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Year 1: 2020 ECOS Final > Lecture 2: Cervical Spine Complaint > Flashcards

Lecture 2: Cervical Spine Complaint Flashcards

1
Q

What are the types of atraumatic neck pain?

A

Musculoskeletal
Neurologic
Non-spinal: systemic disease or referred pain

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2
Q

What are the types of traumatic neck pain?

A 
Myofascial Injury (e.g. muscle strain)
Cervical Fracture
Ligamentous Injury
Disc Injury
Cord or nerve root injury
SCIWORA
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3
Q

Is myofascial neck pain traumatic or atraumatic?

A

Can be both

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4
Q

What are symptoms of myofascial neck pain?

A

Pain
Spasm
Loss of ROM in neck

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5
Q

How can cervical fractures be determined if they are stable or unstable?

A

Imaging (CT/MRI)

Radiological and neurosurgical consultation

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6
Q

What is SCIWORA?

When would you do this?

A

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
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7
Q

What is the Nexus criteria used for?

A

Determine which patients presenting w/ neck pain after trauma needs radiographic imaging?

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8
Q

What is the Nexus Criteria?

A
  1. Absence of posterior midline cervical tenderness
  2. Normal level of alertness
  3. No evidence of intoxication
  4. No abnormal neurological findings
  5. No painful distracting injuries

*If all criteria are met, patient does not need imaging.

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9
Q

What are some examples of atraumatic musculoskeletal neck pain?

A

Cervical spondylosis
Whiplash
Torticollis
Facet osteoarthritis

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10
Q

What are some examples of atraumatic neurologic neck pain?

A

Radiculopathy

Myelopathy

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11
Q

What are some examples of atraumatic non-spinal causes of neck pain?

A 
Coronary artery disease
Malignancy
Neurologic conditions
Referred shoulder pain
Rheumatologic conditions
Fibromyalgia 
Thoracic Outlet Syndrome
Visceral etiolgoies
Infections
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12
Q

What is cervical spondylosis?

A

Degenerative changes in cervical spine that can cause general neck pain, radiculopathy, and myelopathy
-incidence increases w/ age

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13
Q

What is cervical myelopathy?

A

Neurological deficit related to spinal cord

  • Bilateral or distal weakness and numbness in hands
  • Gait disturbance
  • Sexual dysfunction
  • Bowel or bladder dysfunction

Emergent MRI!

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14
Q

What is cervical radiculopathy?

A

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
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15
Q

What are symptoms of meningitis?

A 
Fever
malaise
headache
photophobia
neck pain and stiffness
rash
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16
Q

What tests are positive for meningitis?

A

Nuchal Rigidity
Kernig’s Sign
Brudzinski’s signs

17
Q

What causes meningitis?

A

Bacterial infections: Hemophilus, Strep, Pneumonia (can lead to infection)
Neisseria menigitidis: main cause
Viral infection

18
Q

How is meningitis diagnosed?

A

Lumbar puncture

19
Q

Where is thoracic outlet found?

A

Space between clavicle and first rib

20
Q

What structures are found in the thoracic outlet?

A

Brachial Plexus
Subclavian Artery
Subclavian Vein

21
Q

What is thoracic outlet syndrome?

A

Compression of neurovascular bundles by structures near thoracic outlet

22
Q

What are symptoms of thoracic outlet syndrome?

A

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

23
Q

What tests are positive for thoracic outlet syndrome?

A

Roos/EAST Test

Adson test

24
Q

With patients that have atraumatic neck pain without red flags, when would imaging be appropriate?

A

After 6 weeks if symptoms still persist and do not respond to conservative management

25
Q

What can be a major concern with any recent major neck trauma?

A

Cervical spine fracture (imaging can confirm)

26
Q

What can be a major concern with any neurological symptoms?

A

Cervical cord compression

27
Q

What can be a major concern with any chronic glucocorticoid use?

A

Infection or cervical spine compression fracture

28
Q

What should you look out for when inspecting the neck?

A

Glandular or lymph node swelling
Symmetry
Masses
Scars

29
Q

What structures should you look out for when palpating the neck?

A

Lymph nodes

Thyroid gland

30
Q

What vascular exam should be done at the neck?

A

Carotid pulse

Jugular Venous Distention

31
Q

What tests are positive for cervical radiculopathy?

A

Spurling’s Test

Manual Distraction Test

32
Q

When should you never check for neck ROM?

A

If patient has not been cleared of cervical fractures or spinal cord injury

33
Q

What important feature of the physical exam should always be noted and addressed?

A

Neck stiffnes

34
Q

What are some causes of neck stiffness?

A 
C-spine fractures
Spinal cord injuries
Ligamentous injuries
Muscle strains and spasms
Subarachnoid hemorrhage 
Meningitis
35
Q

When is HVLA contraindicated with patients?

A 
Rheumatoid Arthritis
Down Syndrome
Carotid Disease
Osteoporosis 
Local metastases
Patients on anticoagulants
Osseous or ligamentous disruption

Year 1: 2020 ECOS Final (12 decks)

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