Neck pain: Difference between revisions
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== Background | ==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 DDX}} | |||
{{Blunt neck trauma DDX}} | |||
== | ==Evaluation== | ||
*Musculoskeletal pain | *Musculoskeletal pain | ||
**Pain occurs on side away from head movement | **Pain occurs on side away from head movement | ||
*Radiculopathy | *Radiculopathy | ||
**Spurling test | **Spurling test | ||
***Apply gentle pressure to | ***Apply gentle pressure to patient's head during extension and lateral rotation | ||
***May reproduce | ***May reproduce patient's radicular pain with radiation into ipsilateral upper extremity | ||
**Abduction relief sign | **Abduction relief sign | ||
***Placing hand of affected extremity on top of head leads to relief | ***Placing hand of affected extremity on top of head leads to relief | ||
***Indicates soft disk protrusion | ***Indicates soft disk protrusion | ||
===Imaging=== | |||
== | |||
*Consider x-ray for: | *Consider x-ray for: | ||
**Chronic neck pain (weeks-months) | **Chronic neck pain (weeks-months) | ||
| Line 86: | Line 46: | ||
**Plain films show bone or disk margin destruction | **Plain films show bone or disk margin destruction | ||
**Cervical instability | **Cervical instability | ||
**Epidural abscess is suspected | **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 | |||
== | ==See Also== | ||
* | *[[Neck Diagnoses]] | ||
[[Category: | ==References== | ||
<References/> | |||
[[Category:Orthopedics]] | |||
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