you do before a manipulative approach?

A

Perform extension/flexion films of the odontoid to determine stability

32
Q

Which mechanical abnormality is most common in people over 50?

A

Kyphosis with anterior head carriage

33
Q

Where is point tenderness for Scapulo-Costal syndrome?

A

Insertion of the levator scapulae muscle

34
Q

What movement exacerbates Scapulo-Costal syndrome?

A

Elevation and adduction of the humerus

35
Q

Using a brace for localized hypermobility treatment also requires the patient to do what?

A

Exercise. Lack of exercise will make them more unstable.

36
Q

Possible treatment for localized hypermobility

A 
OMT
Exercise
Bracing
Prolotherapy
Surgical fusion
37
Q

Complications of Ehlers-Danlos

A 
Prominent scarring
Difficulty with surgical wounds healing
Chronic joint pain
Rupture....of everything
Premature aging with sun exposure
Early onset arthritis
38
Q

Ehlers-Danlos treatment

A

OMT (same as for benign hypermobility)
Stabilization exercises
Vitamin C

39
Q

What is Chvostek sign?

A

Facial muscles involuntarily contract when the facial nerve is percussed.

Sign of hypocalcemia.

40
Q

Most common failed surgeries that cause neck pain

A

Cervical spine
Dental
Ophthalmologic
Otolarynologic

41
Q

Pain referred FROM the head and neck

A 
Breast pain (C5/C6 nerve root)
Precordial pain (C5/C6 nerve root) --> pain in front of the heart
Facial pain (trigeminal neuralgia)
42
Q

Conditions that refer pain TO the head and neck

A 
Cardiac pain
Complex regional pain syndrome
(Reflex Sympathetic Dystrophy Syndrome)
(Barre-Leiou syndrome)
Dental pain
Myofascial trigger points
Occipital neuralgia
Ocular pain

OMM M1 CB (6 decks)

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