Neck pain

Question 1

common patient presentations

Answer 1

acute injury and/or arm pain
acute, pseudo-torticollis
postural pain or stiffness due to poor ergonomics
decreased ROM associated with stiffness or pain
headaches

Question 2

C2-3 problems normally refer to?

Answer 2

the head

Question 3

C3-4 problems normally refer to?

Answer 3

lateral neck from head to base

Question 4

C4-5 problems normally refer to?

Answer 4

whole side of neck from head to base and into shoulder

Question 5

C5-6 problems usually refer to?

Answer 5

lower lateral neck and into shoulder

Question 6

C6-7 problems usually refer to?

Answer 6

shoulder to upper mid back

Question 7

neck pain and arm pain is most likely from?

Answer 7

a facet joint

Question 8

does neck pain and arm pain have neurological deficits?

Answer 8

no, even though there might be complaints of numbness or tingling

Question 9

what red flags should you look out for?

Answer 9

trauma
history of cancer
corticosteroid use
history of infection
head trauma with loss of consciousness
nuchal rigidity
bladder dysfunction associated with onset of neck pain
associated dysphagia
associated CN or CNS signs/symptoms
onset of new headache
pre-existing conditions

Question 10

what other things should you look for in the history?

Answer 10

nuchal rigidity/ positive brudzinski’s or kernig
suspected fracture, dislocation, infection, cancer
perform examinations

Question 11

what tests should you do if there is only neck pain

Answer 11

inspection
observation of patient's movements
static palpation
motion palpation
P and AROM
functional assessment and orthopedic screening

Question 12

what tests should you do if there is neck and arm pain?

Answer 12

orthopedic/neurological exam, compressive and neural stretch testing, nerve stretch maneuvers, DTR testing, sensory examination and myotome testing

Question 13

when should you xray someone with neck pain?

Answer 13

if you suspect fracture, dislocation, infection or cancer

or if they have radicular findings

Question 14

when should you perform MRI for neck pain?

Answer 14

ddx of radicular or myelopathy cases to further evaluate stenosis, tumor, herniated disc or multiple sclerosis

Question 15

when should electrodiagnostic studies be done?

Answer 15

when radicular complaints remain unclear

Question 16

pain that radiates into the arm indicates?

Answer 16

disc lesion, nerve root entrapment, referred pain, myelopathy, brachial plexus involvement

Question 17

isolated weakness or numbness suggests?

Answer 17

nerve root involvement

Question 18

numbness and tingling in a diffuse or ill-defined pattern suggest?

Answer 18

referred pain from facet or trigger points

Question 19

what is a red flag for infeciton, tumor or vascular etiologies?

Answer 19

neck pain with a “new” headache or the worst headache they have ever experienced

Question 20

lateral flexion neck injuries

Answer 20

compression injury on side of movement and stretching injury on the opposite side

Question 21

forced flexion neck injuries

Answer 21

compression fracture, myelopathy from stenotic canal considered with arm and leg complaints

Question 22

what is the primary intention of orthopedic testing?

Answer 22

to compress or stretch pain producing structures such as facets and NRs

Question 23

standard orthopedic tests

Answer 23

various forms of cervical compression
cervical distraction
shoulder depression
brachial plexus stretch testing
soto hall
lhermitte's

Question 24

cervical compression test

Answer 24

local pain on extension and/or rotation indcates facet involvement, while radiating pain down the arm indcates nerve root involvement

Question 25

cervical distraction test

Answer 25

an attempt to reduce local or radiating complaints if painful, muscle splinting is suggested

Question 26

lhermitte's

Answer 26

passive flexion of neck that causes electric shock sensations, seen with MS or cervical myelopathy

Question 27

upper limb tension test

Answer 27

also known as brachail plexus test good screening test to rule out cervical radiculopathy pain on contralateral cervical side bending decrease in symptoms with ipsilateral dise bending

Question 28

what is the classic presentation of cervical radiculopathy

Answer 28

patient comlains of neck and arm pain | onset follows a neck injury, may be insidious

Question 29

what is often the history of cervical radiculopathy

Answer 29

multiple bouts of neck pain following minor injuries | patient also complains of weakness in the hand

Question 30

bakody's sign

Answer 30

some cervical radiculopathy patients have a positive bakody's signs

Question 31

describe tests for cervical radiculopathy

Answer 31

``` AROM and PROM painful restriction C compression may reproduce pain cervical distraction may relieve arm pain bakody's may be positive decreased DTR weakess in related myotome sensory abnormality ```

Question 32

C5

Answer 32

motor supply to deltoid (shoulder abduction) and biceps (elbow flexion/supination) biceps relfex, sensory to outer shoulder (axillary N)

Question 33

C6

Answer 33

motor supply to biceps and wrist extension brachioradialis reflex sensory to outer forearm

Question 34

C7

Answer 34

motor supply to triceps (elbow extension), finger extensors and wrist flexors triceps reflex sensory to middle finger

Question 35

C8

Answer 35

motor supply to finger flexors no reflex sensory to little and ring fingers

Question 36

T1

Answer 36

motor supplied to the interosseous muscles of hand (abducion of fingers) no reflex and sensory to medial arm

Question 37

midline C spine disc herniations create

Answer 37

myelopathies

Question 38

lateral disc herniations in C spine do what?

Answer 38

compress NR below

Question 39

midline disc herniation in L spine does what?

Answer 39

compress NR below

Question 40

foraminal disc herniation in the L spine does what?

Answer 40

involves the NR at the same level

Question 41

disc herniationin C spine?

Answer 41

affects NR below

Question 42

hypertrophy of uncinate will affect?

Answer 42

NR at same level

Question 43

disc herniation at C7/T1 will affect

Answer 43

C8 NR

Question 44

hypertrophy changes of T1 vertebral body will affect

Answer 44

C8 NR

Question 45

patient presentation wilth myelopathy can differ based on what?

Answer 45

type and degree of compression

Question 46

what are the classic patient symptoms of myelopathy?

Answer 46

bilateral symptoms of clumsiness of hands, difficulty walking, possible urinary dysfunction, possible shooting pains into arms

Question 47

what are some causes of spinal cord compression?

Answer 47

tumor herniated disc spondylolytic sources

Question 48

direct pressure on posterior columns causes disturbances in?

Answer 48

vibration perception | proprioception

Question 49

what tests may be positive with myelopathies?

Answer 49

pathological reflex decrease strength, proprioception, vibration Lhermitte's

Question 50

what measurement indicates concern for spinal stenosis? indicates stenosis?

Answer 50

<13mm | <11mm

Question 51

cervical spondylolotic myelopathy

Answer 51

severe canal stenosis, significant cord compressions with changes of myelomalacia

Question 52

symptoms of TOS

Answer 52

diffuse arm symptoms, including numbness and tingling | they often describe a path down the inside of the arm to the 4th and 5th digits with overhead activity

Question 53

what can be compressed in TOS?

Answer 53

brachial plexus | subclavian/axillary arteries

Question 54

what are some reasons for TOS?

Answer 54

``` elongated C7 TVP cervical rib scalene muscles costoclavicular area subcoracoid area pec minor ```

Question 55

how is grip strength and reflexes for TOS?

Answer 55

grip strength reduced | relfexes normal

Question 56

what test is positve if the TOS is because of the scalene muscles?

Answer 56

adson's, halstead's

Question 57

what test if positive if the TOS is because of pec minor?

Answer 57

wright's

Question 58

what functional test is positive for TOS?

Answer 58

Roo's

Question 59

symptoms patient might copmlain of with a facet problem

Answer 59

traumatic ir insidious onset of neck and arm pain that doesn't folow a specific dermatome

Question 60

what is the most common location for facet symptoms?

Answer 60

down outer arm to hand (C5-7 facet joints)

Question 61

how can you tell the difference between referred pain and facet pain?

Answer 61

referred pain rarely goes to the hand

Question 62

how is pain reporduced in facet syndrome?

Answer 62

cervical compression with neck in extension and rotated to involved side

Question 63

what may be warranted with facet syndrome?

Answer 63

xrays

Question 64

how will you know if a baby has congenital torticollis?

Answer 64

there will be fixed asymmetry of the head seen within hours or sometimes weeks of the delivery

Question 65

what will an adult with congenital torticollis experience?

Answer 65

painful muscle spasms of SCM, causing the head to be held in rotation and sometimes slight flexion

Question 66

pseudo-torticollis

Answer 66

inability to move head in any direction without pain with head held in neutral position

Question 67

what is a cerviacl sprain/strain?

Answer 67

overstretch or over contraction with possible radiation

Question 68

``` cervical sprain/strain valsalva's ROM orthopedics neurological AROM PROM ```

Answer 68

valsalva's: no radiation ROM: contraction of muscle orstretch of muscle or joint orthopedics: none neurological: none AROM: pain that contracts involved muscles PROM: pain that contracts involved muscle or ligament

Question 69

what is helpful as a treatment for cervical sprain/strain?

Answer 69

``` if significant trauma: radiographs myofascial therapy limit orthotic support ergonomic advice preventative exercises and stretches ```

Question 70

if the cervical sprain/strain is unstabile, what do you need to do?

Answer 70

orthopedic consult