NECK PAIN

Ask the Following Questions:

1. Is there radiation of the pain to one or both upper extremities? The finding of radiation of the pain to one or both upper extremities would suggest a space-occupying lesion such as a herniated disk, spinal cord tumor, fracture, or cervical spondylosis.
2. Are there focal neurologic findings? The presence of focal neurologic findings make a space-occupying lesion even more likely, and the conditions that should be considered are fracture, herniated disk, spinal cord tumor, and cervical spondylosis. One should not forget a Pancoast's tumor.
3. Is there nuchal rigidity? The finding of nuchal rigidity suggests meningitis or subarachnoid hemorrhage.

DIAGNOSTIC WORKUP

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.

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 Stiff neck

Read excerpts from these other book chapters related to Stiff neck:

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

More About Causes of Stiff neck

• Back to symptom: Stiff neck: Introduction (review 127 causes)
• Next Book Extract About Stiff neck: NECK STIFFNESS (Algorithmic Diagnosis of Symptoms and Signs)
• All Book Extracts: All Online Book Extracts for Stiff neck

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

 » Next page: NECK STIFFNESS (Algorithmic Diagnosis of Symptoms and Signs)

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• NECK STIFFNESS (Algorithmic Diagnosis of Symptoms and Signs)
• Neck Stiffness/Pain (In a Page: Signs and Symptoms)
• Nuchal Rigidity (In A Page: Pediatric Signs and Symptoms)
• NECK PAIN (Differential Diagnosis in Primary Care)
• NUCHAL RIGIDITY (Differential Diagnosis in Primary Care)

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