Neck Pain

Question 1

A 31-year-old female presents with pain and numbness in her left hand. On examination, the left radial pulse disappears when the patient’s neck is rotated to the left and then extended while taking a deep breath. Cervical x-ray shows a cervical rib on the left side.

Answer 1

Thoracic Outlet Syndrome

Question 2

A 56-year-old male presents with neck pain worse on right rotation and extension. There is no radiation of the pain. On examination, there is decreased right lateral bending, rotation and extension of the cervical spine. Cervical x-ray shows joint space narrowing, subchondral sclerosis and osteophytes in the C4-6 region.

Answer 2

Cervical spondylosis (would be cervical radiculopathy if there was pain along a dermatome)

Question 3

A 17-year-old high school student presents with neck pain. This follows a sore throat and fever. On examination, the temperature is elevated and both Kernig’s and Brudzinski’s tests are positive. CSF shows raised proteins, low glucose and numerous WBCs.

Answer 3

Meningitis

Question 4

A 43-year-old male presents with burning neck pain which radiates into the lateral aspect of the left forearm and into the left thumb and index finger. The patient is aggravated by left lateral bending and rotation of the cervical spine. On examination, there is weakness in the left biceps muscle and a decreased brachioradialis DTR. MRI of the c-spine shows a posterolateral disc herniation.

Answer 4

Cervical disc lesion causing C6 radiculopathy

Question 5

A 23-year-old male presents with burning pain in the left side of his neck and shoulder following a shoulder distraction injury during a football game yesterday. On examination, there is hyperesthesia over the left shoulder region. Shoulder distraction causes the pain to worsen. No other tests done.

Answer 5

Burner/stinger

Question 6

A 23-year-old male presents with neck pain following a football tackle yesterday. On examination, there is decreased cervical ROM in flexion mainly. Distraction of the neck aggravates the pain. Resisted cervical flexion aggravates the pain as well. There is no midline bony tenderness. No other tests were done.

Answer 6

Cervical sprain/strain

Question 7

A 13-year-old presents with sudden onset of left-sided neck stiffness. On examination, there is spasm of the left sternocleidomastoid muscle as the head is held in left lateral bending with the chin rotated to the opposite side. No other tests were done.

Answer 7

Torticollis