Neck pain

Question 1

Main causes of neck pain

Answer 1

1. Vertebral dysfunction - faset joint
2. Strain/sprain of ligaments

Red flag points similar to low back pain

Question 2

Brachial plexus parts

Answer 2

RhTDm(C)
Roots - C5 to C8, T1
Trunk - Upper, middle, lower
Divisions - Anterior, posterior
Cords - lateral, posterior, medial

Question 3

Brachial plexus associated reflexes

Answer 3

1. Bicep jerk: C5>C6
2. Brachioradial: C6>C5
3. Triceps: C7
4. Finger: C8

Question 4

Brachial plexus associated functions

Answer 4

C5: arm abd
C6: Elbow flexion, wrist extension
C7: Wrist flexion, elbow&finger extension
C8: Grip

Question 5

Cervical spondylosis

Answer 5

1. Degeneration of cervical vertebra
2. mc C5-6, C6-7
3. Narrowing of intervertebral foramen (spinal nerve emerge) … immature bone formation .. radiculopathy
4. Dull aching pain, worse in morning after lifting head
5. Improves with mild activity, deteriorates with heavy activity, aggravated by flexion and extension
6. Pain radiates to head, arm, scapula
7. A/w vertigo
8. Xray - osteoarthritic wear and tear of vertebra (not needed)
9. Mx: PCM, NSAID, exercise

Question 6

Complications of cervical spondylosis

Answer 6

1. Radiculopathy - compression of nerve roots
2. Myelopathy - compression of spinal cord (best inv - MRI)
3. Spinal canal stenosis

Question 7

Radiculopathy

Answer 7

1. Sudden onset (sudden neck movement)
2. Radiates to arm
3. Paraesthesia in *hand, forearm
4. Xray not req until 6-8wks (unless red flag+)
5. Rx: rest, analgesic

Question 8

Myelopathy

Answer 8

1. Insidious onset (yrs)
2. Numbness, tingling in fingers
3. Leg stiffness (both UL and LL affected)
4. UMN lesion signs:
   Spastic weakness
   ↑Tone
   Hyper-reflexia
5. Urgent MRI
6. CT with myelogram - most accurate