Neck Pain Evaluation

Question 1

Prevalence of neck pain

Answer 1

8. 2% (25-74 y/o)
9. 1% (45-64 y/o)
10. 8% with neck pain had it > 6 mos.

Question 2

Incidence of Cervical Disc Herniation

Answer 2

5.5 per 100,000 (annual)

Question 3

Prevalence of Whiplash

Answer 3

2.8% of all police-reported MVAs

Question 4

Long-term outcome of Neck Pain (after 10 yrs)

Answer 4

• • 79% had decreased neck pain
  • • 43% had NO neck pain
  • • 32% had moderate or severe neck pain

Question 5

History Red flags for possible fracture

Answer 5

– Major Trauma

– Fall from a Height

Question 6

Red flags for possible fracture during physical examination

Answer 6

Severely Restricted Range of Active Motion

Question 7

History Red flags for possible infection

Answer 7

Age Over 50 Years
Age Under 20 Years
Fever or Chills
Pain worse supine
Recent Urinary Tract Infection
IV Drug Abuse
Immune Suppression

Question 8

Red flags for possible infection during physical examination

Answer 8

Temperature
Spinous Process Percussive Pain
C7 & T1 Only

Question 9

History Red flags for possible tumor

Answer 9

Age over 50 years
Age under 20 years
Unexplained Weight Loss
Pain worse when Supine
Severe Nocturnal Pain

Question 10

Red flags for possible vertebrobasilar artery compromise #1

Answer 10

Have the sitting patient look up toward the ceiling then turn the head to right and to left.
Observe for the development of nystagmus.

Question 11

Red flags for possible vertebrobasilar artery compromise #2

Answer 11

Wallenberg’s Test – pt supine, flex neck and hold 10 sec, then extend neck and hold 10 sec, then rotate right, rotate left. Positive if pt c/o dizziness, visual changes, lightheadedness, or nystagmus.

Question 12

When should cerebral ischemia be suspected?

Answer 12

When patient presents acute anxiety or panic during examination

Question 13

What is the normal position and movement of neck/head?

Answer 13

Normally head is held erect.

It moves in smooth coordination with the rest of the body

Question 14

Why does the patient need to be disrobed from the waist up during neck examination?

Answer 14

Due to the possibility of reflected pathology

Question 15

During inspection of the neck’s skin, what are some things you should look for?

Answer 15

Blisters
Discoloration
Scars
Surgical
Anteriorly – Thyroid Surgery
Posteriorly – Spinal Surgery

Question 16

Name structures that need to be palpated during physical exam

Answer 16

C4-C5, C5, SCM, Lymph nodes, thyroid gland, parotid gland, trapezius, greater occipital nerve, nuchal ligament,