Cervical Pain Syndrome
Most common causes of neck pain:
- Cervical strain and/or myofascial pain: contributing causes such as sleeping difficulties, poor workplace ergonomics, and posture problems must be ruled out.
- Cervical spondylosis, discogenic, or facet joint pain: there is a poor correlation between radiographic abnormalities and whether or not a patient is having neck pain. Lidocaine injection of the facet joints can determine if facet joint arthritis is the pain generator.
- Cervical whiplash syndrome: caused by a traumatic event resulting in abrupt flexion/extension of the neck usually following a rear-end collision. In up to 50% of patients, pain can persist long after the acute injury in spite of no abnormality being seen on any imaging study. The exact pathology is unclear although alar ligament injury has been demonstrated in many patients. Clinical variables associated with prolonged symptoms include: female, younger age, stationary vehicle, prior history of neck pain, severity of collision, not being at fault, and bored with present job. Whether or not compensation is available also contributes to the length and severity of symptoms.
Comparison of active and passive range of motion is useful for differentiating articular from soft-tissue disorders. Passive neck range of motion is best performed by supporting the head while the patient is supine.
During rotation and lateral bending, ipsilateral discomfort elicited in the direction of movement is suggestive of bony pain. Pain and/or tightness produced on the contralateral side usually implicates a muscular disorder. Finally, palpable tenderness of the spinous processes may indicate bony pathology whereas local tenderness of paraspinous muscles usually indicates myofascial pain. Passive range of motion (and provocative tests) should not be performed if instability or fracture of the cervical spine is suspected.
Symptoms and Findings of Cervical Myelopathy vs. Radiculopathy
FEATURE |
MYELOPATHY |
RADICULOPATHY |
Etiology |
Spinal cord compression |
Nerve root compression |
Neck pain |
Variable |
Variable |
Cranial nerve |
Occasional |
Never |
Sensory loss |
Stocking-glove paresthesias/numbness (all limbs) |
Light touch/pinprick (upper limb dermatome) |
Weakness (early) |
All limbs (diffuse) |
Upper limb myotome |
Weakness (late) |
Spastic paraparesis, quadriparesis |
Upper limb myotome |
Deep tendon reflexes |
Upper limbs (decreased) Lower limbs (increased) |
Upper limb (decreased) |
Pathologic reflexes |
Babinski’s sign, Hoffmann’s sign |
None |
Lhermitte’s sign |
Occasional |
Never |
Bladder disturbance |
Urine retention, urine incontinence |
None |
Spinal automaticity |
Jumping legs |
None |
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