Neck Pain Flashcards
Epidemiology of Neck Pain
- # 4 cause of disability in the US
- 10-20% of general population has neck pain at any given time
Causes of Neck Pain
Traumatic Atraumatic -MSK -Neuro --Radiculopathy --Myelopathy -Non-spinal: systemic disease or referred pain
Traumatic Neck Pain
- myofascial injury **
- cervical fracture
- ligamentous injury
- disc injury
- SCIWORA
Myofascial Neck Pain
-very common
-may or may not be traumatic
-pain, spasm, loss of ROM, occipital head ache
(whiplash, muscle strain)
Cervical Fractures
- 3% of blunt trauma patients
- most are stable
- ALL REQUIRE NEURO CONSULT
- must document presence and level of sensory and motor loss, rectal tone
SCIWORA
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
Nexus Criteria
- 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
Imaging of Traumatic Neck Pain
CT of the cervical spine is the gold standard
Atraumatic Neck Pain
MSK
-cervical spondylosis, whiplash, MF pain, torticollis, OA
Neuro
-radiculopathy
-myleopathy
Nonspinal causes
-systemic disease or referred pain (CAD, malignancy, fibromyalgia)
Cervical Spondylosis
“degenerative changes in the spine”
- degenerative discs and osteophytes
- most common cause of acute and chronic neck pain in adults
- incidence increases with age
Cervical Myelopathy
any neurological deficit related to the spinal cord
Sx: bilateral or distal weakness/numbness, gait disturbance, sexual dysfunction, bowel or bladder dysfunction
*emergent MRI
Cervical Radiculopathy
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
Meningitis
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
Neiserria Menigitidis
common cause of meningitis
- less prevalent since vaccine
- gram - dipplococci
Thoracic Outlet Syndrome
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
Atrauamatic Diagnostic Workup
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
Inspection of Neck
scars, swelling, splinting, ROM *** Never force ROM, TART, glandular lymph node swellings
Palpation of the Neck
lymph nodes, thyroid, muscle, bone, CT, Warmth, swelling, assymetry,
ROM
Flexion, Extension Rotation, Lateral bending, Active vs passive
Neurologic Testing
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
ROM
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
HVLA Contraindications
RA Downs Syndrome Carotid disease OP Local metastases
Jefferson Burst Fx
C1 highly unstable occurs with vertebral compression force transmitted thru the occipital condyles (diving and football) -plain film imaging with open mouth view
Trachea
Trachea should be at midline
deviation: due to neck mass, mediastinal mass, atelectasis, pneumothorax
