Differential Dx of Neck Pain part 1 Flashcards by Amanda Romeu

Powerpoint 1

How many known causes of neck pain are there?

123

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What should you try to rule out in neck pain?

Life threatening conditions
Limb threatening conditions
Organ threatening conditions
Function threatening conditions

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In the absence of trauma, what is demographically worrying about neck pain?

Age less than 20

Age over 50

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In the absence of trauma, what is vitally worrying about neck pain?

Fever and hypertension

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What could be worrying in the history in neck pain?

Trauma
Fever
Abrupt onset
Neurologic symptoms

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What could be worrying in the physical exam for neck pain?

RROM severely restricted (half normal range)
Radicular symptoms provoked by ROM
Signs of inflammation
Neurologic Deficits

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What should be considered for congenital disorders?

Present since childhood

Onset of symptoms at certain ages

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What should be considered for trauma?

History of trauma

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What should be considered for mechanical issues of the neck?

Insidious onset

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What should be considered in exposures to toxins in neck pain?

Exposure to toxins

vocational
avocational
incidental

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What should be considered in metabolic disorders in neck pain?

Endocrine
-diabetes mellitus
-thyroid disease 
Nutrition
-ingestion
-digestion
-excretion

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What should be considered in inflammatory action in neck pain?

Abrupt onset

rubor
tumor
calor
dolor

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What should be considered in degenerative neck pain?

Age 50 and older (needs imaging)

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What should be considered for infection in neck pain?

Fever
WBC elevation (need imaging)

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What should be considered for neoplasms in neck pain?

Age 50 yeas and older (need imaging)

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What should be considered for circulatory problems in neck pain?

Vital signs
-pulse rate
-blood pressure
Physical exam
-palpate pulses-auscultate heart-auscultate arteries

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What should be considered in neurological problems in neck pain?

Nuerologic abnormalities are present
Muscle weakness or spasm
Reflex alterations
Sensory loss
Pain in nerve root and peripheral nerve distribution

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What should be considered in an event of a psychogenic pt with beck pain?

Diagnosis of exclusion

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In the event of trauma, what history should be investigated?

Significant trauma
History of a fall from a height
Possibility of fracture

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If there is trauma and a fracture, what should your physical exam consist of?

Observe unusual head carriage
Palpation of cervical spinous processes
Percussion of spinous processes C2 and C7
Severevly restricted action ROM (do not do passive)X-ray

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When pain is percussed, what are the possible presentations?

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Fracture
Tumor
discitis
Facet joint synovitis

Powerpoint 1

What are some red flags for facet dislocation?

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Violent rotational head injury
Occur with sudden voluntary head turning
Pt hears click of facet lock
Pain present at injury site

What are the physical findings of the facet joint dislocation?

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Abnormal head carriage - torticollis
Palpate articular pillars for facet dislocation
Neurologic exam
Confirmatory x-ray

Which will cause neurologic compromise, unilateral or bilateral facet dislocation?

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Bilateral

Where will pain radiate to in a herniated cervical disc?

Shoulder, arm, forearm, wrist or hand

In a herniated cervical disc what would a history and PE of trauma show?

``` Presence of pain radiating to dermatomes Number of paresthesias Abnormal head carriage Loss or reversal of cervical lordosis Tenderness and muscle spasm at herniated disc ```

If there is a herniated disc due to trauma what would you test?

Active RROM (restricted flexion) Valsalva test (radicular pain) Flexion/contraction test (nerve root) Lhermitte sign

What does the valsalva test do?

Reproduces the symptoms of any space occupying lesion within the spinal canal

What is the Lhermitte sign?

Electrical shock paresthesia down back, arms and legs w/ flexion of neck Occur with any cause of spinal cord compression or inflammation

What do you test for muscle strength at C5 and C6 for a herniated cervical disk?

C5 - deltoid, serratus anterior C5/C6 - biceps C6 - wrist extensors

What do you test for muscle strength at C7, C8 and T1?

C7 - tricpets, wrist flexors, finger extensors C8 - finger flexors Ti1 - interossei

What are the reflexes test for a herniated cervical disk in the case of trauma?

C5 - biceps C6 - brachioradialis C7 - triceps reflex

What is symptoms would you see if a herniated cervical disc caused nerve root compression?

Sensory loss Muscle weakness Reflex loss

What symptoms would you see if a herniated cervical disc caused spinal cord compression?

``` Sensory deficits Muscle spasticty Hyperreflexia Clonus Hoffman reflex Babinski reflex ```

What will an x-ray reveal for trauma of a herniated cervical disc?

Straightening or reversal of cervical lordosis | MRI used to confirm

What would you see in a cervical sprain and strain?

Flattening of the cervical lordosis, abnormal head carriage, torticollis

What is palpated for in cervical sprain and strain?

Sternocleidomastoid, scalenes, paravertebral muscles, superior trap border, and levator scapulae look for spasm and tenderness Nuchael ligament - defects and tenderness

What type of injury could happen with hyperextension?

Sternocleidomastoid tear and hematoma formation

What are some causes and symptoms of torticollis?

``` Strained sternocleidomastoid and scalenes Muscular ischemia Facet dislocation with overriding C1 - C2 dislocation Could be present since birth ```

How would you test for congential muscular torticollis?

Found in newborns and test cervical range of motion | 30 degrees side bend, 90 rotation

What are some risk factors for baby torticollis?

``` Stuck fetus Cephalohematoma Clavicular fracture Brachial plexus injury Prolonged stage 2 labor ```

What are some congenital etiologies of torticollis?

``` Klippel-Feil Syndrome Basilar Impression Atlanto-occipital Fusion Pterygium Colli (web neck) Odontoid Abnormalities ```

What is klippel-feil syndrome?

Cervical spine congenital anomaly consisting of multiple fused vertebrae and maybe a hemivertebrae

What is an odontoid abnormality?

Hypoplastic dens | May present in achondroplastic dwarfism and down syndrome

What are some inflammatory etiologies of torticollis?

Lymphadenitis in neck TB with vertebral destruction and muscle spasm Typhoid with muscle spasm Rheumatoid arthritis with atlanto-axial subluxation

Rheumatoid arthritis erodes away the ______ with subluxation of the dens.

Trasverse odontoid ligament | posterior into spinal cord

What should you test before going in for manipulation for torticollis?

Odontoid

What are some neurologic etiologies?

``` Ocular Dysfunction Syringomyelia Spinal Cord Tumor Cerebellar Tumor Bulbar Palsies Spasmodic Torticollis ```

What is syringomyelia?

Central cavitation of the spinal cord Occurs in 2nd and 3rd decades of life Usually in the lower cervical and upper thoracic area for 6 to 7 segments May see neck pain, kyphosis or scoliosis

What is Sandifer's syndrome?

An acute idiopathic cervical disc calcification Hiatus hernia Gastroesophageal reflux

Differential Dx of Neck Pain part 1 Flashcards

(50 cards)