Neck pain: Difference between revisions

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== Background ==
==Background==
*Two types:  
*Two types:  
*#Musculoskeletal  
#Musculoskeletal  
*#Radiculopathy/myelopathy
#Radiculopathy/myelopathy


== Clinical Features ==
==Clinical Features==
===Musculoskeletal===
===Musculoskeletal===
*Pain is deep, dull ache, episodic  
*Pain is deep, dull ache, episodic  
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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  
*HA may occur if upper cervical roots are involved  
*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  
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{{Blunt neck trauma DDX}}
{{Blunt neck trauma DDX}}


== Diagnosis  ==
==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 pt's head during extension and lateral rotation  
***Apply gentle pressure to patient's head during extension and lateral rotation  
***May reproduce pt's radicular pain w/ radiation into ipsilateral upper extremity  
***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  
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**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==
==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==
==See Also==
*[[Neck Diagnoses]]
*[[Neck Diagnoses]]


== References ==
==References==
</References>
<References/>
[[Category:Ortho]]
[[Category:Orthopedics]]

Latest revision as of 15:29, 20 October 2018

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
  • 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

Neck Trauma

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

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

See Also

References