Neck pain: Difference between revisions
(Created page with "== Background == *Two types: **1. Musculoskeletal **2. Radiculopathy/myelopathy == Clinical Features == *Musculoskeletal **Pain is deep, dull ache, episodic **History of ...") |
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**2. Radiculopathy/myelopathy | **2. Radiculopathy/myelopathy | ||
== Clinical Features == | == Clinical Features == | ||
*Musculoskeletal | *Musculoskeletal | ||
**Pain is deep, dull ache, episodic | **Pain is deep, dull ache, episodic | ||
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**Most common at level of 5th cervical vertebra (shoulder abduction, external rotation) | **Most common at level of 5th cervical vertebra (shoulder abduction, external rotation) | ||
== Diagnosis == | == Diagnosis == | ||
*Musculoskeletal pain | *Musculoskeletal pain | ||
**Pain occurs on side away from head movement | **Pain occurs on side away from head movement | ||
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{| width="450" border="1" cellpadding="1" cellspacing="1" | {| width="450" border="1" cellpadding="1" cellspacing="1" | ||
|- | |- | ||
| Disk Space | | Disk Space | ||
| Cervical Root | | Cervical Root | ||
| Pain | | Pain | ||
| Sensory Abnormality | | Sensory Abnormality | ||
| Motor weakness | | Motor weakness | ||
| Altered reflex | | Altered reflex | ||
|- | |- | ||
| C1-C2 | | C1-C2 | ||
| C2 | | C2 | ||
| Neck, scalp | | Neck, scalp | ||
| Scap | | Scap | ||
| | | | ||
| | | | ||
|- | |- | ||
| C4-C5 | | C4-C5 | ||
| C5 | | C5 | ||
| Neck, shoulder, upper arm | | Neck, shoulder, upper arm | ||
| Shoulder | | Shoulder | ||
| Infraspinatus, deltoid, biceps | | Infraspinatus, deltoid, biceps | ||
| Reduced biceps | | Reduced biceps | ||
|- | |- | ||
| C5-C6 | | C5-C6 | ||
| C6 | | C6 | ||
| Neck, shoulder, proximal forearm, thumb, IF | | Neck, shoulder, proximal forearm, thumb, IF | ||
| Thumb, index finger, lateral forearm | | Thumb, index finger, lateral forearm | ||
| Deltoid, biceps, pronator, wrist extensors | | Deltoid, biceps, pronator, wrist extensors | ||
| Biceps, brachioradialis | | Biceps, brachioradialis | ||
|- | |- | ||
| C6-C7 | | C6-C7 | ||
| C7 | | C7 | ||
| Neck, post arm, chestk, scapula, middle finger | | Neck, post arm, chestk, scapula, middle finger | ||
| Middle finger, forearm | | Middle finger, forearm | ||
| Triceps, pronator teres | | Triceps, pronator teres | ||
| Triceps | | Triceps | ||
|- | |- | ||
| C7-T1 | | C7-T1 | ||
| C8 | | C8 | ||
| Neck, post arm, medial hand, ring, LF | | Neck, post arm, medial hand, ring, LF | ||
| Ring and little fingers | | Ring and little fingers | ||
| Tricpeps, flexor carpi ulnaris, hand intrinsics | | Tricpeps, flexor carpi ulnaris, hand intrinsics | ||
| Triceps | | Triceps | ||
|} | |} | ||
==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 | |||
==Specific Disorders== | |||
== Source == | == Source == | ||
*Tintinalli | *Tintinalli | ||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 01:34, 18 February 2012
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)
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
- Spurling test
| Disk Space | Cervical Root | Pain | Sensory Abnormality | Motor weakness | Altered reflex |
| C1-C2 | C2 | Neck, scalp | Scap | ||
| C4-C5 | C5 | Neck, shoulder, upper arm | Shoulder | Infraspinatus, deltoid, biceps | Reduced biceps |
| C5-C6 | C6 | Neck, shoulder, proximal forearm, thumb, IF | Thumb, index finger, lateral forearm | Deltoid, biceps, pronator, wrist extensors | Biceps, brachioradialis |
| C6-C7 | C7 | Neck, post arm, chestk, scapula, middle finger | Middle finger, forearm | Triceps, pronator teres | Triceps |
| C7-T1 | C8 | Neck, post arm, medial hand, ring, LF | Ring and little fingers | Tricpeps, flexor carpi ulnaris, hand intrinsics | Triceps |
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
Specific Disorders
Source
- Tintinalli