NECK STIFFNESS

Ask the Following Questions:

1. Is it acute or chronic? Acute stiffness of the neck should make one look for nuchal rigidity. If there is nuchal rigidity, meningitis or subarachnoid hemorrhage would be high on the list of possibilities. If there is chronic neck stiffness, one should consider rheumatoid arthritis, cervical spondylosis, and idiopathic torticollis. With a history of trauma, the possibility of flexion-extension injury and fracture is more likely.
2. Is there nuchal rigidity or fever? The presence of nuchal rigidity or fever should make one think of meningitis, subarachnoid hemorrhage, or meningism due to some systemic infectious disease. Retropharyngeal abscess must also be considered.
3. Is it congenital or acquired? The presence of congenital stiffness of the neck should make one think of congenital torticollis or Klippel-Feil syndrome. Chronic acquired neck stiffness should make one think of cervical spondylosis, Parkinson's disease, idiopathic torticollis, rheumatoid arthritis, tuberculosis, fractures of the spine, flexion-extension injuries, and inflammation of the lymph nodes.
4. Are there x-ray changes? Plain films of the cervical spine will often reveal cervical spondylosis, fractures, and tuberculosis. However, one should not jump to the conclusion that this is the cause of the condition.

DIAGNOSTIC WORKUP

If there is nuchal rigidity and fever, a CT scan of the brain should be done to rule out a space-occupying lesion, and, following that, a spinal tap for analysis, smear, and culture should be done.

If there is no nuchal rigidity or fever, plain films of the cervical spine are a good place to start the diagnostic workup. A CBC, sedimentation rate, urinalysis, chemistry panel, and arthritis profile may also be helpful. If the stiffness is associated with pain radiating into the upper extremities, EMG and nerve conduction velocity studies may be useful. If the stiffness persists, MRI of the cervical spine may be necessary. A bone scan may identify a subtle fracture or osteomyelitis. A neurologic specialist should be consulted before ordering expensive diagnostic tests.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

Other Book Chapters Related to Neck symptoms

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Neck symptoms: Introduction (review 620 causes)
• Next Book Extract About Neck symptoms: NECK SWELLING (Algorithmic Diagnosis of Symptoms and Signs)
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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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