Neck Pain

Question 1

Neck pain is the #_ cause of disability in the US

Answer 1

4

Question 2

Cervical Fractures

Answer 2

• most are stable
• all require neurosurgical consultation
• important to document initial presence and level of sensory and motor loss, rectal tone

Question 3

What does SCIWORA stand for?

Answer 3

spinal cord injury without radiographic abnormality

*must keep spin immobilized until MRI and evaluation/consultation with a neurosurgeon

Question 4

Nexus Criteria

Answer 4

– Absence of posterior midline cervical tenderness
– Normal level of alertness
– No evidence of intoxication
– No abnormal neurologic findings
– No painful distracting injuries

• If all criteria are met the patient does not need any imaging
• If all criteria are not met; apply a cervical collar and image the patient

Question 5

What is the standard of care for C-spine radiographs?

Answer 5

CT

Question 6

what is the most common cause of acute and chronic neck pain in adults?

Answer 6

cervical spondylosis

Question 7

What is cervical myelopathy?

Answer 7

– any neurologic deficit related to the spinal cord
– Signs & Sx’s: bilateral or distal sx’s (weakness/numbness), may complain of clumsy hands, gait disturbances, sexual dysfunction, bowel or bladder dysfunction
– Needs emergent MRI

Question 8

What is cervical radiculopathy?

Answer 8

– any neurologic deficit occurring at or near the nerve root
– Signs & Sx’s: sharp, burning, pain radiating to the trapezius, periscapular area, or down the arm. Weakness or paresthesias may develop weeks after pain onset.
– C5-C6 followed by C6-C7 are the most common
– Urgent workup, non-emergent MRI, NSAIDS, OMM, PT

Question 9

What are the symptoms of meningitis?

Answer 9

fever, malaise, headache, photophobia, neck pain and stiffness, AMS, rash (petechiae and purpura) and meningismus

*diagnosed by lumbar puncture

Question 10

What is thoracic outlet syndrome?

Answer 10

compression of the neurovascular bundle by various structures in the area just above the first rib and behind the clavicle

*most of the time is caused by compression of the nerves

Question 11

What type of ROM should you do on someone with cervical pain?

Answer 11

active only

Question 12

Cervical Sensory Dermatomes

Answer 12

C 6 - lateral forearm and thumb

T4 - nipples

T10 - umbilicus