Neck pain: Difference between revisions
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*Radiates to trapzezial and periscapular areas or down arm | *Radiates to trapzezial and periscapular areas or down arm | ||
*Numbness/weakness in myotomal distribution | *Numbness/weakness in myotomal distribution | ||
* | *Headache may occur if upper cervical roots are involved | ||
*Symptoms aggravated by neck hyperextension (esp when head is toward affected extremity) | *Symptoms aggravated by neck hyperextension (esp when head is toward affected extremity) | ||
*Gradual onset of shocklike sensations spreading down spine to extremities | *Gradual onset of shocklike sensations spreading down spine to extremities | ||
| Line 51: | Line 51: | ||
*[[NSAIDs]] or [[acetaminophen]] | *[[NSAIDs]] or [[acetaminophen]] | ||
**1st line therapy | **1st line therapy | ||
*Trigger point injections may be useful for trapezius muscle spasm | |||
*[[Opioids]] | *[[Opioids]] | ||
**Appropriate for moderate-severe pain but only for limited duration | **Appropriate for moderate-severe pain but only for limited duration | ||
Latest revision as of 15:29, 20 October 2018
Background
- Two types:
- Musculoskeletal
- Radiculopathy/myelopathy
Clinical Features
Musculoskeletal
- Pain is deep, dull ache, episodic
- History of excessive or unaccustomed activity
- Pain is localized and asymmetric
- Referred pain: head (upper cervical segments), limb girdle (lower cervical segments)
- Symptoms aggravated by neck movement, relieved by rest
Radiculopathy
- Pain is sharp or burning
- Radiates to trapzezial and periscapular areas or down arm
- Numbness/weakness in myotomal distribution
- Headache may occur if upper cervical roots are involved
- Symptoms aggravated by neck hyperextension (esp when head is toward affected extremity)
- Gradual onset of shocklike sensations spreading down spine to extremities
- Most common at level of 5th cervical vertebra (shoulder abduction, external rotation)
Differential Diagnosis
Neck pain
- Musculoskeletal
- Torticollis
- Dystonic reaction
- Cervical spondylosis
- Cervical stenosis
- Cancer
- Epidural abscess
- Vertebral osteomyelitis
- Transverse myelitis
- Temporal arteritis
- Epidural hematoma (anticoagulation, hemophilia)
- Cervical disk herniation
- Blunt neck trauma
- Anterior horn disease
- Cervical fractures and dislocations
- Cervical radiculopathy
Neck Trauma
- Penetrating neck trauma
- Blunt neck trauma
- Cervical injury
- Neurogenic shock
- Spinal cord injury
Evaluation
- Musculoskeletal pain
- Pain occurs on side away from head movement
- Radiculopathy
- Spurling test
- Apply gentle pressure to patient's head during extension and lateral rotation
- May reproduce patient's radicular pain with radiation into ipsilateral upper extremity
- Abduction relief sign
- Placing hand of affected extremity on top of head leads to relief
- Indicates soft disk protrusion
- Spurling test
Imaging
- Consider x-ray for:
- Chronic neck pain (weeks-months)
- History of malignancy
- History of RA, ankylosing spondylitis, psoriatic spondyloarthropathy
- Consider MRI for:
- Neurologic signs/symptoms
- Plain films show bone or disk margin destruction
- Cervical instability
- Epidural abscess is suspected
Management
- NSAIDs or acetaminophen
- 1st line therapy
- Trigger point injections may be useful for trapezius muscle spasm
- Opioids
- Appropriate for moderate-severe pain but only for limited duration
- Muscle relaxants
- Efficacy appears equal to NSAIDs
- Diazepam 5-10mg PO q6-8hr OR methocarbamol 1000-1500mg PO QID
Disposition
- Discharge unless concerning etiology exists