primary care interpersonal collaborative practice Final verrified answers

Pain can effect the neck or can move into the head, shoulders, or arms Can start without an inciting event risk factors of neck pain -ANSWER- Manual labor occupations Female gender Headaches Smoking Poor job satisfaction Poor biomechanics Chronic pain -ANSWER- neck pain > 12 weeks neck pain clinical presentation -ANSWER- Obtain a thorough Hx and P.E. including past medical, social, occupational, and family history ROS Sx PQRST physical exam for neck pain -ANSWER- Careful observation of the patient Note: cervical alignment, discomfort, frequent position change and evaluating the patient's affect Observe: Gait The skin and vascular system should be appraised for medical causes of neck pain, including meningitis, dental or jaw pain, and malignant neoplasm Spinal palpation Neuro testing, provocative testing Neck Pain: Cervical Compression Test (axial load test) diagnostic for neck pain -ANSWER- X-rays CT scan/MRI Labs (Dependent on systemic symptoms or if anything else is going on) ESR, CBC, alkaline phosphatase, and calcium levels EMG (rare diagnostic) differential diagnosis neck pain -ANSWER- It is imperative to R/O serious sources of neck pain, including Infection, fracture, inflammatory diseases, neoplasm, and other medical causes, with a thorough Hx and P.E. Metastatic disease or infection, diabetic neuropathy, Lyme disease, herpes zoster, thoracic outlet syndrome, and brachial plexopathy Cervical dystonia/torticollis traumatic neck pain risk factors -ANSWER- age >65 years Paresthesia in extremities Altered mental status Multiple fractures Drowning or diving accident Significant head or facial injury Rigid spinal disease (e.g. ankylosing spondylitis) "Dangerous mechanism" defined as: a fall from an elevation of 3 feet or more, or 5 stairs; axial load to the head (e.g. diving), MVC at high speed > 60mph or with rollover or ejection, collision involving a motorized recreational vehicle or a bicycle collision. C-spine injury -ANSWER- C-spine must be immobilized in these situations. C-spine CT is the study of choice to evaluated for injury - screening imaging MUST be done before any neck