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


*Two types:
==Clinical Features==
**1. Musculoskeletal
===Musculoskeletal===
**2. Radiculopathy/myelopathy
*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


== Clinical Features ==
===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)


*Musculoskeletal
==Differential Diagnosis==
**Pain is deep, dull ache, episodic
{{Neck pain DDX}}
**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 ==
{{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 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  
***Indicates soft disk protrusion
***Indicates soft disk protrusion


{| width="450" border="1" cellpadding="1" cellspacing="1"
===Imaging===
|-
*Consider x-ray for:
| Disk Space
**Chronic neck pain (weeks-months)
| Cervical Root
**History of malignancy
| Pain
**History of RA, ankylosing spondylitis, psoriatic spondyloarthropathy
| Sensory Abnormality
*Consider MRI for:
| Motor weakness
**Neurologic signs/symptoms
| Altered reflex
**Plain films show bone or disk margin destruction
|-
**Cervical instability
| C1-C2
**Epidural [[abscess]] is suspected
| 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
|}
 
<br>


<br>
==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


== Source  ==
==Disposition==
*Discharge unless concerning etiology exists


*Tintinalli
==See Also==
*[[Neck Diagnoses]]


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