neck pain Flashcards
risk factors for neck pain
hx of neck pain >40 yo HA talk on telephone stress twisting/bending at work
good prognosis
regular exerciser
poor prognosis
hx of neck pain, prior sick leave
majority of neck pain in family med office
nonspecific: mechanical forces of daily movement/posture/sleep/neck tension
aging effects on neck
disks less resilient to compression/torsion
narrowed disk space
increase osteophytic impingement
arthritic facet joints
neck pain without cervical nerve root radiculopathy
anterior longitudinal ligament injury d/t acute hyperextension or anterior disc bulge
neck pain with nerve root impingement in spinal cord - radiculopathy
posterior longitudinal ligament injury d/t posterior disc bulge
neurogenic pain - nerve root impingement
sensory + motor nerves join after passing through IVF:
parasthesia
hypestheisa: ↓ sensation
hypalgesia: ↓ pain sense
sensory nerve root impingement
pain in dermatomal distribution
motor nerve root impingement
unpleasant sensation in region of muscle group innervated by root
pain receptors in neck:
outer annulus of disc
ligaments
facet joints
neck muscles
degenerative disk disease - cervical spondylosis
disc space narrowing
osteophytes in disc margins
facet joint arthritis
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
cervical myelopathy
acceleration/deceleration injury
mild: muscle strain
severe: anterior longitudinal ligament, nerve roots (need imaging!), disk annulus, facet joints impact posteriorly on each other
most common cause of chronic pain after MVA
facet joints
spurling test
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
axial manual traction test
cervical disc herniation
examiner pulls up on head to decrease pressure on cervical root
Positive: relief of pain
arm abduction test
cervical disc herniation
elevating (full abduction of shoulder)
affected arm overhead to decrease pressure on cervical root
positive: relief of pain
lhermitte sign
cervical myelopathy
shooting pain down back with axial head compression
if signs of infection, inflammation, bone damage get
ESR
CBC
calcium phospate
most non-traumatic neck pain resolves in
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)
xray detection with neck pain (AP, lateral, and oblique - show foramina, flexion/extension if no fracture and looking for spondyloslisthesis
bone mets
paget disease
myeloma
ankylosing spondylitis
lumbar and cervical spine: incidental abnormalities frequently found
imaging confirms a diagnosis - does not make diagnosis
