NECK PAIN
NECK PAIN: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Is there radiation of the pain to one or both upper extremities? The finding of radiation of the pain to one or both upper extremities would suggest a space-occupying lesion such as a herniated disk, spinal cord tumor, fracture, or cervical spondylosis.
- Are there focal neurologic findings? The presence of focal neurologic findings make a space-occupying lesion even more likely, and the conditions that should be considered are fracture, herniated disk, spinal cord tumor, and cervical spondylosis. One should not forget a Pancoast's tumor.
- Is there nuchal rigidity? The finding of nuchal rigidity suggests meningitis or subarachnoid hemorrhage.
DIAGNOSTIC WORKUP
Routine tests include a CBC, sedimentation rate, urinalysis, chemistry panel, arthritis panel, and plain films of the cervical spine. At this point, it is best to observe the results of conservative treatment before an expensive workup is begun. If there are focal neurologic findings, MRI of the cervical spine, as well as EMG examinations, nerve conduction velocity studies, and dermatomal SSEP studies may need to be done.
It is wise to consult a neurologist or neurosurgeon before ordering these expensive tests. If there is nuchal rigidity, a CT scan of the brain should be done before performing a spinal tap unless there are clear-cut clinical findings of meningitis. If possible, a neurologist should be consulted first in these circumstances.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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