Neck pain: Difference between revisions
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== Background == | == Background == | ||
*Two types: | *Two types: | ||
**1. Musculoskeletal | **1. Musculoskeletal | ||
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**Gradual onset of shocklike sensations spreading down spine to extremities | **Gradual onset of shocklike sensations spreading down spine to extremities | ||
**Most common at level of 5th cervical vertebra (shoulder abduction, external rotation) | **Most common at level of 5th cervical vertebra (shoulder abduction, external rotation) | ||
==DDX== | |||
*Musculoskeletal | |||
*Cervical disk herniation | |||
*Cervical spondylosis | |||
*Cervical stenosis | |||
*Cancer | |||
*Epidural abscess | |||
*Vertebral osteomyelitis | |||
*Transverse myelitis | |||
*Temporal arteritis | |||
*Epidural hematoma (anticoagulation, hemophilia) | |||
== Diagnosis == | == Diagnosis == | ||
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==Specific Disorders== | ==Specific Disorders== | ||
===Whiplash Injury=== | |||
*Sudden acceleration-deceleration trauma that occurs when car is rear-ended | |||
*Pain, stiffness, paracervical muscle tenderness | |||
*Use [[C-Spine (NEXUS)]] criteria to determine whether imaging is required | |||
*Consider brain, cord, carotid/vertebral artery dissection if neuro findings are present | |||
===Cervical Disk Herniation=== | |||
*Nucleus pulposus protrudes through posterior annular fibrosis | |||
**Leads to radiculopathy or less commonly myelopathy | |||
*Neck/shoulder/arm pain in dermatome distribution, weakness, hyperreflexia | |||
*MRI required for diagnosis | |||
== Source == | == Source == |
Revision as of 04:45, 19 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)
DDX
- Musculoskeletal
- Cervical disk herniation
- Cervical spondylosis
- Cervical stenosis
- Cancer
- Epidural abscess
- Vertebral osteomyelitis
- Transverse myelitis
- Temporal arteritis
- Epidural hematoma (anticoagulation, hemophilia)
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
Whiplash Injury
- Sudden acceleration-deceleration trauma that occurs when car is rear-ended
- Pain, stiffness, paracervical muscle tenderness
- Use C-Spine (NEXUS) criteria to determine whether imaging is required
- Consider brain, cord, carotid/vertebral artery dissection if neuro findings are present
Cervical Disk Herniation
- Nucleus pulposus protrudes through posterior annular fibrosis
- Leads to radiculopathy or less commonly myelopathy
- Neck/shoulder/arm pain in dermatome distribution, weakness, hyperreflexia
- MRI required for diagnosis
Source
- Tintinalli