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OMM M1T2 test 2 > Differential Dx of Neck Pain part 1 > Flashcards

Differential Dx of Neck Pain part 1 Flashcards

1
Q

Powerpoint 1

How many known causes of neck pain are there?

A

123

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2
Q

Powerpoint 1

What should you try to rule out in neck pain?

A

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

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3
Q

Powerpoint 1

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

A

Age less than 20

Age over 50

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4
Q

Powerpoint 1

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

A

Fever and hypertension

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5
Q

Powerpoint 1

What could be worrying in the history in neck pain?

A

Trauma
Fever
Abrupt onset
Neurologic symptoms

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6
Q

Powerpoint 1

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

A

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

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7
Q

Powerpoint 1

What should be considered for congenital disorders?

A

Present since childhood

Onset of symptoms at certain ages

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8
Q

Powerpoint 1

What should be considered for trauma?

A

History of trauma

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9
Q

Powerpoint 1

What should be considered for mechanical issues of the neck?

A

Insidious onset

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10
Q

Powerpoint 1

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

A

Exposure to toxins

  • vocational
  • avocational
  • incidental
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11
Q

Powerpoint 1

What should be considered in metabolic disorders in neck pain?

A 
Endocrine
-diabetes mellitus
-thyroid disease 
Nutrition
-ingestion
-digestion
-excretion
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12
Q

Powerpoint 1

What should be considered in inflammatory action in neck pain?

A

Abrupt onset

  • rubor
  • tumor
  • calor
  • dolor
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13
Q

Powerpoint 1

What should be considered in degenerative neck pain?

A

Age 50 and older (needs imaging)

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14
Q

Powerpoint 1

What should be considered for infection in neck pain?

A 
Fever
WBC elevation (need imaging)
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15
Q

Powerpoint 1

What should be considered for neoplasms in neck pain?

A

Age 50 yeas and older (need imaging)

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16
Q

Powerpoint 1

What should be considered for circulatory problems in neck pain?

A 
Vital signs
-pulse rate
-blood pressure
Physical exam
-palpate pulses-auscultate heart-auscultate arteries
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17
Q

Powerpoint 1

What should be considered in neurological problems in neck pain?

A 
Nuerologic abnormalities are present
Muscle weakness or spasm
Reflex alterations
Sensory loss
Pain in nerve root and peripheral nerve distribution
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18
Q

Powerpoint 1

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

A

Diagnosis of exclusion

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19
Q

Powerpoint 1

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

A

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

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20
Q

Powerpoint 1

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

A

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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21
Q

Powerpoint 1

When pain is percussed, what are the possible presentations?

A

Fracture
Tumor
discitis
Facet joint synovitis

22
Q

Powerpoint 1

What are some red flags for facet dislocation?

A

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

23
Q

What are the physical findings of the facet joint dislocation?

A

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

24
Q

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

A

Bilateral

25
Q

Where will pain radiate to in a herniated cervical disc?

A

Shoulder, arm, forearm, wrist or hand

26
Q

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

A 
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
27
Q

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

A

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

28
Q

What does the valsalva test do?

A

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

29
Q

What is the Lhermitte sign?

A

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

30
Q

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

A

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

31
Q

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

A

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

32
Q

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

A

C5 - biceps
C6 - brachioradialis
C7 - triceps reflex

33
Q

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

A

Sensory loss
Muscle weakness
Reflex loss

34
Q

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

A 
Sensory deficits
Muscle spasticty
Hyperreflexia
Clonus
Hoffman reflex
Babinski reflex
35
Q

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

A

Straightening or reversal of cervical lordosis

MRI used to confirm

36
Q

What would you see in a cervical sprain and strain?

A

Flattening of the cervical lordosis, abnormal head carriage, torticollis

37
Q

What is palpated for in cervical sprain and strain?

A

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

38
Q

What type of injury could happen with hyperextension?

A

Sternocleidomastoid tear and hematoma formation

39
Q

What are some causes and symptoms of torticollis?

A 
Strained sternocleidomastoid and scalenes 
Muscular ischemia
Facet dislocation with overriding
C1 - C2 dislocation 
Could be present since birth
40
Q

How would you test for congential muscular torticollis?

A

Found in newborns and test cervical range of motion

30 degrees side bend, 90 rotation

41
Q

What are some risk factors for baby torticollis?

A 
Stuck fetus
Cephalohematoma
Clavicular fracture 
Brachial plexus injury
Prolonged stage 2 labor
42
Q

What are some congenital etiologies of torticollis?

A 
Klippel-Feil Syndrome
Basilar Impression
Atlanto-occipital Fusion
Pterygium Colli (web neck)
Odontoid Abnormalities
43
Q

What is klippel-feil syndrome?

A

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

44
Q

What is an odontoid abnormality?

A

Hypoplastic dens

May present in achondroplastic dwarfism and down syndrome

45
Q

What are some inflammatory etiologies of torticollis?

A

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

46
Q

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

A

Trasverse odontoid ligament

posterior into spinal cord

47
Q

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

A

Odontoid

48
Q

What are some neurologic etiologies?

A 
Ocular Dysfunction
Syringomyelia
Spinal Cord Tumor
Cerebellar Tumor
Bulbar Palsies
Spasmodic Torticollis
49
Q

What is syringomyelia?

A

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

50
Q

What is Sandifer’s syndrome?

A

An acute idiopathic cervical disc calcification
Hiatus hernia
Gastroesophageal reflux

OMM M1T2 test 2 (9 decks)

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