Festival Neck Pain

Presentation:

Chest pain or tightness

Can present as pain radiating down one or both arms or as neck or jaw pain

Acute Coronary Insufficiency

Presentation:

Chest pain or tightness

Can present as pain radiating down one or both arms or as neck or jaw pain

May be associated with dyspnea, diaphoresis, pallor, weakness, and nausea

MI

Presentation:

Severe tearing or crushing pain along chest, anterior base of neck, or interscapular region

Symptoms may include ischemic neuropathy

Dissecting Aneurysm of the Thoracic Aorta

What are risk factors of Dissecting Aneurysm of the Thoracic Aorta?

Male, hypertension, lung disease, arteriosclerosis, connective tissue disease

Presentation:

Shoulder or lateral neck pain with chest pain

Deep breathing and changes in position aggravate the symptoms

Diaphragm Injury

Presentation:

Pain in the midepigastric region or right upper quadrant, with referred pain to the superior shoulder, interscapular, and upper trapezius regions

Liver Injury

Liver injury MOI?

MVA, body shot while fighting

What are additional signs of liver injury?

Signs of blood loss such as shock and hypotension

Presentation:

Sharp anterior chest pain

May radiate to neck, back, left shoulder, or left supraclavicular region

Pericarditis

What makes pain of pericarditis worse?

deep inspiration, coughing, trunk rotation or sidebending, and lying supine

What alleviates pain of pericarditis?

Sitting up or leaning forward

Pericarditis may be associated with history of?

Recent respiratory illness, fever, chills, neoplasm, or heart disease

Presentation:

Anterior neck pain in association with a firm mass, hoarseness, or signs of tracheal compression

Women in their 60s are most commonly affected

Riedel’s Struma

Presentation:

Moderate to severe pain in the anterior neck and chest

Accompanied by SOB, throat soreness, or dysphagia

More common in young men

Spontaneous Pneumomediastinum

What aggravates symptoms of Spontaneous Pneumomediastinum?

Deep breathing, coughing, or lying supine

What alleviates symptoms of Spontaneous Pneumomediastinum?

Sitting up or leaning forward

Presentation:

Pain in the upper region of the neck near the angle of the jaw

Pain may also occur in the ipsilateral side of the face, ears, throat, temple, and SCM

Eagle’s Syndrome

What aggravates pain of Eagle’s Syndrome?

Swallowing, talking, and turning the head toward the painful side

Presentation:

Pain and edema of the mouth, submandibular, and anterior neck regions in association with sublingual firmness, excessive drooling, fever, malaise, and tachcardia

Submandibular Space infection

What are risk factors of submandibular space infection?

Recent dental work, oral piercing, and mandibular fracture

Presentation:

Pain in the C-spine and UE

associated with parasthesias and unremarkable reflex, sensation,, and myotomal strength test

T4 syndrome

Presentation:

Lateral neck pain that radiates into the arm and hand accompanied by paresthesias and numbness in the medial forearm and 4th/5th fingers with possible weakness of the intrinsic hand muscles

(Can occur from trauma)

TOS

Presentation:

Pain, tenderness, and swelling anteromedially to the SCM

Abscess or Cyst Infection

Presentation:

Pain and swelling of carotid sheath and carotid artery

Symptoms may include general malaise and fever

Arteritis

Presentation:

Neck pain and stiffness

Associated with HA, fever, nausea, vomiting, photophobia, and CNS dysfunction including altered mental status, seizures, gait disturbances, and paresis.

Symptoms may progress rapidly or over a period of several days

Bacterial Meningitis

What aggravates symptoms of Bacterial Meningitis?

Flexion and Rotation

Presentation:

Anterior neck pain

Other symptoms include hemoptysis (spitting of blood), hoarseness of the voice when speaking, dysphagia (swallowing difficulties), odynophagia, and obstruction of the airway

Trauma to Larynx or Trachea

Presentation:

Traumatic onset of variable symptoms in the C-spine and the UEs.

Neurological symptoms

Brachial plexus lesion

Presentation:

Pain in the posterior or posterior lateral region of the neck with or without radiculopathy

More present in older population

Cervical DDD/DJD

Presentation:

Pain the in the posterior or posterolateral aspect of the neck with or without radicular symptoms down the arm or through the midthoracic region

Cervical Disk Herniation

Demographics of Disc herniation

Traumatic in midlife

Degenerative in older population

Presentation:

Anterior or Lateral neck pain and rotational position of the head and neck

Cervical Dystonia

Presentation:

Sharp pain in the posterior or posterolateral aspect of the C-spine accompanied by ipsilateral ROM loss in the directions of Side-bending and rotation

Cervical Facet Dysfunction

Presentation:

Pain along the SCM to the jaw with swelling and tenderness of the lymph nodes

Fever, sore throat, and pain with shallowing may also occur

Cervical Lymphadenitis

Presentation:

Posterior, midline neck pain and progresses to include:

radiculopathy/paresthesias

weakness into one or more extremeties

Loss of bowel and bladder control

Cervical Osteomyelitis

What aggravates cervical osteomyelitis?

Movement (accompanied by low grade fever)

Risk factors for osteomyelitis?

DM, trauma, and infection outside the C-spine

Presentation:

Pain in the posterior or posterolateral region of the neck with or without radiculopathy

Cervical stenosis

What worsens symptoms of cervical stenosis? Eases?

Worsens- extension

Eases- flexion

New onset of unexplained or persistent or recurrent physical or mental fatigue that substantially reduced activity level and is characterized by post exertional malaise

**Diagnosis of exclusion**

Chronic Fatigue Syndrome

Presentation:

Sudden onset of severe neck pain and head pain on one or both sides during sexual intercourse

Pain may be accompanied by nausea, vomiting, and anxiety.

Coital Neck pain

Presentation:

Traumatic onset of severe chronic neck and shoulder pain accompanied by allodynia, hyperalgesia, and trophic, vasomotor, and sudomotor changes

CRPS

Presentation:

Moderate to severe neck pain and stiffness

Crowned Dens Syndrome

Presentation:

Posterior and/or anterior neck and jaw pain

Digastric and Stylohyoid muscle strain

What is a digastric and stylohyoid muscle strain associated with?

TMJ dysfunction, teeth clenching and grinding

Presentation:

Sudden onset of knife-like, tearing, unilateral neck pain with HA and face pain.

Lying in supine usually aggravates symptoms

Dissection of the internal carotid artery

Unilateral or bilateral HA, pain, paresthesia and hypoesthesia in the distribution of the greater or lesser sub occipital nerve

Nausea, dizziness, or visual disturbances may be present

Greater occipital nerve entrapment

Presentation:

Unilateral neck and shoulder pain, associated with altered scapulohumeral mechanics during elevation and abduction

Spinal Accessory Nerve Entrapment

MOI for spinal accessory nerve entrapment?

Gun shot/ stab wounds, during surgical procedures

Presentation:

sudden onset of severe HA and/or severe localized neck pain with stiffness. A pattern of loss of consciousness, followed by lucidity/alertness, then another loss of consciousness is typical though not present in all cases

Other symptoms include dizziness, nausea or vomiting, confusion, enlarged pupil, seizures, and focal neurological deficits

Epidural Hematoma

Who has higher risks for epidural hematoma?

AS, hypertension, coronary and peripheral vascular disease, and patients taking anticoagulant drugs are at higher risk for developing this condition.

Presentation:

Chronic widespread joint and muscle pain defined as bilateral upper body, lower body, and spine pain, associated with tendrness to palpation of 11 of 18 specific muscle-tendon sites

Fibromyalgia

Presentation:

Pain in all areas of the cervical spine, associated with generalized body pain

Trigger points may develop

Fibromyositis

Presentation:

Midline tenderness to palpation

Neck pain with muscle spasm, crepitus, step-off deformity, and restricted and painful AROM

Low C-Spine fracture

Presentation:

Suboccipital midline tenderness, muscle spasm, and neck pain that may or may not include

Upper C-Spine Fracture (C0-C2)

Presentation:

Rapid onset of unilateral neck pain and swelling

Hemorrhage

What increases risk of hemorrhage?

Hypertension, trauma, or thrombolytic therapy

Presentation:

Fatigue, HA, fever, neck stiffness, joint and muscle pain, anorexia, sore throat, and nausea

Lyme Disease

Presentation:

Neck pain and stiffness, sore throat, HA, fever, nausea, vomiting, drowsiness, confusion, and myalgia

Meningismus

Presentation:

Local pain that may be present in various regions of the C-spine dependent on the location of the injury

Muscle Strain

Presentation:

Diffuse bone pain and tenderness of affected bones with progressive muscle weakness and fracture with minimal trauma

Osteomalacia

Presentation:

Pain following a fracture of the C-spine associated with limited bone mineral density in the area

Osteoporosis

Osteoporosis risk factors?

Female, Caucasian or Asian, early menopause, family history, under weight, excessive drinking or smoking, and overuse of steroids

Presentation:

Bone pain, bone deformity, fracture, and deafness

Symptoms are continuous, increases with rest, weight bearing, when limbs are warmed, and at night

Paget’s Disease

Presentation:

Morning stiffness and generalized pain throughout multiple joints in a symmetric distribution, with possible tenderness and swelling of affected joints

RA of C-spine

Presentation:

Severe HA and/or neck pain with nuchal rigidity.

Additional symptoms include nausea, vomiting, photophobia, drowsiness, confusion, dizziness, transient loss of consciousness, and enlarged pupils

Subarachnoid Hemorrhage

2 big risk factors or subarachnoid hemorrhage?

Hypertension and DM

Subarachnoid hemorrhage most common causes?

Head trauma and intracranial aneurysms

Presentation:

Neck pain and unilateral or occipital HA associated with a decline in level of consciousness and focal neurological deficits.

Secondary symptoms include autonomic signs, vomiting, somnolence, or signs of personality change

Subdural Hematoma

Causes of subdural hematoma?

Severe sneezing, coughing, strain from heavy lifting, and whiplash injury

Presentation:

Neck pain with or without neurological deficits

Traumatic/Degenerative/Congenital Subluxations/Dislocations

Causes of degenerative subluxations?

Transverse ligament rupture in pts with RA and downs syndrome

Presentation:

Neck pain associated with fatigue and joint pain/swelling affecting the hands knees, feet, and shoulders

Lupus

Demographics of Lupus?

Mostly women of child bearing age

Presentation:

HA radiating from the muscles of mastification, periauricular, or the TMJ joint

Associated with abnormal jaw function, asymmetric chewing, bruxism, neck pain, tinnitus, and vertigo

TMJ Dysfunction

Presentation:

Neck pain, swelling, and tenderness to palpation of the thyroid

Subacutely, this presentation includes dull, aching paratracheal neck pain that radiates to one or both ears

Other symptoms include sore throat, thyroid enlargement and tenderness, and pain with swallowing

Thyroiditis

Presentation:

Posterior neck pain with radiculopathy and paresthesias into the UE followed by LE weakness and paresthesias

Transverse Myelitis

Presentation:

Sharp, burning or stabbing, substernal, anterior neck and throat pain that can include radiating pain around the thorax to the midline of the back

Pts may report melena, odynophobia, and dysphagia

Carcinoma of the Esophagus

Presentation:

Diffuse anterior neck pain with swelling and tenderness to palpation of the lymph nodes combined with fever, fatigue, weight loss, night sweats, and itching without evidence of skin lesion

Lymphoma

Demographics of lymphoma:

Over 50 years old

Presentation:

Rapid onset of severe unilateral or posterior neck pain with HA in occipital region

Possible vertigo and neurological deficits

Dissection of Vertebral Artery