Neck Pain Flashcards
traumatic neck pain?
myofascial injury
cervical fracture
ligamentous injury
disc injury
Cord or nerve root injury
SCIWORA (radiographic abnormality)
Myofascial neck pain
very common, may or may not be traumatic
sitting at a desk or whiplash
Cervical Fractures
most are stable
neurosurgical consult
*** do they have sensory or motor loss, loss of rectal tone.
SCIWORA
phenomenal where you have a normal plain film and CT
because they have a high amount of sensory loss you have to keep their spine immobilized until MRI and evaluation/consultation with neurosurgeon
***Nexus Criteria
neck pain after trauma
1) if they don’t have any midline tenderness
2) normal level of alertness
3) no evidence of intoxication
4) no abnormal neurologic findings
5) no painful distracting injuries
if all these are no, you take the collar off and they do not need imaging..
any of these you do imaging.
standard for Cervical spine problems?
CT
Atraumatic neck pain?
Musculoskeletal
Neurologic
Nonspinal
musculoskeletal
cervical spondylosis (degenerative changes)
Neurologic
Radiculopathy or Myelopathy
Nonspinal causes
systemic disease or referred pain.
Cervical Spondylosis
degenerative changes of cervical spine
lose disc height and osteophytes in that region
MOST COMMON CAUSE OF ACUTE AND CHRONIC NECK PAIN IN ADULTS… especially elderly
**Myelopathy vs radiculopathy
is it a trunk problem or a branch problem
Myelopathy –> any deficit related to the spinal cord (south of the neck)… gait disturbances, sexual dysfunction, bowel or bladder dysfunction
radiculopathy –> problems of the nerves.. so pain radiating to the arms, down the legs,
any cord problem/myelopathy is what?
an emergency
***Meningitis?
what do they present with
caused by?
dx by?
neck is stiff, fever, malaise, headache
meningococcal rash.
caused by Neiserria meningitides
lumbar puncture (L3/L4 and L4/L5)
Thoracic Outlet Syndrome
confined space between clavicle and first rib, extra rib will will get numbness, tingling, weakness in the arm.
symptoms of TOS
arm pain, numbness, weakness
Atraumatic diagnosis workup
most patients with atraumatic neck pain without red flags do not require imaging
C6 dermatome?
C7?
C8?
Nipples?
umbilicus?
lateral forearm and thumb
middle finger
pinky finger
T4
T10
What tests do you do for cervical radiculopathy?
Spurling’s test, Manual dis traction
tests For meningeal irritation?
Kernig’s sign
Brudzinski’s sign
tests Thoracic Outlet?
Roo’s or East test
neck stiffness, what do you do for range of motion?
never force range of motion
contraindications of HVLA
RA –> odontoid ligament is susceptible to rupture
Down syndrome
carotid disease
26 y/o athlete presents to office with left neck and shoulder pain
no bladder or bowel dysfunction.. numbness left shoulder.
atraumatic
radiculopathy
spurling is + on the side of it.
