Neck pain
Revision as of 14:34, 3 February 2015 by Rossdonaldson1 (talk | contribs) (→Differential Diagnosis)
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)
Differential Diagnosis
- Musculoskeletal
- Cervical disk herniation
- Cervical spondylosis
- Cervical stenosis
- Cancer
- Epidural abscess
- Vertebral osteomyelitis
- Transverse myelitis
- Temporal arteritis
- Epidural hematoma (anticoagulation, hemophilia)
Neck Trauma
- Penetrating neck trauma
- Blunt neck trauma
- Cervical injury
- Neurogenic shock
- Spinal cord injury
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
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
See Also
Source
- Tintinalli