Neck Pain Red Flags

Question 1

Which red flags in a neck pain case could indicate meningitis?

Answer 1

1. Severe nuchal rigidity
2. Neck pain increased by Cx flexion
3. Rash
4. SSX of infection (fever, sweats / chills, malaise)

Question 2

Which red flags in a neck pain case could indicate a tumour?

Answer 2

1. Dysphagia (difficulty swallowing)
2. Headache
3. Vomiting

Question 3

Which red flags in a neck pain case could indicate a CAD (Cervical Arterial Dissection)?

Answer 3

1. Unilateral headache and unilateral neck pain
2. Asymmetrical cervical nerve findings
3. Dizziness
4. Tinnitus
5. Speech and/ or vision change
6. Horner’s syndrome (unilateral SSX of diminished pupil, eyelid droop, lack of facial sweating)
7. Diminished co-ordination

Question 4

Which risk factors increase the likelihood of a CAD in a neck pain case?

Answer 4

1. Family or personal history of CVD
2. Risk factors for CVD (over 50, metabolic syndrome)
3. Diabetes
4. Tobacco use

Question 5

Which tests should be performed if CAD is considered a potential diagnosis?

Answer 5

1. BP (diminished BP can indicate a cervical aneurysm)

2. Cranial nerve exam (asymmetrical cranial nerve findings can indicate a CAD)

Question 6

Which tests should be performed if meningitis is considered a potential diagnosis?

Answer 6

1. Vitals (increased temperature can indicate an infection which may be meningitis)
2. Cervical flexion (severely reduced ROM in Cx flexion and severely increased pain in flexion can indicate meningitis)

Question 7

What are the 3 main serious pathologies to screen for in a neck pain case?

Answer 7

1. CAD
2. Meningitis
3. Tumour