Neck Pain

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Neck Pain

• Dzung H. Dinh, MD, MBA
• Professor of Neurosurgery
• University of Illinois College of Medicine at
  Peoria

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Disclosure

• Aesculap
• ROI
• Nuvasive

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Content1.
Anatomy2. Evaluation of neck pain3.
Differential diagnosis4. Treatment plan
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Anatomy
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Anatomy
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Anatomy
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Anatomy
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Anatomy
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Anatomy
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Evaluation

• History
• Ask the right questions
• Listen to the patient
• Formulate a diagnosis
• Examination
• To confirm your diagnosis, not to make diagnosis
• Ordering additional tests
• Again, to confirm or r/o diagnosis.

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HistoryAsk the right questions

• Critical questions
• 1. Pain location
• Central/Axial/Paraspinal
• Refer HA or Arm Sx
• 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

• Not so critical questions
• 1. Pain onset/inciting event
• 2. Pain provocation
• 3. Pain diminution
• 4. Up-to-date Rx

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HistoryListen 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

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HistoryDiagnosis 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)

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Examinationto 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

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Additional Teststo confirm your diagnosis

• Myofascial pain- EMG/NCV if there is lots of
  refer Sx
• Myelopathy MRI
• Radicular MRI
• Peripheral entrapment EMG/NCV

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Treatment Plan

1. Myelopathy with cord compression surgery
2. Radiculopathy with deficit surgery /-
3. Myofascial Pain Never surgery
4. Peripheral Entrapment Sx - Maybe
5. Double crush Sx Depends
6. Radiculopathy and Myofascial Pain - depends

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Case Presentation
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Thank You