neck pain dzung h. dinh, md, mba professor of neurosurgery university of illinois college of...
TRANSCRIPT
Neck Pain
Dzung H. Dinh, MD, MBA
Professor of Neurosurgery
University of Illinois College of Medicine at Peoria
Evaluation
1. History1. Ask the right questions
2. Listen to the patient
3. Formulate a diagnosis
2. Examination1. To confirm your diagnosis, not to make diagnosis
3. Ordering additional tests1. Again, to confirm or r/o diagnosis.
HistoryAsk the right questions
Critical questions1. Pain location
Central/Axial/Paraspinal Refer HA or Arm Sx True Radicular
2. Pain quality Dull ache Sharp shooting –neck, occiput,
arm Burning vs. dysesthesia
3. Pain Pattern - Diffuse Discrete
4. Numbness – pattern, location
5. Deficit – pattern/distribution
Not so critical questions
1. Pain onset/inciting event
2. Pain provocation3. Pain diminution4. Up-to-date Rx
HistoryListen to the patient
Stumbling gaitDropping thingsHand falling asleepSkin feels burntTrouble going upstairUrinary hesitancyNo painWoke up with weaknessSlowly getting worse
HistoryDiagnosis formulation
Diffuse neck pain, HA, skin burning, TP – myofascial pain.
Discrete arm pain, not much neck pain, discrete deficit – radiculopathy
Weakness, no pain, no numbness – ALSHand numbness in median or ulnar pattern-
CTS or cubbital Sx
Wrist extensor weakness- C7 or radial nerve
Radicular sx and entrapment sx - Double crush syndrome (C5 or 6 and CTS, C8 or T1 and ulnar)
Examinationto confirm your diagnosis
Myofascial pain: Trigger points (supraspinatus, rhomboid, teres), no deficit
Myelopathy: spastic gait, hyperreflexia, path reflex
Radicular distribution deficit – radicularC5: deltoid, infra/supraspinatusC6: bicep, dorsal forarm, thumb, index fingerC7: tricep, index, middle finger, finger, wrist extensionC8: 4th,5th fingers, volar of forearm, grip weaknessT1: under arm, finger extension.
Peripheral entrapment CTS: middle 3 fingers, grip weakness, + PhalenCubittal Sx: last 2 fingers, opponens, + TinelRadial nerve pathology
Additional Teststo confirm your diagnosis
Myofascial pain- EMG/NCV if there is lots of refer Sx
Myelopathy: MRI Radicular – MRIPeripheral entrapment – EMG/NCV
Treatment Plan
1. Myelopathy with cord compression – surgery
2. Radiculopathy with deficit – surgery +/-
3. Myofascial Pain – Never surgery
4. Peripheral Entrapment Sx - Maybe
5. Double crush Sx – Depends
6. Radiculopathy and Myofascial Pain - depends