Diagnostic Tests for Ankylosing Spondylitis
Ankylosing Spondylitis: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Ankylosing Spondylitis
includes:
Ankylosing Spondylitis Tests: Book Excerpts
Ankylosing Spondylitis Diagnosis: Book Excerpts
Diagnostic Tests for Ankylosing Spondylitis: Online Medical Books
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NECK PAIN:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
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.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Neck pain:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient hasn’t sustained trauma, find out the severity and onset of his neck pain. Where specifically in the neck does he feel pain? Does anything relieve or worsen the pain? Is there any particular event that precipitates the pain? Also, ask about the development of other symptoms such as headaches. Next, focus on the patient’s current and past illnesses and injuries, diet, drug history, and family health history.
Thoroughly inspect the patient’s neck, shoulders, and cervical spine for swelling, masses, erythema, and ecchymoses. Assess active range of motion in his neck by having him perform flexion, extension, rotation, and lateral side bending. Note the degree of pain produced by these movements. Examine his posture, and test and compare bilateral muscle strength. Check the sensation in his arms, and assess his hand grasp and arm reflexes. Attempt to elicit Brudzinski’s and Kernig’s signs if there isn’t a history of neck trauma, and palpate the cervical lymph nodes for enlargement. (See Neck pain: Common causes and associated findings, pages 432 and 433.)
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Neck pain:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient hasn’t sustained trauma, find out the severity and onset of his neck pain. Where specifically in the neck does he feel pain? Does anything relieve or worsen the pain? Is there any particular event that precipitates the pain? Also, ask about the development of other symptoms such as headaches. Next, focus on the patient’s current and past illnesses and injuries, diet, drug history, and family health history.
Thoroughly inspect the patient’s neck, shoulders, and cervical spine for swelling, masses, erythema, and ecchymoses. Assess active range of motion in his neck by having him perform flexion, extension, rotation, and lateral side bending. Note the degree of pain produced by these movements. Examine his posture, and test and compare bilateral muscle strength. Check the sensation in his arms, and assess his hand grasp and arm reflexes. Attempt to elicit Brudzinski’s and Kernig’s signs if there is not a history of neck trauma, and palpate the cervical lymph nodes for enlargement. (See Neck pain: Causes and associated findings, pages 548 to 551.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Neck Pain:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. General. After any cervical spine injury, order an x-ray study first to rule out an unstable injury. Assess gait, which can be impaired with a cervical myelopathy. Notice neck posture (3). Torticollis can occur secondary to trauma, muscle strain, vertebral subluxation, viral infection or from a psychogenic cause. Examine other head and neck structures (e.g., lymph nodes) and the temporomandibular joints (1). Look for meningeal signs, if appropriate.
B. Musculoskeletal examination. Palpate for muscle tenderness or spasm in the neck and head. Tender trigger points may be found in fibromyalgia. Assess active and passive range of motion (ROM) of the neck and shoulders. ROM is not affected with referred sources of pain. Decreased passive ROM may be seen in rheumatoid arthritis (RA), ankylosing spondylitis (AS), disseminated idiopathic skeletal hyperostosis (DISH), compression fractures, and cervical spondylosis. Active contraction or stretching of strained muscles or ligaments will precipitate pain.
C. Neurologic examination. Include the examination of cranial nerves, motor function, tone, and reflexes of the upper and lower extremities. Look for muscle atrophy. Check pinprick and light touch sensation in the upper extremities, looking for a dermatomal pattern of loss. Evaluate cerebellar, vibration, and position sense in the legs. The exact level of nerve root involvement cannot be precisely known from the physical examination because of overlapping innervation (2) (Table 12.9). A Spurling’s test (extension and rotation of the head and neck while applying downward pressure to the top of the head) that precipitates radicular symptoms is very suggestive of nerve root pathology (1).
Testing
A. Clinical laboratory testing. A complete blood count and erythrocyte sedimentation rate are warranted for suspected infection or neoplasm. A positive rheumatoid factor (RF) is found in more than two-thirds of patients with RA, but is also found in 10% to 20% of all elderly individuals. RF and antinuclear antibody are absent in AS. Creatine phosphokinase is elevated in myositis and, possibly, muscle trauma (Chapters 16.3 and 17.3).
B. Diagnostic radiology. Cervical spine films are mandatory after any spine trauma (3). A cross-table lateral film is used to rule out an unstable fracture or dislocation (2). The lateral view must include all seven cervical vertebrae as well as the C7-T1 interspace (3). Cervical spine films are also useful for a vertebral compression fracture, cancer, and rheumatologic disorders. Cortical erosion of the vertebral body indicates an inflammatory process. Increased width of the prevertebral soft tissues can suggest a prevertebral hematoma. Degenerative changes in the vertebral joints, also called spondylosis, are very common with aging and do not correlate well with symptomatology (1,2). Computed tomography scans are excellent for definitive delineation of bony fracture anatomy, when necessary. Magnetic resonance imaging (MRI) is the most effective means to evaluate the soft tissues of the neck. An MRI will distinguish between neoplasm and degenerative disorders of the vertebrae, and visualize ligamentous injury, occult disc herniation, hematoma, or edema around the spinal cord. MRI may identify abnormalities that have no clinical significance (1).
C. Other. An electromyogram (EMG) can delineate the site of a particular nerve lesion or clarify the diagnosis when symptoms and physical examination are discordant (1). An EMG may be negative in nerve damage of less than 3 weeks’duration (1,2).
Diagnostic assessment
A. Spondylosis. Degenerative changes can encroach on the spinal canal or intervertebral foramina. Consider spondylosis-related symptoms in patients aged more than 40 years. Symptoms affect men twice as often as women. Common symptoms include a unilateral or bilateral occipital headache that is worse in the morning and radiates to the frontal region, upper chest, and shoulders.
B. Radiculopathy or myelopathy. Radicular pain usually involves the proximal arm with more distal paresthesias (Table 12.9) (Chapter 4.6). Cervical myelopathy presents with upper extremity nerve root symptoms and long tract signs in the legs. Spasticity may be the most prominent neurologic change. Long tract signs in the legs occur uncommonly without root signs (2). Symptoms can be precipitated by neck movement. Myelopathy is more typically secondary to spondylosis rather than disc herniation.
C. Rheumatologic. Axial involvement with RA may be limited to the upper cervical spine; atlantoaxial subluxation can present as occipital pain. Subluxation can cause cord compression. DISH has a characteristic appearance on x-ray film. It is the most common rheumatologic process affecting the cervical spine, but rarely causes symptoms (1). AS also affects the cervical spine. Gout and pseudogout usually do not.
References
1. Swezey RI. Chronic neck pain. Rheum Dis Clin North Am 1996;22:411–437.
2. Cailliet R. Neck and arm pain. Philadelphia: FA Davis, 1989.
3. Graber MA, Kathol M. Cervical spine radiographs in the trauma patient. Am Fam Physician 1999;59:331–342.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Neck Pain:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
With neck pain after trauma, a cervical fracture must always be ruled out and the patient’s neck immobilized until this is ascertained.
Assess radicular signs of nerve compression as a marker for more serious pathology. The Spurling sign, production of radicular pain with extension and lateral neck rotation, suggests narrowing of the neural foramen. The Lhermitte sign, an electrical sensation radiating down the spine with neck flexion, is a sign of a spinal cord lesion.
With neck pain in the presence of headache or fever, actively consider meningitis.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Neck pain:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Thoroughly inspect the patient’s neck, shoulders, and cervical spine for swelling, masses, erythema, and ecchymoses. Assess active range of motion (ROM) in his neck by having him perform flexion, extension, rotation, and lateral side bending. Note the degree of pain produced by these movements. Examine his posture, and test and compare bilateral muscle strength. Check the sensation in his arms, and assess his hand grasp and arm reflexes. Attempt to elicit Brudzinski’s and Kernig’s signs if there’s no history of neck trauma, and palpate the cervical lymph nodes for enlargement.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Neck pain:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient hasn't sustained trauma, find out the severity and onset of his neck pain. Where specifically in the neck does he feel pain? Does anything relieve or worsen the pain? Does any particular event precipitate the pain? Also, ask about other symptoms, such as headaches or back pain. Next, focus on the patient's current and past illnesses and injuries, diet, drug history, and family health history.
Thoroughly inspect the patient's neck, shoulders, and cervical spine for swelling, masses, erythema, and ecchymoses. Assess active range of motion (ROM) in his neck by having him perform flexion, extension, rotation, and lateral side bending. Note the degree of pain produced by these movements. Examine his posture, and test and compare bilateral muscle strength. Check the sensation in his arms, and assess his hand grasp and arm reflexes. Attempt to elicit Brudzinski's and Kernig's signs if there isn't a history of neck trauma, and palpate the cervical lymph nodes for enlargement.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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