Neck pain

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

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

Source

• Tintinalli