Neck and Arm pain Flashcards
What percent of people who develop neck pain will have it chronically?
10%
Over what age is a red flag for neck pain?
Over 50
Pain lasting greater than how long is a red flag?
one month
Neck pain with associated HA, shoulder or hip girdle pain in an older person = ?
Rheumatologic disease
Neck pain with a h/o fever, chills, unexplained weight loss = ?
Cancer
Neck pain with neurological signs or symptoms (arm clumsiness, gait difficulty, bowel or bladder dysfunction) = ?
Cervical myelopathy
A shock-like paresthesia occurring with neck flexion suggesting compression of the cervical cord by a midline disc herniation = ?
Cervical myelopathy
What are the neuro signs that should be elicited when evaluating neck pain?
DTRs
UMN testing
Provocative maneuvers
The majority of neck pain has what origin?
Muscular
What is the degenerative cascade model?
Discogenic conditions (dysfunction phase) Stenotic phase (stabilization of the chronic SD)
What is a sprain?
Injury to the ligament
What is a strain?
muscle tendon unit injury
What is cervical strain?
Overload injury to the muscle tendon unit of the neck.
What is cervical spondylosis?
Degenerative changes in the neck, followed by osteophyte formation
How do you diagnose cervical spondylosis?
Cervical x-ray
Do x-ray findings for cervical spondylosis correspond well to the pain patients experience
No
What are the three common x-ray findings with cervical spondylosis?
- Loss of disc height
- Anterior osteophytes
- Narrowing of the foramina
What is degenerative disc disease? What causes it?
Degenerative process causing a loss of disc height, nuclear degradation, and disc bulging
Part of natural aging, but also a consequence of poor nutrition
What is internal disc disruption?
When the disc develops a rip or tear, usually caused by cervical trauma
What is a herniated nucleus pulposus?
When the nucleus pulposus squeezes out of the vertebrae
True or false: degenerative disc disease is a radiologic diagnosis
True
What are internal disc disruptions?
symptoms exaggerated with neck helo in one position for prolonged periods
What is radicular pain?
When pain shoots down a lumb and courses down a dermatome
What is the sign that may be elicited with a cervical disc herniation?
Spurlings sign
What areas of the spine are most commonly affected with cervical disc herniation?
C5-C6, followed by C6-C7
What are the radiological findings of disc degeneration?
Loss of white coloring
Protrusion into the spinal cord
What is the relation of UE pain with neck pain?
Compression of the brachial plexus
What is cervical radiculopathy?
nerve root injury in the presence of spondylosis or stenosis
What are the ssx of cervical radiculopathy?
Sensory, motor, or reflex abnormalities
Which cervical levels are usually affected by radiculopathy?
Lower (C7, C6)
What is spinal stenosis?
Progressive narrowing of the central spinal canal
What can cause spinal stenosis?
Bulging or protrusion of the intervertebral disc annulus posteriorly
Hypertrophy of spinal ligaments or facet joints
What are the primary ssx of spinal stenosis?
Chronic pain
Numbness
Motor weakness
UMN occur with spinal stenosis or neural foraminal stenosis?
Spinal stenosis
Cervical stenosis is associated with an AP diameter less than what?
Less than 10 mm
What are the UMN reflexes like?
Hyperreflexive
What is cervical spondylotic myelopathy?
Defined by degenerative changes narrowing the spinal canal
What are the ssx of cervical myelopathy?
- Weakness
- Coordination impairment
- Gait disturbances
- Bowel or bladder dysfunction
What is thoracic outlet syndrome?
Compression injury or irritation by the brachial plexus
What is neurogenic thoracic outlet syndrome?
Brachial plexus is injured
What is vascular thoracic outlet syndrome?
Subclavian and/or vein is damaged
What is nonspecific thoracic outlet syndrome?
Patients have ssx but no abnormal tests to document the lesion clearly
What are the boundaries of the brachial plexus?
Scalenes
Clavicle and first rib
Beneath the pec minor
Cervical radiculopathy is most commonly found involving which cervical root? Where would you sensory test for this?
C7
Proximal phalex
What are a myofascial trigger points?
Hyperirritable spots in skeletal muscle that respond painfully to stretch and is TTP
What is the major etiology of most neck pain?
Biomechanical stress
