Neck pain Flashcards
What are is the grade 1 classifications for neck pain by the Quebec task force?
- No signs or symptoms suggestive of major structural pathology and no minor interference
What are is the grade 2 classifications for neck pain by the Quebec task force?
No signs and symptoms of major structural pathology but major interference in DALY
What are is the grade 3 classifications for neck pain by the Quebec task force?
No signs and symptoms of major structural pathology but Presence of neurological S&S, decreased reflexes, weakness
What are is the grade 4 classifications for neck pain by the Quebec task force?
IV signs and symptoms of major structural pathology
What are is the grade 1 classifications for whiplash by the Quebec task force?
Neck pain and assoc. symptoms in the absence of objective sign
What are is the grade 2 classifications for whiplash by the Quebec task force?
Neck pain and assoc. symptoms in the presence of objective signs with no Neuro
What are is the grade 3 classifications for whiplash by the Quebec task force?
Neck pain and assoc. symptoms with evidence of neurological s&S decr. reflex, mm. weakness, limited sensation
What are is the grade 4 classifications for whiplash by the Quebec task force?
Neck pain with evidence of fracture and limitation
What is the osteopathic treatment of neck pain
Patient education effective Hx taking treatment addresses everything beyond technique.
What is the home management of neck pain?
establish goals include motor re-learning, resistance and proprioception education to manage patient expectation
Red flags for acute neck pain
TRAUMA
Age
corticosteroids
Infection
fracture
tumour
neuro condition
cerebral or spinal haemorrhage CAD
What are some possible causes of neck pain “VINDICATE” Neck pain sieve
Vascular
infection/inflammation
Neoplasia
Degenerative
Idiopathic/ Iatrogenic
Congenital
Autoimmune
Trauma
Endocrine
Possible ddx for neck pain?
Musculo-ligamentuous: Strains / Sprains VBD Cervical Spondilosis
Serious disorders for Neck pain?
- CAD, - Myocardial Ischaemia -Haemorrhage -Tumour - Meningitis - Osteomyelitis - Vertebral #/ - Cx Dislocation
What other Cx conditions?
- Radiculopathy - Myelopathy - Thoracic Outlet syndrome - Cx Lymphadenitis - Psychogenic - RA - Ankoylosis Spondylitis - Fibromyalgia - Pagets
What are the possible causes of somatic pain to the Cx?
Discogenic Facet joint Myofascial Spondylosis Somatic Referred
What is superficial somatic pain?
localised, sharp pain caused by nociceptor activation in superficial non neural tissues
What is Deep somatic pain?
Poorly localised dull or aching pain from nociceptor activation in deep non neural tissue
What is Neuropathic pain?
pain caused by a lesion of the somatosensory nervous system
What is radicular pain?
Pain caused by inflammation or compression of a nerve root
What is the referral pattern of each Cx facet joint?
What are the nerves of the cervical plexus?
- Accesory
- HYpoglosal
- lesser occipital
- Greater Ausricular
- Transverse cervical
- Ansa cervicalis
- Phrenic Nerve
- Nerve roots C1-C5
Define cervical radiculopathy
•Cervical radiculopathy refers to any process that causes irritation, compression, or dysfunction of one or more of the cervical nerve roots.
S&S
- numbness & tingling
- weakness
What are the 2 main causes of cervical radiculopathy?
- Disc compression to the root
- Stenosis due to osteoporosis
- Spondylosis degeneration
What aspect of the disc is innervated by nociceptors
Outer 3th of annulus fibrosis
What is discogenic pain?
Pain caused by damage to the intervertebral disc.
can be caused by damage to the annulus fibrosis or herniation of the nucleus pulposos.
What are the two types of herniations on the disc?
- Protrusion the base of the material is greater than apex
- Extrusion base is thinner than apex.
What is disc sequestration?
When the nucleus pulposo herniates and detaches completely from the disc
What are the signs and symptoms of radiculopathy?
- Nerve root inflammation
- Sensory deficit
- motor deficit
- numbness tingling.
- Dermatomal distribution of sensory loss helps to determine segment of root compression
- Radicular pain is felt over multiple dermatomes
Where does radicular pain come from?
•pain evoked by ectopic discharges emanating from a dorsal root or its ganglion
How do you test for radiculopathy?
Upper limb neuro
Define cervical myelopathy
Cervical cord compression
What are the causes of cervical myelopathy?
- Osteocytes build up in the canal
- Disc calcification resulting in loss of disc height
- ligamentous ossification PLL
- ligamentous buckling LF
What are the clinical S&S of cervical myelopathy?
- Gradual onset (insidious)
- Hypersensitivity and clumsiness in hands
- Tightness on legs (spasticity)
- Hyperreflexia, clonus, Babinski (reflex)
- Weakness ataxia
- May be combined with LBP and Leg pain
What is whiplash?
•An acceleration-deceleration mechanism of energy transfer to the neck.
What are other S&S related to whiplash besides de task force grading?
- Tinnitus, deafness
- Visual problems, dizziness
- TMJ pain, Dysphagia
- Depression, anxiety, sleep disturbance, memory loss
What is thoracic outlet syndrome?
Nerve entrapment of the nerves as they pass the thoracic outlet in the axilla.
What are the most common sites of compression in TOS?
Interscalene triangle
Costo clavicular space (clavicle and 1st rib)
Under pec minor
What are the clinical S&S for TOS?
- Neurogenic
- Pain upper and/or lower limb
- Paresthesia
- Fatigue
- Discordination
- weakness
- cramping
- mm. atrophy
- Arterial
- Ischaemic pain
- exertional fatigue
- paresthesia
- coldness
- Pallor & skin change
- Atrhrophy, weakness cramping mm.
- Venous
- Pain
- heaviness
- fatigue
- Upper limb oedema
- Cyanosis
- Ecchymosis (skin decolouration)
- Engorgement of superficial veins
What tests are used for TOS?
Adsons test - brachial artery impingement (decrease pulse)
East test - TOS nerve impingement (elevated arm stress test)
What are the general treatments for neck pain?
- Patient education - reassure + return to activities
- exercise prescription - low load postural endurance - strengthening
- Pain medication - NSAID, analgesic, opioid
- Incorporate aspects of motor re-learning, resistance, proprioception.
WHat are the 3 X-ray view available for the neck?
AP - normal
AP open mouth (exclude fracture, tumour, arthridesm, congenital)
Lateral
What is the nerve supply to the cervical facet joints ?
medial branch nerves
What is a facet joint nerve block?
Injecting an anesthetic to the medial branch nerve to stop pain reproduction with the aid of imaging. (X-ray or Ultrasound).
