neck pain

Question 1

risk factors for neck pain

Answer 1

hx of neck pain
>40 yo
HA
talk on telephone
stress
twisting/bending at work

Question 2

good prognosis

Answer 2

regular exerciser

Question 3

poor prognosis

Answer 3

hx of neck pain, prior sick leave

Question 4

majority of neck pain in family med office

Answer 4

nonspecific: mechanical forces of daily movement/posture/sleep/neck tension

Question 5

aging effects on neck

Answer 5

disks less resilient to compression/torsion
narrowed disk space
increase osteophytic impingement
arthritic facet joints

Question 6

neck pain without cervical nerve root radiculopathy

Answer 6

anterior longitudinal ligament injury d/t acute hyperextension or anterior disc bulge

Question 7

neck pain with nerve root impingement in spinal cord - radiculopathy

Answer 7

posterior longitudinal ligament injury d/t posterior disc bulge

Question 8

neurogenic pain - nerve root impingement

Answer 8

sensory + motor nerves join after passing through IVF:
parasthesia
hypestheisa: ↓ sensation
hypalgesia: ↓ pain sense

Question 9

sensory nerve root impingement

Answer 9

pain in dermatomal distribution

Question 10

motor nerve root impingement

Answer 10

unpleasant sensation in region of muscle group innervated by root

Question 11

pain receptors in neck:

Answer 11

outer annulus of disc
ligaments
facet joints
neck muscles

Question 12

degenerative disk disease - cervical spondylosis

Answer 12

disc space narrowing
osteophytes in disc margins
facet joint arthritis

Question 13

osteophytes and thickening of ligamentum flavum cause direct compression on spinal cord
worsen: flexion stretches cord over osteophtyes, extension stretches LF over cord
*unsteady gait, LE weakness, hyperreflexia, B/B or sexual dysfunction
+ Lhermitte sign

Answer 13

cervical myelopathy

Question 14

acceleration/deceleration injury

Answer 14

mild: muscle strain
severe: anterior longitudinal ligament, nerve roots (need imaging!), disk annulus, facet joints impact posteriorly on each other

Question 15

most common cause of chronic pain after MVA

Answer 15

facet joints

Question 16

spurling test

Answer 16

cervical disc herniation
useful when positive test
pt brings ear to shoulder to side of radicular pain and extends head back
examiner exerts downward pressure on head to intensify radicular sx

Question 17

axial manual traction test

Answer 17

cervical disc herniation
examiner pulls up on head to decrease pressure on cervical root
Positive: relief of pain

Question 18

arm abduction test

Answer 18

cervical disc herniation
elevating (full abduction of shoulder)
affected arm overhead to decrease pressure on cervical root
positive: relief of pain

Question 19

lhermitte sign

Answer 19

cervical myelopathy

shooting pain down back with axial head compression

Question 20

if signs of infection, inflammation, bone damage get

Answer 20

ESR
CBC
calcium phospate

Question 21

most non-traumatic neck pain resolves in

Answer 21

4 weeks - no imaging required
if neuro deficit and non-surgical tx not helping: CT or MRI (nerve root compression, disc disease, soft tissue, especially if surgery being considered)

Question 22

xray detection with neck pain (AP, lateral, and oblique - show foramina, flexion/extension if no fracture and looking for spondyloslisthesis

Answer 22

bone mets
paget disease
myeloma
ankylosing spondylitis

Question 23

lumbar and cervical spine: incidental abnormalities frequently found

Answer 23

imaging confirms a diagnosis - does not make diagnosis