Neck pain

From WikEM
Jump to: navigation, search

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
  • 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