Lecture 2: Cervical Spine Complaint

Question 1

What are the types of atraumatic neck pain?

Answer 1

Musculoskeletal
Neurologic
Non-spinal: systemic disease or referred pain

Question 2

What are the types of traumatic neck pain?

Answer 2

Myofascial Injury (e.g. muscle strain)
Cervical Fracture
Ligamentous Injury
Disc Injury
Cord or nerve root injury
SCIWORA

Question 3

Is myofascial neck pain traumatic or atraumatic?

Answer 3

Can be both

Question 4

What are symptoms of myofascial neck pain?

Answer 4

Pain
Spasm
Loss of ROM in neck

Question 5

How can cervical fractures be determined if they are stable or unstable?

Answer 5

Imaging (CT/MRI)

Radiological and neurosurgical consultation

Question 6

What is SCIWORA?

When would you do this?

Answer 6

Spinal Cord Injury w.o Radiographic Abnormality

• Normal films but neurologic symptoms persist
• High degree of suspicion needed to order MRI
• Mostly done w/ kids or elderly

Question 7

What is the Nexus criteria used for?

Answer 7

Determine which patients presenting w/ neck pain after trauma needs radiographic imaging?

Question 8

What is the Nexus Criteria?

Answer 8

1. Absence of posterior midline cervical tenderness
2. Normal level of alertness
3. No evidence of intoxication
4. No abnormal neurological findings
5. No painful distracting injuries

*If all criteria are met, patient does not need imaging.

Question 9

What are some examples of atraumatic musculoskeletal neck pain?

Answer 9

Cervical spondylosis
Whiplash
Torticollis
Facet osteoarthritis

Question 10

What are some examples of atraumatic neurologic neck pain?

Answer 10

Radiculopathy

Myelopathy

Question 11

What are some examples of atraumatic non-spinal causes of neck pain?

Answer 11

Coronary artery disease
Malignancy
Neurologic conditions
Referred shoulder pain
Rheumatologic conditions
Fibromyalgia 
Thoracic Outlet Syndrome
Visceral etiolgoies
Infections

Question 12

What is cervical spondylosis?

Answer 12

Degenerative changes in cervical spine that can cause general neck pain, radiculopathy, and myelopathy
-incidence increases w/ age

Question 13

What is cervical myelopathy?

Answer 13

Neurological deficit related to spinal cord

• Bilateral or distal weakness and numbness in hands
• Gait disturbance
• Sexual dysfunction
• Bowel or bladder dysfunction

Emergent MRI!

Question 14

What is cervical radiculopathy?

Answer 14

Neurological deficit occurring at or near nerve root

• Sharp, burning, pain radiating to trapezius, periscapular area, or down arm
• Most common in C5/C6 or C6/C7

Question 15

What are symptoms of meningitis?

Answer 15

Fever
malaise
headache
photophobia
neck pain and stiffness
rash

Question 16

What tests are positive for meningitis?

Answer 16

Nuchal Rigidity
Kernig’s Sign
Brudzinski’s signs

Question 17

What causes meningitis?

Answer 17

Bacterial infections: Hemophilus, Strep, Pneumonia (can lead to infection)
Neisseria menigitidis: main cause
Viral infection

Question 18

How is meningitis diagnosed?

Answer 18

Lumbar puncture

Question 19

Where is thoracic outlet found?

Answer 19

Space between clavicle and first rib

Question 20

What structures are found in the thoracic outlet?

Answer 20

Brachial Plexus
Subclavian Artery
Subclavian Vein

Question 21

What is thoracic outlet syndrome?

Answer 21

Compression of neurovascular bundles by structures near thoracic outlet

Question 22

What are symptoms of thoracic outlet syndrome?

Answer 22

Arm pain, numbness or weakness
Aggravated by activities requiring elevation or sustained use of arms or hand above head
Decreased/absent distal pulses
Digital cyanosis and ischemia

Question 23

What tests are positive for thoracic outlet syndrome?

Answer 23

Roos/EAST Test

Adson test

Question 24

With patients that have atraumatic neck pain without red flags, when would imaging be appropriate?

Answer 24

After 6 weeks if symptoms still persist and do not respond to conservative management

Question 25

What can be a major concern with any recent major neck trauma?

Answer 25

Cervical spine fracture (imaging can confirm)

Question 26

What can be a major concern with any neurological symptoms?

Answer 26

Cervical cord compression

Question 27

What can be a major concern with any chronic glucocorticoid use?

Answer 27

Infection or cervical spine compression fracture

Question 28

What should you look out for when inspecting the neck?

Answer 28

Glandular or lymph node swelling Symmetry Masses Scars

Question 29

What structures should you look out for when palpating the neck?

Answer 29

Lymph nodes | Thyroid gland

Question 30

What vascular exam should be done at the neck?

Answer 30

Carotid pulse | Jugular Venous Distention

Question 31

What tests are positive for cervical radiculopathy?

Answer 31

Spurling's Test | Manual Distraction Test

Question 32

When should you never check for neck ROM?

Answer 32

If patient has not been cleared of cervical fractures or spinal cord injury

Question 33

What important feature of the physical exam should always be noted and addressed?

Answer 33

Neck stiffnes

Question 34

What are some causes of neck stiffness?

Answer 34

``` C-spine fractures Spinal cord injuries Ligamentous injuries Muscle strains and spasms Subarachnoid hemorrhage Meningitis ```

Question 35

When is HVLA contraindicated with patients?

Answer 35

``` Rheumatoid Arthritis Down Syndrome Carotid Disease Osteoporosis Local metastases Patients on anticoagulants Osseous or ligamentous disruption ```