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Diff Dx > Neck pain > Flashcards

Neck pain Flashcards

1
Q

common patient presentations

A

acute injury and/or arm pain
acute, pseudo-torticollis
postural pain or stiffness due to poor ergonomics
decreased ROM associated with stiffness or pain
headaches

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2
Q

C2-3 problems normally refer to?

A

the head

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3
Q

C3-4 problems normally refer to?

A

lateral neck from head to base

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4
Q

C4-5 problems normally refer to?

A

whole side of neck from head to base and into shoulder

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5
Q

C5-6 problems usually refer to?

A

lower lateral neck and into shoulder

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6
Q

C6-7 problems usually refer to?

A

shoulder to upper mid back

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7
Q

neck pain and arm pain is most likely from?

A

a facet joint

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8
Q

does neck pain and arm pain have neurological deficits?

A

no, even though there might be complaints of numbness or tingling

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9
Q

what red flags should you look out for?

A 
trauma
history of cancer
corticosteroid use
history of infection
head trauma with loss of consciousness
nuchal rigidity
bladder dysfunction associated with onset of neck pain
associated dysphagia
associated CN or CNS signs/symptoms
onset of new headache
pre-existing conditions
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10
Q

what other things should you look for in the history?

A

nuchal rigidity/ positive brudzinski’s or kernig
suspected fracture, dislocation, infection, cancer
perform examinations

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11
Q

what tests should you do if there is only neck pain

A 
inspection
observation of patient's movements
static palpation
motion palpation
P and AROM
functional assessment and orthopedic screening
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12
Q

what tests should you do if there is neck and arm pain?

A

orthopedic/neurological exam, compressive and neural stretch testing, nerve stretch maneuvers, DTR testing, sensory examination and myotome testing

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13
Q

when should you xray someone with neck pain?

A

if you suspect fracture, dislocation, infection or cancer

or if they have radicular findings

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14
Q

when should you perform MRI for neck pain?

A

ddx of radicular or myelopathy cases to further evaluate stenosis, tumor, herniated disc or multiple sclerosis

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15
Q

when should electrodiagnostic studies be done?

A

when radicular complaints remain unclear

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16
Q

pain that radiates into the arm indicates?

A

disc lesion, nerve root entrapment, referred pain, myelopathy, brachial plexus involvement

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17
Q

isolated weakness or numbness suggests?

A

nerve root involvement

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18
Q

numbness and tingling in a diffuse or ill-defined pattern suggest?

A

referred pain from facet or trigger points

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19
Q

what is a red flag for infeciton, tumor or vascular etiologies?

A

neck pain with a “new” headache or the worst headache they have ever experienced

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20
Q

lateral flexion neck injuries

A

compression injury on side of movement and stretching injury on the opposite side

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21
Q

forced flexion neck injuries

A

compression fracture, myelopathy from stenotic canal considered with arm and leg complaints

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22
Q

what is the primary intention of orthopedic testing?

A

to compress or stretch pain producing structures such as facets and NRs

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23
Q

standard orthopedic tests

A 
various forms of cervical compression
cervical distraction
shoulder depression
brachial plexus stretch testing
soto hall
lhermitte's
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24
Q

cervical compression test

A

local pain on extension and/or rotation indcates facet involvement, while radiating pain down the arm indcates nerve root involvement

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25
Q

cervical distraction test

A

an attempt to reduce local or radiating complaints if painful, muscle splinting is suggested

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26
Q

lhermitte’s

A

passive flexion of neck that causes electric shock sensations, seen with MS or cervical myelopathy

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27
Q

upper limb tension test

A

also known as brachail plexus test
good screening test to rule out cervical radiculopathy
pain on contralateral cervical side bending
decrease in symptoms with ipsilateral dise bending

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28
Q

what is the classic presentation of cervical radiculopathy

A

patient comlains of neck and arm pain

onset follows a neck injury, may be insidious

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29
Q

what is often the history of cervical radiculopathy

A

multiple bouts of neck pain following minor injuries

patient also complains of weakness in the hand

30
Q

bakody’s sign

A

some cervical radiculopathy patients have a positive bakody’s signs

31
Q

describe tests for cervical radiculopathy

A 
AROM and PROM painful restriction
C compression may reproduce pain
cervical distraction may relieve arm pain
bakody's may be positive
decreased DTR
weakess in related myotome
sensory abnormality
32
Q

C5

A

motor supply to deltoid (shoulder abduction) and biceps (elbow flexion/supination) biceps relfex, sensory to outer shoulder (axillary N)

33
Q

C6

A

motor supply to biceps and wrist extension
brachioradialis reflex
sensory to outer forearm

34
Q

C7

A

motor supply to triceps (elbow extension), finger extensors and wrist flexors
triceps reflex
sensory to middle finger

35
Q

C8

A

motor supply to finger flexors
no reflex
sensory to little and ring fingers

36
Q

T1

A

motor supplied to the interosseous muscles of hand (abducion of fingers) no reflex and sensory to medial arm

37
Q

midline C spine disc herniations create

A

myelopathies

38
Q

lateral disc herniations in C spine do what?

A

compress NR below

39
Q

midline disc herniation in L spine does what?

A

compress NR below

40
Q

foraminal disc herniation in the L spine does what?

A

involves the NR at the same level

41
Q

disc herniationin C spine?

A

affects NR below

42
Q

hypertrophy of uncinate will affect?

A

NR at same level

43
Q

disc herniation at C7/T1 will affect

A

C8 NR

44
Q

hypertrophy changes of T1 vertebral body will affect

A

C8 NR

45
Q

patient presentation wilth myelopathy can differ based on what?

A

type and degree of compression

46
Q

what are the classic patient symptoms of myelopathy?

A

bilateral symptoms of clumsiness of hands, difficulty walking, possible urinary dysfunction, possible shooting pains into arms

47
Q

what are some causes of spinal cord compression?

A

tumor
herniated disc
spondylolytic sources

48
Q

direct pressure on posterior columns causes disturbances in?

A

vibration perception

proprioception

49
Q

what tests may be positive with myelopathies?

A

pathological reflex
decrease strength, proprioception, vibration
Lhermitte’s

50
Q

what measurement indicates concern for spinal stenosis? indicates stenosis?

A

<13mm

<11mm

51
Q

cervical spondylolotic myelopathy

A

severe canal stenosis, significant cord compressions with changes of myelomalacia

52
Q

symptoms of TOS

A

diffuse arm symptoms, including numbness and tingling

they often describe a path down the inside of the arm to the 4th and 5th digits with overhead activity

53
Q

what can be compressed in TOS?

A

brachial plexus

subclavian/axillary arteries

54
Q

what are some reasons for TOS?

A 
elongated C7 TVP
cervical rib
scalene muscles
costoclavicular area
subcoracoid area
pec minor
55
Q

how is grip strength and reflexes for TOS?

A

grip strength reduced

relfexes normal

56
Q

what test is positve if the TOS is because of the scalene muscles?

A

adson’s, halstead’s

57
Q

what test if positive if the TOS is because of pec minor?

A

wright’s

58
Q

what functional test is positive for TOS?

A

Roo’s

59
Q

symptoms patient might copmlain of with a facet problem

A

traumatic ir insidious onset of neck and arm pain that doesn’t folow a specific dermatome

60
Q

what is the most common location for facet symptoms?

A

down outer arm to hand (C5-7 facet joints)

61
Q

how can you tell the difference between referred pain and facet pain?

A

referred pain rarely goes to the hand

62
Q

how is pain reporduced in facet syndrome?

A

cervical compression with neck in extension and rotated to involved side

63
Q

what may be warranted with facet syndrome?

A

xrays

64
Q

how will you know if a baby has congenital torticollis?

A

there will be fixed asymmetry of the head seen within hours or sometimes weeks of the delivery

65
Q

what will an adult with congenital torticollis experience?

A

painful muscle spasms of SCM, causing the head to be held in rotation and sometimes slight flexion

66
Q

pseudo-torticollis

A

inability to move head in any direction without pain with head held in neutral position

67
Q

what is a cerviacl sprain/strain?

A

overstretch or over contraction with possible radiation

68
Q 
cervical sprain/strain
valsalva's
ROM
orthopedics
neurological
AROM
PROM
A

valsalva’s: no radiation
ROM: contraction of muscle orstretch of muscle or joint
orthopedics: none
neurological: none
AROM: pain that contracts involved muscles
PROM: pain that contracts involved muscle or ligament

69
Q

what is helpful as a treatment for cervical sprain/strain?

A 
if significant trauma: radiographs
myofascial therapy
limit orthotic support
ergonomic advice
preventative exercises and stretches
70
Q

if the cervical sprain/strain is unstabile, what do you need to do?

A

orthopedic consult

Diff Dx (17 decks)

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