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PCM2 Midterm > Neck Pain > Flashcards

Neck Pain Flashcards

1
Q

Epidemiology of Neck Pain

A
  • # 4 cause of disability in the US

- 10-20% of general population has neck pain at any given time

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2
Q

Causes of Neck Pain

A 
Traumatic
Atraumatic
-MSK
-Neuro
--Radiculopathy
--Myelopathy
-Non-spinal: systemic disease or referred pain
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3
Q

Traumatic Neck Pain

A
  • myofascial injury **
  • cervical fracture
  • ligamentous injury
  • disc injury
  • SCIWORA
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4
Q

Myofascial Neck Pain

A

-very common
-may or may not be traumatic
-pain, spasm, loss of ROM, occipital head ache
(whiplash, muscle strain)

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5
Q

Cervical Fractures

A
  • 3% of blunt trauma patients
  • most are stable
  • ALL REQUIRE NEURO CONSULT
  • must document presence and level of sensory and motor loss, rectal tone
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6
Q

SCIWORA

A

Spinal Cord Injury without radiographic abnormality

  • normal plain films and normal CT of cervical spine but neurologic signs and symptoms continue
  • must keep spine immobilized until MRI and evaluation/consult with neuro
  • more common in kids and elderly
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7
Q

Nexus Criteria

A
  • used to determine which patients presenting with neck pain after trauma need radiographic imaging (very sensitive)
  • -no posterior midline cervical tenderness
  • -normal level of alertness
  • -no level of intoxication
  • -no abnormal neurological findings
  • -no painful distracting injuries

If all criteria is met, patient doesn’t need any imaging. If criteria not met, apply cervical collar and image the patient

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8
Q

Imaging of Traumatic Neck Pain

A

CT of the cervical spine is the gold standard

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9
Q

Atraumatic Neck Pain

A

MSK
-cervical spondylosis, whiplash, MF pain, torticollis, OA
Neuro
-radiculopathy
-myleopathy
Nonspinal causes
-systemic disease or referred pain (CAD, malignancy, fibromyalgia)

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10
Q

Cervical Spondylosis

A

“degenerative changes in the spine”

  • degenerative discs and osteophytes
  • most common cause of acute and chronic neck pain in adults
  • incidence increases with age
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11
Q

Cervical Myelopathy

A

any neurological deficit related to the spinal cord
Sx: bilateral or distal weakness/numbness, gait disturbance, sexual dysfunction, bowel or bladder dysfunction

*emergent MRI

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12
Q

Cervical Radiculopathy

A

any neurologic deficit occurring at or near the nerve root
Sx: sharp, burning, pain radiating to the traps or down the arm, weakness/ parasthesias
(C5-C6 followed by C6-C7 are most common)
urgent workup, non emergent MRI: NSAIDS, OMM, PT

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13
Q

Meningitis

A

fever, malaise, headache, photophobia, neck pain stiffness
-nuchal rigidity, Kernig’s and Brudzinsi’s sign of menigeal inflammation
d/t: hemophilus, strep, pneumonia, neiserria, viral
dx: **lumbar puncture

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14
Q

Neiserria Menigitidis

A

common cause of meningitis

  • less prevalent since vaccine
  • gram - dipplococci
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15
Q

Thoracic Outlet Syndrome

A

d/t confined space between clavicle and first rib where brachial plexus and subclavian artery pass

  • compression of the neurovascular bundle
    sx: arm pain, numbness, weakness that is aggravated by activity that requires elevation or sustained used of the arms or hands above head
  • Neurogenic is more common
  • Roo’s EAST test
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16
Q

Atrauamatic Diagnostic Workup

A

if no ‘red flags’ there is no imaging required
-plain film, CT, MRI
must image if there is progressive neurologic finding or if the patient doesn’t respond to conservative treatment

General ROS: fever, chills, SOA, hx of recent trauma
Focused ROS: recent major neck trauma, weakness, gait difficulty, bowel or bladder dysfunction, shock like parestheia with neck flexion
PMH: hypertension, DM, CAD, CHF, prior neck or back problems, cervical malformation, cancer, RA
Meds: blood thinners, diabetic meds, cardiac meds, HTN
Social History: IV drug use
–excess glucocorticoid use: increase possibility for infection and increased risk for cervical spine compression fracture

17
Q

Inspection of Neck

A

scars, swelling, splinting, ROM *** Never force ROM, TART, glandular lymph node swellings

18
Q

Palpation of the Neck

A

lymph nodes, thyroid, muscle, bone, CT, Warmth, swelling, assymetry,

19
Q

ROM

A 
Flexion, 
Extension
Rotation, 
Lateral bending, 
Active vs passive
20
Q

Neurologic Testing

A

C5: biceps
C6: Brachioradialis
C7: Triceps

C6: lateral forearm, thumb
C7: middle finger
T1: medial elbow
T10: umbillicus
T4: nipple line

Strength Testing:
C2-C4: scapular elevation
C5: Deltoid
C6: Biceps, wrist extension

21
Q

ROM

A

NEVER do ROM on trauma patient unless they have been cleared from cervical fracture and or spinal cord injury

NEVER force ROM and do Spurling Maneuver with caution

Neck stiffness is v concerning

22
Q

HVLA Contraindications

A 
RA
Downs Syndrome
Carotid disease
OP
Local metastases
23
Q

Jefferson Burst Fx

A 
C1
highly unstable
occurs with vertebral compression force transmitted thru the occipital condyles
(diving and football)
-plain film imaging with open mouth view
24
Q

Trachea

A

Trachea should be at midline

deviation: due to neck mass, mediastinal mass, atelectasis, pneumothorax

25
Q

Thyroid Palpation

A

Patient must flex neck to relax SCM…index fingers just below the cricoid cartilage. have patient swallow

26
Q

Roos East

A

Shoulder out to the side and elbows at 90 degrees.. Open and close fist for up to 3 mins:

+ test: pain and parastheisa
TOS: compression of subclavian Artery

27
Q

Addson’s Test

A

Dr. feels radial pulse while standing behind the patient
patient abducts, extends and externally rotates the shoulder. first extend head and rotate toward then rotate away

Positive test: loss or change in pulse
TOS: compression of subclavian Artery between the scalenes or 1st cervical rib

28
Q

Wright’s Hyper Abduction Test

A

locate and monitor the radial pulse on the affected side. abduct arm above the head with some extension.
+ test: loss or change in pulse
TOS: neurovascular entrapment by pec minor

29
Q

Nuchal Rigidity

A

flex neck until chin touches chest
+ test: marked neck stiffness or resistance to flexion
indication: inflammation in subarachnoid space (menigitis or sub arachnoid hemorhage)

30
Q

Brudzinski’s Sign

A

flex neck foward till chin touches the chest
+ test: flexion in both hips an knees
indicates: inflammation in subarachnoid space

31
Q

Kernig’s Sign

A

flex hip and knee to 90 degrees..attempt to passively extend the leg at the knee
+ test: increased resistance to extension and pain behind the knee
indicates: meningeal dural irritation

PCM2 Midterm (8 decks)

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