Neck pain: Difference between revisions
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== Clinical Features  ==
== Clinical Features  ==
*Musculoskeletal  
===Musculoskeletal===
**Pain is deep, dull ache, episodic  
*Pain is deep, dull ache, episodic  
**History of excessive or unaccustomed activity  
*History of excessive or unaccustomed activity  
**Pain is localized and asymmetric  
*Pain is localized and asymmetric  
**Referred pain: head (upper cervical segments), limb girdle (lower cervical segments)  
*Referred pain: head (upper cervical segments), limb girdle (lower cervical segments)  
**Symptoms aggravated by neck movement, relieved by rest  
*Symptoms aggravated by neck movement, relieved by rest  
*Radiculopathy  
 
**Pain is sharp or burning  
===Radiculopathy===
**Radiates to trapzezial and periscapular areas or down arm  
*Pain is sharp or burning  
**Numbness/weakness in myotomal distribution  
*Radiates to trapzezial and periscapular areas or down arm  
**HA may occur if upper cervical roots are involved  
*Numbness/weakness in myotomal distribution  
**Symptoms aggravated by neck hyperextension (esp when head is toward affected extremity)  
*HA may occur if upper cervical roots are involved  
**Gradual onset of shocklike sensations spreading down spine to extremities  
*Symptoms aggravated by neck hyperextension (esp when head is toward affected extremity)  
**Most common at level of 5th cervical vertebra (shoulder abduction, external rotation)
*Gradual onset of shocklike sensations spreading down spine to extremities  
*Most common at level of 5th cervical vertebra (shoulder abduction, external rotation)


==Differential Diagnosis==
==Differential Diagnosis==

Revision as of 16:58, 25 September 2015

Background

  • Two types:
    1. Musculoskeletal
    2. 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
  • HA 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

Neck Trauma

Diagnosis

  • Musculoskeletal pain
    • Pain occurs on side away from head movement
  • Radiculopathy
    • Spurling test
      • Apply gentle pressure to pt's head during extension and lateral rotation
      • May reproduce pt's radicular pain w/ radiation into ipsilateral upper extremity
    • Abduction relief sign
      • Placing hand of affected extremity on top of head leads to relief
      • Indicates soft disk protrusion

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

See Also

Source

  • Tintinalli
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