Cervical Spine Flashcards
(25 cards)
Non-specific neck pain: subjective
Dull or aching pain in the neck
Refer to shoulder or upper back
Linked to posture, stress, or muscle overuse
Non-specific neck pain: objective
Muscle tenderness, tightness - e.g. upper traps, levator scapulae
Decreased active range of motion due too pain or stiffness
No neurological signs
Persistent neck pain: subjective
Chronic neck pain
Constant or fluctuating
Impact sleep, mood or function
Persistent neck pain: objective
Tender muscle
Restricted active and passive range of motion
Possible central sensitisation signs - e.g. hypersensitivity, low pain threshold
Cervical spondylosis (degenerative disc disease): subjective
Gradual onset neck pain
Often worse with activity
May have stiffness, grinding or clicking
Possible radicular symptoms if nerve root involved
Cervical spondylosis (degenerative disc disease): objective
Decreased range of motion especially extension and rotation
Crepitus on movement
Possible neurological signs if foraminal narrowing - weakness, reflex changes
Disc injury pathology (e.g. disc herniation): subjective
Sudden or gradual onset neck pain
Possibly following strain or trauma
Radicular symptoms - shooting pain, numbness, tingling in dermatomal pattern
Disc injury pathology (e.g. disc herniation): objective
Decreased range of motion especially flexion and rotation
Positive spurling’s test, distraction test
Myotomal weakness
Dermatomal sensory loss
Decreased reflexes
Cervical stenosis/ myelopathy: subjective
Neck pain with bilateral limb symptoms - clumsiness, gait issues, weakness
May include numbness in hands/ feet, bowel or bladder changes
Cervical stenosis/ myelopathy: objective
Upper motor neurone signs - hyperreflexia, clonus, positive hoffmann’s or babinski
Decreased range of motion especially extension
Wide based, unsteady gait
Whiplash-associated disorder: subjective
Neck pain after sudden acceleration-deceleration - e.g. car crash
May include headache, dizziness, jaw pain, visual changes
Whiplash-associated disorder: objective
Muscle guarding
Decreased active range of motion
Tenderness over soft tissue especially SCM, traps
No fracture on imaging unless WAD is high grade
Acute torticollis (wry neck): subjective
Sudden onset of painful, fixed neck posture, often after sleeping awkwardly
Neck “locked” in rotation and/or lateral flexion
Acute torticollis (wry neck): objective
Marked asymmetry
Decreased active and passive range of motion
Muscle spasm, tenderness (SCM, levator scapulae)
No neurological signs
Polymyalgia rheumatica (PMR): subjective
Bilateral aching ir stiffness in neck, shoulders, and hips, especially in morning (>45 mins)
Systemic - fatigue, weight loss, low-grade fever
Age > 50 years
Polymyalgia rheumatica (PMR): objective
Limited active range of motion due to pain, especially in shoulder girdle
No true muscle weakness - strength preserved
Increased ESR/CRP on blood tests
Axial spondyloarthritis/ ankylosing spondylitis: subjective
Chronic, inflammatory-type back/neck pain - morning stiffness > 30 mins, improving with activity
Worse at night
Often in young males (<40 years)
May report eye symptoms (uveitis), heel pain, family history
Axial spondyloarthritis/ ankylosing spondylitis: objective
Decreased cervical and thoracic spinal mobility - Schober’s, tragus-to-wall distance
Tenderness over sacroiliac joints
Imaging - sacroilitis, syndesmophytes
Cervicogenic headache: subjective
Unilateral headache, often tarting form neck and radiating to temple or eye
Triggered or worsened by neck movement/ posture
Cervicogenic headache: objective
Decreased cervical range of motion especially extension and rotation
Reproduction of headache with palpation of upper cervical joints - e.g. C1-C3
Often tender suboccipital muscles
Radicular pain
Nerve root involvement
Dermatomal upper limb pain
Upper limb pain worse than neck pain
Upper limb pain increased with straining, cough etc, nerve tissue provocation
Radiculopathy
Weakness
Loss of sensation
Loss of reflex
Or combination
Red flags
Neurological signs and symptoms - cognitive state, weakness involving more than one myotome or loss of sensation involving more than one Dermatomal
History of immunosuppression, tuberculosis or intravenous drug abuse
History of violent trauma or fall from a height or minor trauma in a person at risk of osteoporosis
History of neck surgery
History of inflammatory arthritis
History of cancer
History or features of vascular disease such as blackouts, dizziness, or a pulsatile mass in the neck
5Ds
Dizziness and/or unsteadiness
Diplopia - double vision, visual field loss
Dysarthria/ dysphasia - difficulty with speech or finding words
Dysphagia - difficulty swallowing or unexplained hoarse voice
Drop attacks - sudden collapse without loss of consciousness
