_________________________________________________________________________ Neck Pain in Adults
“RED FLAG” FEATURES IN NECK PAIN
Red Flag
Potential Conditions
Associated Signs and Symptoms
Trauma (fall, motor vehicle accident, whiplash injury)
Vertebral fractures, spinal cord injury/syrinx, ligamentous disruption
Loss of or alternating consciousness, cognitive deficits, traumatic brain injury, headaches, neurologic symptoms Easily fatigued, gait abnormalities, limited neck mobility, torticollis, clumsiness, spasticity, sensory deficits, upper motor neuron signs Weight loss, unexplained fevers, anorexia, family or personal history of malignant neoplasm, diffuse joint pain and stiffness, abnormal laboratory test results Fever, neck stiffness, photophobia, elevated white blood cell count Hoffmann sign, hyper-reflexia, Babinski sign, spasticity, incontinence, sexual dysfunction Birthmarks, overlying skin tags, patches of hair, family history, systemic disease (diabetes, epilepsy for spina bifida) Male sex, poor work or school performance, depression or other psychiatric morbidity Nausea, extension of pain into the left arm (especially medial upper arm) Family or personal history of malignant neoplasm, previous trauma Arterial dissection: tearing sensation, headache, visual loss, or other neurologic sequelae Diplopia, dizziness, drop attacks (syncope), dysarthria, dysphagia, ataxia of gait, nausea, numbness, and nystagmus
Rheumatoid arthritis, Down syndrome, spondyloarthropathy Constitutional symptoms
Atlantoaxial subluxation
Metastases, infectious process, systemic rheumatologic disease
Infectious symptoms
Epidural abscess, spondylodiskitis, meningitis
Upper motor neuron lesion Spinal cord compression, demyelinating disease
Age younger than 20 years
Congenital abnormalities (cervical spina bifida, Scheuermann disease)
Conditions associated with substance abuse (e.g., infection) Myocardial ischemia or infarction
Concurrent chest pain, diaphoresis, or shortness of breath Age older than 50 years
Metastases, vertebral fracture, carotid or vertebral artery dissection/ bleeding
5 Ds and 3 Ns
Vertebrobasilar ischemia, carotid artery dissection
Source: [2]
Table 2
To assess the history of the present illness, clinicians should inquire regarding: • Pain details ‒ Quality ‒ Onset ‒ Duration
‒ Time of day (e.g., at night, on awakening) ‒ Tolerance for neck flexion • Associated symptoms ‒ Stiffness
‒ Numbness ‒ Paresthesia ‒ Weakness ‒ Urinary retention ‒ Constipation ‒ Urinary/fecal incontinence • Primary/secondary complaints ‒ Primary neck pain ‒ Secondary arm pain ‒ Headaches ‒ Shoulder girdle complaints
‒ Severity ‒ Location
‒ Time course ‒ Progression • Modifying factors ‒ Rest/activity
‒ Changes in position ‒ Weight-bearing
41
MDKY1626
Powered by FlippingBook