Neck pain: Difference between revisions
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***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 | ||
==Imaging== | ==Imaging== |
Revision as of 01:35, 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
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