Neck pain Red flags

gotepoca's version from 2016-03-15 17:43

Section 1

Question Answer
Significant trauma (fall in osteoporotic pt, MVA)bony/ligamentous disruption of cervical spine
Hx of Rheumatoid ArthritisAtlanto-axial disruption
Infective symptoms (fever, meningism, hx of immunosuppression, IV drug use)-Infectional abscess, Retropharyngeal abcess, Discitis, subarrachnoid hemorrhage
Constitutional symptoms (fever, wl, anorexia, past or current hx of malignancy)-Malignancy/infiltrative process, Rheumatological dz, Polymyalgia rheumatica, Giant cell arteritis
Neurology (S+S of UMN pathology)-Cervical cord compression, Demyelinating process
Concurrent chest pain, SOB, DiaphoresisMyocardial ischaem

Section 2

Question Answer
Indications for Imaging neck painAge > 50 w/ new sx, constitutional sx, Infection risk, moderate-severe neck pain lasting more than 6 weeks, Neuro findings, Hx of malignancy
First + second line for neck pain -medsfirst-NSAIDs, second-Muscle relaxant
Sx of Cervical RadiculopathyArm pain, Pain in Trapezius, interscapular m., Dermatomal paresthesias
Etiology of Cervical RadiculopathyDirect irritation of Cervical nerve root, (osteophyte, space-occupying lesion, increased stress/tension, inflammation
term referring to degenerative osteoarthritis of the joints between the center of the spinal vertebrae and/or neural foraminaSpondylosis
Pathology--contracture of neck muscle (usually SCM)-causes SB to side of spasm + rotated opposite w/ flexion "twisted neck"Torticollis
Mechanical neck pain w/ aching paracervical tenderness/stiffness beginning one day after injuryWhiplash
Injury associated w/ whiplashForced hyperflexion + hyperextension
Mechanism of this injury is Forcible Hyperextension of head w/ distraction of neckHangman's Fracture
The most common scenario would be a frontal motor vehicle accident with an unrestrained passenger or driver, with the person striking the dashboard or windshield with their face or chin. Hangman's fracture
Bone path of Hangman's fracture?C2 pars interarticularis fx, Prevertebral soft tissue swelling, Anterior dislocation of C2 VB
Best way to view Odontoid FractureAP view- Right through the mouth--open mouth--posterior

Section 3

Question Answer
During gross motion testing what direction does head SB + Rotate automatiallyHead automatically SB + rotates in OPPOSITE directions
If Head SB + rotates SAME direction what should you expectedSD in TYPICAL CERVICALs
Dysphagia (sensation of swallowing difficulties)Think STRAP muscles + hyoid
Radiation of pain to Upper extremitiesEntrapment -Spondylosis, scalenes, first rib dysfunction, herinated disc
Radiation of pain to OcciputOccipital nerve, muscles,
Headache w/ pressure + tight Headband sensationSuboccipital + occipital muscles and greater + lesser cranial nerves
Dizziness or syncope (esp on head turnign w/ extension)Compromise of carotids or vertebral arteries--BE CAREFUL!
Respiratory dzScalenes + SCM muscles (secondary muscles of resp), C3, C4, C5 + RIb 1 (attachement of scalenes + origin of phrenic nerve)
Radiation to ear or jawSCM, Stylohoid, TMJ + Angina