MSK 08: Axial Neck Injuries

Question 1

Phases

Answer 1

• acute (within hours)
• 1-2 weeks
• 4-12 weeks (subacute period)
• 6 months or more (chronic pain)

Question 2

Canadian C-Spine Rule

Answer 2

• high risk factors: ≥ 65, dangerous mechanism, paresthesias in extremities
• NO low risk factors: simple rear-end MVC, delayed onset of neck pain, sitting position in ED, ambulatory at any time, absence of midline C-spine tenderness
• neck rotation: cannot rotate 45º

Question 3

Acute Treatment – OTC NSAIDs

Answer 3

• ibuprofen
• naproxen

Question 4

Acute Treatment – OTC Acetaminophen/APAP

Answer 4

• immediate release
• extended release

Question 5

Acute Treatment – OTC APAP/NSAID Combination

Answer 5

• Combogesic
• Advil Plus APAP

Question 6

Acute Treatment – OTC Muscle Relaxant

Answer 6

methocarbamol

• combo
• single

Question 7

Acute Treatment – OTC Opioids

Answer 7

• Tylenol No. 1
• AC&C

Question 8

Acute Treatment – Rx NSAIDs

Answer 8

• celecoxib – similar
• naproxen – similar
• ibuprofen – similar
• meloxicam
• diclofenac – avoid
• ketorolac – avoid

Question 9

Acute Treatment – Rx Muscle Relaxants

Answer 9

• cyclobenzaprine – low dose preferred, no difference in efficacy with higher dose
• baclofen – gradual
• tizanidine – gradual
• methocarbamol

Question 10

Acute Treatment – Rx Opioids

Answer 10

should be avoided

Question 11

Acute to Chronic Therapy

Answer 11

• relevant to subacute stage and beyond
• acetaminophen can be continued within maximum daily dose
• NSAIDs need to be used sparingly
• opioids should be tapered and discontinued

Question 12

MACS Prescribing

Answer 12

• NSAIDs only