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Clinic - Common Conditions Overview > Neck > Flashcards

Neck Flashcards

1
Q

What are the 7 serious conditions that can present with neck pain?

A 
CAD
Stroke / haemorrhage
Myocardial ischaemia
Meningitis
Osteomyelitis
Bone tumour
Vertebral fracture
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2
Q

What are the 4 types of vertebral fracture that can occur in the cervical spine?

A

Avulsion
Jefferson (C1)
Odontoid (C2)
Pars

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3
Q

What are the red flags in a neck pain presentation that can indicate CAD?

A
  • Acute onset unilateral neck pain with unilateral HA
  • dizziness
  • asymmetrical CN
  • Horners
  • tinnitus
  • vision / speech change
  • decreased co-ordination
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4
Q

What are the red flags in a neck pain presentation that can indicate a tumour?

A
  • over 50
  • history of malignancy
  • unexplained weight loss
  • failure to improve
  • dysphagia
  • headache
  • vomiting
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5
Q

What are the red flags in a neck pain presentation that can indicate a fracture?

A
  • traumatic onset (including minor trauma if over 50, osteoperosis or corticosteroid use)
  • long term corticosteroids

Other signs:

  • bone pain
  • pain at night and rest
  • may have: altered consciousness, double vision, dysphagia, radiculopathy or deficits in Cx and UL
  • may have SSX of cervical instability in the case of an odontoid fracture (nystagmus, lip paraesthesia, overt loss of balance with head movements)
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6
Q

What are the signs that a neck pain presentation is caused by myocardial ischaemia?

A
  • chest pain
  • pain may radiate to shoulder and arm (left more than right), jaw and interscap region
  • pallor
  • sweating
  • dyspnoea / SOB
  • tachycardia / palpitations
  • severe fatigue
  • SSX aggravated by exercise and stress
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7
Q

Describe the presentation of meningitis

A
  • severe throbbing HA and severe neck pain
  • nuchal rigidity
  • pain worsened by neck flexion
  • fever

Potential signs:

  • rash
  • joint pain
  • fatigue / malaise
  • nausea / anorexia / vomiting
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8
Q

What are 4 neurological causes of neck pain to consider?

A

Thoracic outlet syndrome
Radiculopathy
Myelopathy
Burners / stingers

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9
Q

What are 6 musculoskeletal / discogenic causes of neck pain to consider?

A 
Facet sprain
Muscle strain
Acute torticollis
Whiplash
Cervical spondylosis
Annular fissure (disc)
Disc herniation
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10
Q

What are 5 rheumatological causes of neck pain to consider?

A 
Rheumatoid arthritis
Ankylosing spondylitis
Fibromyalgia
Paget's disease
Polymyalgia rheumatica
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11
Q

What are some common PROMs to use in neck pain presentations?

A

NDI (Neck Disability Index)

NPAD (Neck Pain and Disability Scale)

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12
Q

Describe the condition of a cervical facet sprain

A

(Very common)

Pain:

  • unilateral dull / aching constant pain, sharp w/ agg movement
  • may have radicular pain
  • may radiate to head, face ear (upper Cx) or shoulder, suprascap (lower Cx)

Pattern:

  • agg. by movement, particularly extension, ipsilateral sidebending, and rotation
  • agg. by prolonged sitting or overuse

Mechanism:

  • postural strain
  • overuse
  • Cx degeneration
  • minor or major trauma

Findings:

  • decreased Cx ROM
  • increased Cx tenderness and hypertonicity
  • point tenderness over facet

Healing timeframes:

  • pain free 2-3/52
  • complete healing: 4-6/52
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13
Q

Describe the condition of acute torticollis

A
  • acute onset severe tightness and spasm of unilateral Cx mm

Mechanism:

  • mild trauma (ie: poor sleep posture, unaccustomed activity)
  • underlying facet or disc pathology
  • medication / substance

Advice:
- self-limiting (focus on patient reassurance) within 2-7/7

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14
Q

Describe the 5 types of disc pathology

A

Annular fissure:
- tearing of annulus fibrosis (only outer third of fibres are nociceptive)

Protrusion:
- annulus intact but nucleus protrudes into disc

Prolapse:
- annulus intact but nucleus forced into outer layer of annular

Extrusion:
- small annular breach, fluid moves into epidural space

Sequestration:
- annular breached, nucleus fragments detach

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15
Q

What is the typical mechanism, typical findings and healing timeframes for discogenic pathologies in the neck?

A

Mechanism:

  • can be acute or insidious
  • typical mechanism of injury: flexion with rotation

Findings:

  • pain is variable: can be centralized, unilateral or asymptomatic
  • pain typically dull with sharp aggravations
  • may cause radicular pain in in affected dermatome
  • pain aggravated by Cx flexion
  • may have unilateral UL neuro findings if spinal nerve affected (bilateral neuro findings indicate myelopathy and requires emergency referral)

Healing timeframes:

  • annular fissure: usually self-limiting
  • disc herniation: resolution within 3-6/12
  • radiculopathy: SSX reduction within 1-2/52; resolution within 3-6/12
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16
Q

What are the normal healing timeframes for a muscular strain?

A

Grade 1: 2-3/52
Grade 2: 2-3/12
Grade 3: surgical repair

17
Q

Describe the presentation and treatment of whiplash

A

Mechanism:
- traumatic onset involving rapid acceleration / decceleration (MVA, diving injury, contact sports, collision) causing rapid hyperextension - hyperflexion - hyperextension of neck

Presentation:

  • neck pain, may radiate to shoulders, subocc and intercap region
  • decreased Cx ROM
  • Cx hypertonicity
  • protective spasm of deep neck flexors

Associated disorders:

  • can cause multiple other pathologies including facet sprain, disc injury, muscular injury, myelopathy, radiculopathy
  • highly co-morbid with depression, anxiety, PTSD, mood disturbance

Management:

  • must be referred to a medical professional for screening and management
  • use psychosocial screening tools
  • follow whiplash guidelines
18
Q

Describe the presentation, findings and treatment for thoracic outlet syndrome (neurological)

A

Presentation:

  • unilateral neck pain, maybe radiating into GH & UL
  • pain is radicular / aching in quality and can be intermittent or constant

Agg by:

  • UL movement, esp. OH
  • sleeping on arm

UL Neuro:
- paraesthesia
- decreased grip strength, early fatigability
- decreased co-ordination and propioception
- diminished reflexes
(sensory SSX precede motor SSX)

Clinical:
- positive Roos Stress test, Wright’s test, Eden’s test, ULNTs, Tinel’s (brachial plexus)

Treatment:

  • address cause of restriction (at the scalene triangle, costoclavicular space and/or underneath pec minor)
  • ULNT glides / flosses
  • complete resolution typically possible
19
Q

Describe the presentation, findings and treatment of thoracic outlet syndrome (vascular)

A

Pain:

  • unilateral neck, may radiate to GH and UL
  • pain can be intermittent or constant

Pattern:

  • UL becomes painful, swollen and blue with strenuous or prolonged activity
  • sense of heaviness / fatigue in arm esp. with mvmt or elevation

Agg by:

  • UL movement, esp OH
  • sleeping on arm

Other SSX:

  • pallor / cyanosis
  • coldness in UL
  • mm atrophy / weakness / cramping
  • ischaemic pain and exertional fatigue
  • UL oedema (non-pitting)

Findings:

  • asymmetrical decreased radial HR
  • asymmetrical brachial BP
  • asymmetrical decreased capillary return
  • asymmetrical distal coldness
  • positive Allens and Adson’s test

Emergency referral

20
Q

Which tests should be performed if vascular thoracic outlet syndrome is suspected?

A

Peripheral CVD:
- look for asymmetrical radial HR, asymmetrical BP, asymmetrical diminished capillary return, asymmetrical positive Allen’s test, asymmetrical distal coldness

Adson’s test
- decrease or disappearance of radial pulse indicates vascular TOS

Emergency referral if vascular TOS suspected

21
Q

What is the most sensitive clinical test to perform for neurological thoracic outlet syndrome?

A

Roos / EAST test (chicken dance)

22
Q

Describe the condition of cervical radiculopathy including presentation, pathology, findings and prognosis

A

Presentation:

  • typically unilateral radicular pain in Cx and affected dermatome
  • pain agg. by Cx extension and flexion, and ipsilateral rotation

Pathology:

  • compression or irritation of the Cx spinal nerve
  • common causes: disc herniation, disc pathology causing local inflammation, Cx stenosis / osteophytic growth, local or referred inflammation of the nerve root

Findings:

  • sensory changes in a dermatomal pattern
  • motor changes (weakness) in a myotomal pattern)
  • diminished reflexes

Ortho tests:
- positive Spurlings, distraction and maybe ULNT tests

Prognosis:

  • SSX reduction 4-6/12
  • recovery 1-3 yrs in most cases
  • if underlying factors cannot be resolved, may need management rather than full recovery
23
Q

Describe the condition of burners / stingers including presentation, mechanism, grades of nerve injury, and prognosis

A

Pain:

  • unilateral radicular (burning / shocking)
  • supraclavicular, maybe radiation to UL

Other:
- UL paraesthesia, numbness and weakness

Mechanism:

  • traumatic injury to upper trunk of brachial plexus or C5-6 spinal nerve roots
  • can be caused by traction or compression

Nerve injuries:

  • Grade 1 (neurapraxia): demyelination (3/52 healing)
  • Grade 2 (axonotmesis): axonal damage and Wallerian degeneration (slow regeneration 1mm / day)
  • Grade 3 (neurotmesis) - rare, completely severed nerve, requires intervention and typically not able to achieve full recovery
24
Q

Describe the condition of cervical myelopathy including presentation, mechanism and pathology, findings and prognosis

A

Pain:
- insidious onset bilateral Cx pain, maybe occipital headache, LBP and leg pain

UL and LL Neuro findings:

  • hyperreflexia
  • clonus with reflexes
  • Babinsi sign
  • spasticity LL
  • decreased pain sensation
  • paraesthesia
  • decreased motor strength, co-ordination and propioception
  • gait change, clumsiness

Mechanism and Pathology:

  • compression of spinal cord in Cx vertebral canal
  • can cbe secondary to Cx spondylosis / osteophytic growth, disc herniation, traumatic injury, space occupying lesion
  • affects both ascending and descending pathways, and innervation of both upper and lower limbs

Prognosis:

  • emergency referral
  • complete resolution usually not achievable (often degenerative and progressive)
25
Q

What findings can differentiate a radiculopathy from a myelopathy in the cervical spine?

A

Myelopathy: affects upper and lower limbs; radiculopathy: affects upper limb only

Signs present in myelopathy and not radiculopathy:
gait change / ataxia, hyper-reflexia, clonus with reflex, spasticity LL

26
Q

What is the difference between stenosis, spondylosis, spondylolysis, and spondylolisthesis?

A

Stenosis: narrowing of Cx spinal canal

Spondylosis: OA of Cx vertebrae / discs

Spondylolysis: Pars fracture

Spondylolisthesis: anterior displacement of vertebrae (often secondary to a pars fracture)

27
Q

What part of the vertebrae is injured in a pars fracture?

A

The pars interarticularis (between the superior and inferior articular facet)

28
Q

Describe the pathology of cervical spondylosis

A
  • also referred to as OA or DJD of the cervical spine
  • progressive degeneration of cervical joints (DJD) and/or discs (DDD)
  • discs dehydrate and shrink over time, and/or cartilage in facet joints deteriorates
  • causes compression of vertebral column and intravertebral foramen
  • bony osteophytes may develop to ‘hold’ vertebral space open
29
Q

Describe the typical presentation and findings with cervical spondylosis

A

Presentation:

  • variable: can have mild - severe pain, or can be asymptomatic
  • usually insidious onset
  • if pain: agg. by Cx movements (esp. flexion and extension)

Potential findings (not always present):

  • diminished UL reflexes, motor strength, sensation
  • radiculopathy

Potential SSX (not always present)

  • cervicogenic headache
  • Cx radiculopathy
  • Cx myelopathy

Cx findings:

  • decreased Cx ROM
  • increased Cx hypertonicity
30
Q

What are the typical mechanisms for developing spondylolisthesis?

A
  • hyperextension overuse (gymnastics, yoga, diving)
  • underlying pars fracture (spondylolysis)
  • underlying degeneration (spondylosis)
31
Q

Describe the condition of rheumatoid arthritis, including pathology, presentation, and management

A

Pathology:

  • chronic inflammatory autoimmune condition
  • causes deterioration of synovial joint membrane, tendons and ligaments
  • can cause joints to lose alignment and integrity
  • can cause myelopathy / radiculopathy / spondylolisthesis

Presentation:

  • variable neck pain (mild to severe)
  • may have radicular pain, cervicogenic headache, and/or UL paraesthesia
  • SSX usually worse in the am and after inactivity, and improves with movement

Treatment:

  • no cure
  • typically progressive in periods of flares and remission
  • medical referral for management

Clinic - Common Conditions Overview (26 decks)

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