Lecture 2: Cervical Spine Complaint Flashcards
What are the types of atraumatic neck pain?
Musculoskeletal
Neurologic
Non-spinal: systemic disease or referred pain
What are the types of traumatic neck pain?
Myofascial Injury (e.g. muscle strain) Cervical Fracture Ligamentous Injury Disc Injury Cord or nerve root injury SCIWORA
Is myofascial neck pain traumatic or atraumatic?
Can be both
What are symptoms of myofascial neck pain?
Pain
Spasm
Loss of ROM in neck
How can cervical fractures be determined if they are stable or unstable?
Imaging (CT/MRI)
Radiological and neurosurgical consultation
What is SCIWORA?
When would you do this?
Spinal Cord Injury w.o Radiographic Abnormality
- Normal films but neurologic symptoms persist
- High degree of suspicion needed to order MRI
- Mostly done w/ kids or elderly
What is the Nexus criteria used for?
Determine which patients presenting w/ neck pain after trauma needs radiographic imaging?
What is the Nexus Criteria?
- Absence of posterior midline cervical tenderness
- Normal level of alertness
- No evidence of intoxication
- No abnormal neurological findings
- No painful distracting injuries
*If all criteria are met, patient does not need imaging.
What are some examples of atraumatic musculoskeletal neck pain?
Cervical spondylosis
Whiplash
Torticollis
Facet osteoarthritis
What are some examples of atraumatic neurologic neck pain?
Radiculopathy
Myelopathy
What are some examples of atraumatic non-spinal causes of neck pain?
Coronary artery disease Malignancy Neurologic conditions Referred shoulder pain Rheumatologic conditions Fibromyalgia Thoracic Outlet Syndrome Visceral etiolgoies Infections
What is cervical spondylosis?
Degenerative changes in cervical spine that can cause general neck pain, radiculopathy, and myelopathy
-incidence increases w/ age
What is cervical myelopathy?
Neurological deficit related to spinal cord
- Bilateral or distal weakness and numbness in hands
- Gait disturbance
- Sexual dysfunction
- Bowel or bladder dysfunction
Emergent MRI!
What is cervical radiculopathy?
Neurological deficit occurring at or near nerve root
- Sharp, burning, pain radiating to trapezius, periscapular area, or down arm
- Most common in C5/C6 or C6/C7
What are symptoms of meningitis?
Fever malaise headache photophobia neck pain and stiffness rash
What tests are positive for meningitis?
Nuchal Rigidity
Kernig’s Sign
Brudzinski’s signs
What causes meningitis?
Bacterial infections: Hemophilus, Strep, Pneumonia (can lead to infection)
Neisseria menigitidis: main cause
Viral infection
How is meningitis diagnosed?
Lumbar puncture
Where is thoracic outlet found?
Space between clavicle and first rib
What structures are found in the thoracic outlet?
Brachial Plexus
Subclavian Artery
Subclavian Vein
What is thoracic outlet syndrome?
Compression of neurovascular bundles by structures near thoracic outlet
What are symptoms of thoracic outlet syndrome?
Arm pain, numbness or weakness
Aggravated by activities requiring elevation or sustained use of arms or hand above head
Decreased/absent distal pulses
Digital cyanosis and ischemia
What tests are positive for thoracic outlet syndrome?
Roos/EAST Test
Adson test
With patients that have atraumatic neck pain without red flags, when would imaging be appropriate?
After 6 weeks if symptoms still persist and do not respond to conservative management
What can be a major concern with any recent major neck trauma?
Cervical spine fracture (imaging can confirm)
What can be a major concern with any neurological symptoms?
Cervical cord compression
What can be a major concern with any chronic glucocorticoid use?
Infection or cervical spine compression fracture
What should you look out for when inspecting the neck?
Glandular or lymph node swelling
Symmetry
Masses
Scars
What structures should you look out for when palpating the neck?
Lymph nodes
Thyroid gland
What vascular exam should be done at the neck?
Carotid pulse
Jugular Venous Distention
What tests are positive for cervical radiculopathy?
Spurling’s Test
Manual Distraction Test
When should you never check for neck ROM?
If patient has not been cleared of cervical fractures or spinal cord injury
What important feature of the physical exam should always be noted and addressed?
Neck stiffnes
What are some causes of neck stiffness?
C-spine fractures Spinal cord injuries Ligamentous injuries Muscle strains and spasms Subarachnoid hemorrhage Meningitis
When is HVLA contraindicated with patients?
Rheumatoid Arthritis Down Syndrome Carotid Disease Osteoporosis Local metastases Patients on anticoagulants Osseous or ligamentous disruption
