Neck Pain

Question 1

traumatic neck pain?

Answer 1

myofascial injury

cervical fracture

ligamentous injury

disc injury

Cord or nerve root injury

SCIWORA (radiographic abnormality)

Question 2

Myofascial neck pain

Answer 2

very common, may or may not be traumatic

sitting at a desk or whiplash

Question 3

Cervical Fractures

Answer 3

most are stable

neurosurgical consult

*** do they have sensory or motor loss, loss of rectal tone.

Question 4

SCIWORA

Answer 4

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

Question 5

***Nexus Criteria

Answer 5

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.

Question 6

standard for Cervical spine problems?

Answer 6

CT

Question 7

Atraumatic neck pain?

Answer 7

Musculoskeletal
Neurologic
Nonspinal

Question 8

musculoskeletal

Answer 8

cervical spondylosis (degenerative changes)

Question 9

Neurologic

Answer 9

Radiculopathy or Myelopathy

Question 10

Nonspinal causes

Answer 10

systemic disease or referred pain.

Question 11

Cervical Spondylosis

Answer 11

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

Question 12

**Myelopathy vs radiculopathy

Answer 12

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,

Question 13

any cord problem/myelopathy is what?

Answer 13

an emergency

Question 14

***Meningitis?

what do they present with

caused by?

dx by?

Answer 14

neck is stiff, fever, malaise, headache

meningococcal rash.

caused by Neiserria meningitides

lumbar puncture (L3/L4 and L4/L5)

Question 15

Thoracic Outlet Syndrome

Answer 15

confined space between clavicle and first rib, extra rib will will get numbness, tingling, weakness in the arm.

Question 16

symptoms of TOS

Answer 16

arm pain, numbness, weakness

Question 17

Atraumatic diagnosis workup

Answer 17

most patients with atraumatic neck pain without red flags do not require imaging

Question 18

C6 dermatome?

C7?

C8?

Nipples?

umbilicus?

Answer 18

lateral forearm and thumb

middle finger

pinky finger

T4

T10

Question 19

What tests do you do for cervical radiculopathy?

Answer 19

Spurling’s test, Manual dis traction

Question 20

tests For meningeal irritation?

Answer 20

Kernig’s sign

Brudzinski’s sign

Question 21

tests Thoracic Outlet?

Answer 21

Roo’s or East test

Question 22

neck stiffness, what do you do for range of motion?

Answer 22

never force range of motion

Question 23

contraindications of HVLA

Answer 23

RA –> odontoid ligament is susceptible to rupture

Down syndrome

carotid disease

Question 24

26 y/o athlete presents to office with left neck and shoulder pain

no bladder or bowel dysfunction.. numbness left shoulder.

Answer 24

atraumatic

radiculopathy

spurling is + on the side of it.

Question 25

What do you image someone with for radiculopathy?

when would you tell them to go to the ER

Answer 25

MRI

cord compression.. so myelopathy

Question 26

old person, diffuse neck pain

what imaging do you do

what do you see

what do you not want to do?

Answer 26

Cervical Spondylosis (degenerative changes)

Xray, no radicular symptoms.

loss of disc space, bone spurs

HVLA

Question 27

17 y/o falls out of tree lands on head

decreased touch from mandible down

muscle strength normal

Answer 27

traumatic –> cervical fracture –> Jefferson burst

Question 28

Jefferson Burst Fracture

Answer 28

burst fracture of C1.

Question 29

rear ended person

posterior and lateral pain, not midline.

sober

no loss of consciousness

no bones sticking out of soft tissue

no neurologic complaints

Answer 29

whiplash –> myofascial injury

remove the cervical collar

take her through range of motion

return with worsening symptoms.