Neck Pain Flashcards
Describe neck pain frequency?
- common - 70 % of all people will have neck pain
- those that do have it 60% will have again
- can result from infammatory arthropathy
- most neck pain is MSK and benign ie non path
why is diagnosing Neck pain tricky?
- MSK diagnosis based on incriminating tissue cause
- but like LBP cause is complex, multifactorial, or unclear, = murky
- diagnosis assumes that all neck pain is alike and similar in underlying drivers
the neck is defined as?
- superior nuchal line
- transverse line tip of T1 SP
- sagital plane = physical border of the neck
how else is the neck divided ie. in terms of pain, subocciptal pain,
- division in halves between superior nuchal line and Tsp1
- pain - upper and lower cervicals
- sub-occipital pain = sup nuchal line and imaginary line of 2nd cervical sp
- neck pain usually describes pain where? anterior neck pain is described as?
- posterior neck
- pain in the throat
differential between radicular pain and radiculopathy
- 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
common conditions that might result in radiculopathy or radicular pain?
- herniated
- discforaminal stenosis,
- peridural fibrosis
Somatic referred pain?
- not neuralgic in nature (no shooting, burnining, stabbing pain)
- dull achy, diffuse, poor location, deeply
- cause by convergence - ie confusion in perception
- in neck referral is determined by if pain is in lower Cx or upper Cx
Lower Cx pain refers where?
- shoulder
- scapular
- anterior chest wall
Upper Cx refers where?
- occiput
- frontal region
- orbit
- caudally - into neck
interspinous muscles of C5, C6,C7, C8 refer where?
- C5 shoulder
- C6 outer arm to outer part of thenar area
- C7 inner wrist, posterior forearm
- C8 lower rhomboid, lower pec, inside/arm and hand, posterior inside half of arm and lowerpt upper arm
referred pain from Z jts (IVD) where?
- C2/3 = occiput and upper neck
- C3/4 = neck
- C4/5 = neck to upper shoulder blade
- C5/6= upper trap
- C6/7 =back of shoulder blade
Sources and causes of pain must have?
- nerve supply
- produce clinical levels/type of pain
- be shown to be a source of pain via testing
Z joints are the only proved source of referred somatic pain describe?
- common source of neck pain >50% of neck pain cases
- main cause of pain after whiplash 80=> cases
3.
Atlantooccipital and laterial alantoaxial jts can produce referred somatic pain where? and also produce?
- similar distribution to C2/3 Z jts = subocciptal region
- headache
define somatic dysfunction?
impaired/altered function of somatic system = nerve/msk/fascial/lymph
T.A.R.T defines somatic dysfunction
- T = Tissue texture
- A = Assymmetry
- R = Restriction ROM
- T = Tenderness
why is motion/positional lesion criteria for dysfunction a problem?
- too subjective
- intra/inter examiner reliablity = questionable
- question if such examinations are valid.
Rank evidence of physical examinations in determining tissue causing symptom?
- 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
- WEAK EVIDENCE if there is a point of tenderness on jt
- WEAK EVIDENCE if Tx doesnt produce change
- STRONG EVIDENCE if Active/Passive ROM reproduces pain
- STRONG EVIDENCE if palpation jt reproduces pain
- STRONG EVIDENCE if reassessment there is decrease in patients symptoms
