Neck Pain

Question 1

Disorders causing neck pain

Answer 1

1. Cervical Strain
2. Internal disc disruption syndrome/discogenic pain
3. Cervical face-mediated pain
4. Cervical whiplash syndrome
5. Myofascial pain

Question 2

Disorder causign extremity pain and or neurological dysfunction

Answer 2

1. Cervical radiculopathy

2. Cervical spondylotic myelopathy

Question 3

Classification system for neck pain

Answer 3

Grades I - IV

Question 4

Grade I neck pain

Answer 4

No signs of major pathology and little interference with daily activities

Question 5

Grade II neck pain

Answer 5

No signs of major pathology but may impact daily activities

Question 6

Grade III neck pain

Answer 6

Neck pain with neurological signs/symptoms (radiculopathy)

Question 7

Grade IV neck pain

Answer 7

Neck pain with major pathology (e.g. fracture, myelopathy, neoplasm, spinal infection)

Question 8

Factors that suggest rheumatologic disease (polymyalgia, rheumatic, or giant cell arthritis)

Answer 8

neck pain associated with HA, shoulder/hip girdle pain, or visual symptoms in older person

Question 9

Factors that raise suspicion for tumor/infection

Answer 9

neck pain w/ history of fever, chills, unexplained weight loss, immunosuppression, cancer, or intravenous drug use

Question 10

Factors that suggest cervical myelopathy

Answer 10

neck pain with neurological s/s (arm clumsiness, gait difficulty, bowel/bladder dysfunction, + babinski)

Question 11

What does a shock-like paresthesia occurring with neck flexion suggest (Lhermitte’s phenomenon)

Answer 11

compression of cervical cord by a midline disc herniation or spondylosis but may also be sign of intramedullary pathology such as MS plaque

Question 12

Cervical Spondylosis

Answer 12

soft tissue, disc, and degenerative bony lesions

Question 13

Cervical Discogenic pain

Answer 13

1. The degenerative process that occurs in the intervertebral disc is associated with an inability to effectively distribute pressures between the disc, vertebral endplates, and facet joints
2. Symptoms are often exacerbated when the neck is held in one position for prolonged periods, such as occurs with driving, reading, or working at a computer and is often associated muscle tightness and spasms

Question 14

Cervical Facet Syndrome

Answer 14

1.Patients often have a history of trauma with an abrupt flexion-extension type injury, or an occupation which leads to repeatedly positioning the neck in extension

Question 15

Cervical Myofascial Pain

Answer 15

Regional pain with associated trigger points, taut bands, and pressure sensitivity

Question 16

Diffuse Skeletal Hyperostosis

Answer 16

1. Inappropriate bone deposition in the insertions of the ligaments and tendons
2. Stiffness, loss of mobility and pain

Question 17

Thoracic Outlet Syndrome Positive Test

Answer 17

Roos Test

Adison Test

Question 18

Thoracic Outlet Syndrome description

Answer 18

Numbness, weakness and a sensation of swelling in the upper limbs is strongly suggestive of thoracic outlet syndrome
NONSPINAL CAUSE OF NECK PAIN

Question 19

Radiography Non-traumatic event causing neck pain

Answer 19

1. Age greater than 50
2. History of malignancy
3. moderate to severe neck pain lasting more than 6 weeks
4. Progressive neurological findings
5. Consistutional symptoms (chills, fever, unexplained weight loss)
6. Infectious risk

Question 20

Treatment acute axial neck pain

Answer 20

1. Education - posture/activities
2. Medications - NSAIDS, anti-depressants, muscle relax
3. HEP - stretching/ROM
4. Cervical collar
5. Low level laser

Question 21

Treatment for persistent axial neck pain

Answer 21

1. PT
2. Manual PT
3. Massage
4. Spinal manipulation
5. Medications
6. Trigger point injections
7. Cervical medial branch block
8. TENS
9. Electromagnetic Therapy
10. Cognitive-behavior therapy
11. Surgery
12. Tai Chi
13. Acupuncture
14. Low level laser