Neck Pain
Dzung H. Dinh, MD, MBA
Professor of Neurosurgery
University of Illinois College of Medicine at Peoria
Disclosure
Aesculap
ROI
Nuvasive
Content
1.
2.
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4.
Anatomy
Evaluation of neck pain
Differential diagnosis
Treatment plan
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
Evaluation
1. History
1.
2.
3.
Ask the right questions
Listen to the patient
Formulate a diagnosis
2. Examination
1.
To confirm your diagnosis, not to make diagnosis
3. Ordering additional tests
1.
Again, to confirm or r/o diagnosis.
History
Ask the right questions
 Critical questions
 Not so critical questions
 1. Pain location
 1. Pain onset/inciting event
 Central/Axial/Paraspinal
 2. Pain provocation
 Refer HA or Arm Sx
 3. Pain diminution
 True Radicular
 2. Pain quality
 Dull ache
 Sharp shooting –neck, occiput, arm
 Burning vs. dysesthesia
 3. Pain Pattern - Diffuse Discrete
 4. Numbness – pattern, location
 5. Deficit – pattern/distribution
 4. Up-to-date Rx
History
Listen to the patient
 Stumbling gait
 Dropping things
 Hand falling asleep
 Skin feels burnt
 Trouble going upstair
 Urinary hesitancy
 No pain
 Woke up with weakness
 Slowly getting worse
History
Diagnosis formulation
 Diffuse neck pain, HA, skin burning, TP – myofascial
pain.
 Discrete arm pain, not much neck pain, discrete deficit
– radiculopathy
 Weakness, no pain, no numbness – ALS
 Hand numbness in median or ulnar pattern- CTS or
cubbital Sx
 Wrist extensor weakness- C7 or radial nerve
 Radicular sx and entrapment sx - Double crush syndrome
(C5 or 6 and CTS, C8 or T1 and ulnar)
Examination
to confirm your diagnosis
 Myofascial pain: Trigger points (supraspinatus, rhomboid, teres),
no deficit
 Myelopathy: spastic gait, hyperreflexia, path reflex
 Radicular distribution deficit – radicular
 C5: deltoid, infra/supraspinatus
 C6: bicep, dorsal forarm, thumb, index finger
 C7: tricep, index, middle finger, finger, wrist extension
 C8: 4th,5th fingers, volar of forearm, grip weakness
 T1: under arm, finger extension.
 Peripheral entrapment
 CTS: middle 3 fingers, grip weakness, + Phalen
 Cubittal Sx: last 2 fingers, opponens, + Tinel
 Radial nerve pathology
Additional Tests
to confirm your diagnosis
 Myofascial pain- EMG/NCV if there is lots of refer Sx
 Myelopathy: MRI
 Radicular – MRI
 Peripheral entrapment – EMG/NCV
Treatment Plan
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Myelopathy with cord compression – surgery
Radiculopathy with deficit – surgery +/Myofascial Pain – Never surgery
Peripheral Entrapment Sx - Maybe
Double crush Sx – Depends
Radiculopathy and Myofascial Pain - depends
Case Presentation
Thank You