Evaluation of the Patient with Neck Pain - Part I

Question 1

State the percent prevalence of neck pain for the following groups:

25-74 y/o

45-64 y/o

Answer 1

8.2%; 10.1%

Question 2

What percent of patients with neck pain had/have had it for more than 6 months?

Answer 2

13.8%

Question 3

What is the annual incidence of cervical dic herniation?

Answer 3

5.5 per 100,000

Question 4

What is the prevalence of whiplash?

Answer 4

2.8% of all police-reported MVAs

Question 5

What are the long-term outcomes of neck pain after 10 years?

Answer 5

79% had decreased neck pain

43% had no neck pain

32% had moderate or severe neck pain

Question 6

What are red flags for possible fracture?

Answer 6

History - major trauma

History - Fall from a height

Physical Exam - severely restricted ROM (active)

Question 7

What are red flags for possible infection?

Answer 7

Age: under 20, over 50

Fever or chills

Pain worse supine

Recent UTI

IV drug abuse

Immune suppression

Physical exam - temperature, percussive pain at C7 & T1

Question 8

What are red flags for possible tumor?

Answer 8

Age: under 20, over 50

Unexplained weight loss

Pain worse when supine

Sever nocturnal pain

Question 9

What are red flags for vertebrobasilar artery compromise?

What test do you perform to discover them?

Answer 9

Patient is positive for Wallenberg’s Test:

Dizziness

Visual changes

Lightheadedness

Nystagmus

Question 10

How do you perform Wallenberg’s Test?

Answer 10

While supine, patient flexes neck, holds for 10 seconds, then extends neck, again holding for 10 seconds, followed by rotation to the right, then left.

Question 11

What is the red flag for cerebral ischemia?

Answer 11

Any sense of acute anxiety or panic on the part of the patient during any part of the examination or treatment.

Question 12

How is the head normally held during inspection?

How should it move?

Answer 12

Erect

It should move in smooth coordination with the rest of the body.

Question 13

How far should the patient disrobe for neck examination? Why?

Answer 13

To the level of the waist due to possibility of reflected pathology.

Question 14

When inspecting the patient’s skin, what should you look for?

Answer 14

Blisters

Discoloration

Scars - Surgical: anterior (thyroid), posterior (spine)

Question 15

When palpating the supraclavicular fossa, what are you looking for?

Answer 15

Lumps, swelling, bone

Question 16

What pathology might you find when palpating the supraclavicular fossa?

Answer 16

Lumps - lymph nodes, apical lung tumor

Swelling - clavicular fracture, lymphatic obstruction

Bone - cervical rib

Question 17

What should you palpate for if your patient has sustained a whiplash injury?

Answer 17

Avulsion fractures

C2

T1

Question 18

What is being performed?

Answer 18

C4-C5 Palpation

Question 19

What is being performed?

Answer 19

C6 Palpation

Question 20

What is being performed?

Answer 20

Carotid pulse palpation and auscultation

Question 21

What is being performed?

Answer 21

Greater occipital nerves palpation

Question 22

What is being performed?

Answer 22

Lymph node palpation

Question 23

What is being performed?

Answer 23

Lymph node palpation

Question 24

What is being performed?

Answer 24

Nuchal ligament palpation

Question 25

What is being performed?

Answer 25

Parotid gland palpation

Question 26

What is being performed?

Answer 26

Sternocleidomastoid palpation

Question 27

What is being performed?

Answer 27

Thyroid palpation

Question 28

What is being performed?

Answer 28

Trapezius muscle palpation