What is the pattern behind neck pain?
Diffuse
What are the public health consequences of biomedical focus?
- Overuse of radiology - financial cost 2. Overuse of radiology - impact on patient beliefs and self-efficacy 3. Inappropriate surgical referrals 4. Overuse of ineffective treatment
What is the diagnostic triage for neck pain and how does it work?
- Clinicians should conduct a clinical evaluation to rule out major structural or other pathologies 2. The Canadian C-spine Rule should be used to rule out cervical spine fractures and dislocations
What is the Canadian C-spine rule?
What is the clinical presentation for cervical artery dissection?
- Younger patients under 55 years
- Acute sudden onset of unfamiliar headache or neck pain
- Moderate to severe pain
- Spontaneous onset following recent exposure to minor trauma or neck strain
- Recent unfamiliar neurological symptoms (5Ds and 3Ns)
- Developing neurological symptoms and signs during or after examination or treatment
- If there is anything about patient’s presentation that makes you concerned
What are the 5Ds and 3Ns?
What should you do if you suspect CAD?
- Immediate referral to nearest Emergency Department
- Send a written report of history and signs or symptoms of concern
What features should you look out for in vertebal artery insufficiency? What is VBI more commonly associated with? What are the symptoms related to?
- 5Ds and 3Ns
- Longstanding neck pain and stiffness.
- Symptoms are commonly related to movement and positions of the neck
How do we test for vertebral artery insufficiency?
- Positional tests
- Sustained rotation in sitting
- Sustain for at least 10 seconds
- Wait 10 seconds in neutral between sides
When should the VBI positional tests be used?
If the symptoms are unclear and the clinician is exploring the possibility of VBI differentiating the source of any dizziness, light headahces or unsteadiness
What are the indications of radiculopathy?
- Parasthesia or numbness in the arms or legs
- Pain radiating to arm or leg
- Muscle atrophy
- Suspicion of radiculopathy or myelopathy
What does the neurological examination consist of?
- Sensation
- Muscle power
- Reflexes
Understand what movements C5-T1 are responsible for.
Understand what peripheral nerves are associated with wrist extension, thumb abudcition and 5th digit abudction.
Radial nerve, Median nerve, Ulnar nerve
What does the presence of clonus or absence of Babinski reflex indicate?
CNS problem
