Neck Pain

Question 1

Describe neck pain frequency?

Answer 1

1. common - 70 % of all people will have neck pain
2. those that do have it 60% will have again
3. can result from infammatory arthropathy
4. most neck pain is MSK and benign ie non path

Question 2

why is diagnosing Neck pain tricky?

Answer 2

1. MSK diagnosis based on incriminating tissue cause
2. but like LBP cause is complex, multifactorial, or unclear, = murky
3. diagnosis assumes that all neck pain is alike and similar in underlying drivers

Question 3

the neck is defined as?

Answer 3

• superior nuchal line
• transverse line tip of T1 SP
• sagital plane = physical border of the neck

Question 4

how else is the neck divided ie. in terms of pain, subocciptal pain,

Answer 4

1. division in halves between superior nuchal line and Tsp1
2. pain - upper and lower cervicals
3. sub-occipital pain = sup nuchal line and imaginary line of 2nd cervical sp

Question 5

1. neck pain usually describes pain where? anterior neck pain is described as?

Answer 5

• posterior neck
• pain in the throat

Question 6

differential between radicular pain and radiculopathy

Answer 6

• radicular pain = pain radiates course of nerve into UEX or LEX, caused by compression/inflammation/injury to spinal nerve root
• radiculopathy = consequences of that damage in areas suppled by the nerve/changes in sensation and strength

Question 7

common conditions that might result in radiculopathy or radicular pain?

Answer 7

1. herniated
2. discforaminal stenosis,
3. peridural fibrosis

Question 8

Somatic referred pain?

Answer 8

1. not neuralgic in nature (no shooting, burnining, stabbing pain)
2. dull achy, diffuse, poor location, deeply
3. cause by convergence - ie confusion in perception
4. in neck referral is determined by if pain is in lower Cx or upper Cx

Question 9

Lower Cx pain refers where?

Answer 9

1. shoulder
2. scapular
3. anterior chest wall

Question 10

Upper Cx refers where?

Answer 10

1. occiput
2. frontal region
3. orbit
4. caudally - into neck

Question 11

interspinous muscles of C5, C6,C7, C8 refer where?

Answer 11

1. C5 shoulder
2. C6 outer arm to outer part of thenar area
3. C7 inner wrist, posterior forearm
4. C8 lower rhomboid, lower pec, inside/arm and hand, posterior inside half of arm and lowerpt upper arm

Question 12

referred pain from Z jts (IVD) where?

Answer 12

1. C2/3 = occiput and upper neck
2. C3/4 = neck
3. C4/5 = neck to upper shoulder blade
4. C5/6= upper trap
5. C6/7 =back of shoulder blade

Question 13

Sources and causes of pain must have?

Answer 13

1. nerve supply
2. produce clinical levels/type of pain
3. be shown to be a source of pain via testing

Question 14

Z joints are the only proved source of referred somatic pain describe?

Answer 14

1. common source of neck pain >50% of neck pain cases
2. main cause of pain after whiplash 80=> cases
   3.

Question 15

Atlantooccipital and laterial alantoaxial jts can produce referred somatic pain where? and also produce?

Answer 15

1. similar distribution to C2/3 Z jts = subocciptal region
2. headache

Question 16

define somatic dysfunction?

Answer 16

impaired/altered function of somatic system = nerve/msk/fascial/lymph

Question 17

T.A.R.T defines somatic dysfunction

Answer 17

• T = Tissue texture
• A = Assymmetry
• R = Restriction ROM
• T = Tenderness

Question 18

why is motion/positional lesion criteria for dysfunction a problem?

Answer 18

1. too subjective
2. intra/inter examiner reliablity = questionable
3. question if such examinations are valid.

Question 19

Rank evidence of physical examinations in determining tissue causing symptom?

Answer 19

1. WEAK EVIDENCE testing with Active/Passive ROM if there is an increase or decrease in ROM or a change in movt quality, increase/decrease resistence
2. WEAK EVIDENCE if there is a point of tenderness on jt
3. WEAK EVIDENCE if Tx doesnt produce change
4. STRONG EVIDENCE if Active/Passive ROM reproduces pain
5. STRONG EVIDENCE if palpation jt reproduces pain
6. STRONG EVIDENCE if reassessment there is decrease in patients symptoms