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Flashcards in neck pain Deck (23):
1

risk factors for neck pain

hx of neck pain
>40 yo
HA
talk on telephone
stress
twisting/bending at work

2

good prognosis

regular exerciser

3

poor prognosis

hx of neck pain, prior sick leave

4

majority of neck pain in family med office

nonspecific: mechanical forces of daily movement/posture/sleep/neck tension

5

aging effects on neck

disks less resilient to compression/torsion
narrowed disk space
increase osteophytic impingement
arthritic facet joints

6

neck pain without cervical nerve root radiculopathy

anterior longitudinal ligament injury d/t acute hyperextension or anterior disc bulge

7

neck pain with nerve root impingement in spinal cord - radiculopathy

posterior longitudinal ligament injury d/t posterior disc bulge

8

neurogenic pain - nerve root impingement

sensory + motor nerves join after passing through IVF:
parasthesia
hypestheisa: ↓ sensation
hypalgesia: ↓ pain sense

9

sensory nerve root impingement

pain in dermatomal distribution

10

motor nerve root impingement

unpleasant sensation in region of muscle group innervated by root

11

pain receptors in neck:

outer annulus of disc
ligaments
facet joints
neck muscles

12

degenerative disk disease - cervical spondylosis

disc space narrowing
osteophytes in disc margins
facet joint arthritis

13

osteophytes and thickening of ligamentum flavum cause direct compression on spinal cord
worsen: flexion stretches cord over osteophtyes, extension stretches LF over cord
*unsteady gait, LE weakness, hyperreflexia, B/B or sexual dysfunction
+ Lhermitte sign

cervical myelopathy

14

acceleration/deceleration injury

mild: muscle strain
severe: anterior longitudinal ligament, nerve roots (need imaging!), disk annulus, facet joints impact posteriorly on each other

15

most common cause of chronic pain after MVA

facet joints

16

spurling test

cervical disc herniation
useful when positive test
pt brings ear to shoulder to side of radicular pain and extends head back
examiner exerts downward pressure on head to intensify radicular sx

17

axial manual traction test

cervical disc herniation
examiner pulls up on head to decrease pressure on cervical root
Positive: relief of pain

18

arm abduction test

cervical disc herniation
elevating (full abduction of shoulder)
affected arm overhead to decrease pressure on cervical root
positive: relief of pain

19

lhermitte sign

cervical myelopathy
shooting pain down back with axial head compression

20

if signs of infection, inflammation, bone damage get

ESR
CBC
calcium phospate

21

most non-traumatic neck pain resolves in

4 weeks - no imaging required
if neuro deficit and non-surgical tx not helping: CT or MRI (nerve root compression, disc disease, soft tissue, especially if surgery being considered)

22

xray detection with neck pain (AP, lateral, and oblique - show foramina, flexion/extension if no fracture and looking for spondyloslisthesis

bone mets
paget disease
myeloma
ankylosing spondylitis

23

lumbar and cervical spine: incidental abnormalities frequently found

imaging confirms a diagnosis - does not make diagnosis