Neck Pain Flashcards
How much of the population will neck pain at any given time?
10 to 20% of adult general population
What are the two main categories you can separate neck pain into?
Traumatic and Atraumatic
What are types of traumatic neck pain?
Myofascial Injury Cervical Fracture Ligamentous Injury Disc Injury Cord or nerve root injury Spinal Cord Injury w/o Radiographic Abnormality (SCIWORA)
What is Myofascial neck pain?
May or may not be traumatic
Symptoms: pain, spasms, loss or range of motion in neck, occipital headache
Hard to see on any scans
Examples: whiplash, muscle strain, sitting improperly at a desk
Cervical Fractures
For most part, they are stable
Diagnosed with imaging
DOCUMENT: Initial presence, level of sensory and motor loss, rectal tone
Spinal Cord Injury w/o Radiographic Abnormality
High suspicion needed
CT clean but still has symptoms/signs
MRI can show contusion to chord
Most common with kids and elderly
Nexus Criteria
VERY IMPORTANT
High sensitivity to determine whether pt needs imaging
Criteria: All must be met for no imaging needed
1) Absence of posterior midline cervical tenderness
2) Normal level of alertness
3) No evidence of intoxication
4) No abnormal neurologic findings
5) No painful distracting injuries
What is an acceptable film study for neck pain?
Imaging that has:
1) Acceptable odontoid view
2) See through top of T1 on lateral
*CT of C-spine normally is good enough
What is cervical spondylosis?
Degenerative discs and osteophytes
-Bone spurs and narrowing of disks
Incidence increases with age
Can cause general neck pain, radiculopathy, and myelopathy
What is Cervical Myelopathy?
Neurological deficits related to spinal cord
Sym: Bilateral or distal weakness
Needs emergent MRI
What is Cervical Radiculopathy? What tests can use to diagnose it?
Neurological deficits occurring at or near nerve root
Sym: Sharp, burning pain radiating down unilaterally
Normally C5/C6 most common
Urgent work up needed but not emergent
Tests: Spurling’s test, Manual Distraction Test
How would you diagnose meningitis?
Sym: Fever, malaise, headache, photophobia, neck pain and stiffness
Test for: Nuchal Rigidity, Kernig’s and Brudzinski’s signs
Main Cause: Neiserria meningitis
Diagnos via Lumbar Puncture
What is Thoracic Outlet Syndrome?
When the confined space between clavicle and first rib can compress the various structures there.
-Brachial plexus, subclavian artery, subclavian vein
Symptoms: Arm pain, numbness, weakness
Tests: Roo’s/EAST test, Adson’s test
Imaging: CT or MRI if there are red flags
What dermatome does C6 correlate to?
Lateral forearm and thumb
What dermatome does T4 correlate to?
Nipples
