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Neck pain case presentation - Cervical spondylosis
This document summarizes a case of a 55-year-old female tailor presenting with neck pain for 4 months. Her examination showed decreased range of motion of the neck without neurological deficits. Her comorbidities included diabetes mellitus. Differential diagnoses included cervical spondylosis, mechanical neck pain, and cervical disc herniation. She was managed with analgesics, a cervical collar, and physiotherapy. The discussion covered mechanical neck disorders, cervical spondylosis, and cervical disc herniation as potential causes and their typical presentations, investigations, and management approaches.
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Overview of neck pain experienced by a 55-year-old tailor, presenting with pain for 4 months.
Detailed patient history including symptoms, concerns about diagnosis, and expectations for treatment.
Identification of red flag symptoms and examination techniques to assess neck pain and potential spinal cord compression.
Differentiation of neck pain causes, emphasizing cervical spondylosis, and outlining management options.
Primary and secondary prevention strategies, along with guidelines for assessing pain and functional improvement.
Discussion on mechanical neck disorders, cervical spondylosis causes, symptoms, and management protocols.
Overview of cervical disk herniation, symptoms, risk factors, examination methods, and management strategies.
Insights on spinal cancers, particularly metastasis, symptoms to watch for, and management approaches.
Acknowledgments for presentation resources and invitation for any questions from the audience.
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Neck pain case presentation - Cervical spondylosis
- 1. Neck Pain 25th Batch- Prof C - Group 1 Department of Family Medicine Faculty of Medical Sciences University of Sri Jayewardenepura
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- 3. INTRODUCTION Mrs. Xxxxxx Xxxxxxxxxxxx 55yrs From Nugegoda Occupation – Self-employed as a tailor Married 2 children
- 4. Presented with Neck painfor 4 months
- 5. History of thePatient Known patient with DM for 5 years on oral (Metformin 500mg bd) + dietary • Pain—insidious onset episodic pain for 4 months • Site – in the back of the neck • Worsened with time intense in last 2 weeks • Severity - moderate, taken pcm • No radiation to the shoulder or back • Aggravated – movements of neck • Relieved by resting and lying down • Stiffness and restriction
- 6. Diferential Diagnosis • Cervical spondylosis •Mechanical Pain (Posture, Trauma, Whiplash) – No Hx of injury to neck • Cervical spinal CA – LOA0, LOW0, No past Hx of thyroid or breast CA • Cervical disk herniation (Nerve root entrapment) – No tingling, numbness, weakness of arms • Rheumatoid arthritis – No pain, swelling, stiffness of small joints or knee, No night sweating, no fever or chills
- 7. History of thePatient • PMHx – DM+, HTN0 • PSHx – nil • Family Hx – DM+Mother, No family Hx of Malignancy, osteoporosis • Allergy Hx – F0, D0, P0 • Drug Hx – Metformin 500mg bd • Social Hx – • Patient - educated up to O/L • Husband - three-wheeler driver, educated up to O/L • 2 school going children • Lives in their own house • Spends most of the time at sewing machine keeping neck bent down on sewing • Financially unstable • Smoking0, Alcohol0
- 8. History of thePatient Concerns • Is this a sinister condition • Will I be able to recover completely • Will this affect my occupation • Will this end up in deformity Expectatio ns • She had already been to a GP, prescribed with NSAIDs and had transient improvements of symptoms, She wants the GP to diagnose her condition, She wants a complete cure • She finds its difficult to carryon her sewing work due to pain, so she wanted a pain relief
- 9. Red flag symptoms •Significant preceding trauma or neck surgery • Systemic upset (weight loss, night sweats, fevers) • Severe pain • Nocturnal pain • Relatively young (<20) or old (>55) • Signs of spinal cord compression • Significant vertebral body tenderness • History of TB, HIV, cancer or inflammatory arthritis
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- 11. Examination of thePatient General • Averagely built, Afebrile, no pallor • No lymphadenopathy • Normal gait • No tenderness, swelling of small joints • No rashes Neck • Look – No deformities, no visible lumps, no scars, swellings, muscle wasting in the neck or upper limbs • Feel - No tenderness over the spine • Move – decreased range of all the neck movements Neurology • No weakness or altered sensation in upper or lower limbs
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- 14. To check SpinalCord Compression Hoffman’s Test – Elicits a pathological reflex present in spinal cord compression. – Hold the middle finger at the middle phalanx between the index and middle finger of the examiner’s hand. Flick the distal phalanx at the pulp with the examiner’s free thumb. – The test is positive if the patient’s index finger and thumb flex.
- 15. To check SpinalCord Compression Lhermitte’s Test – Barber’s chair phenomenon – Flexion / extension of the neck produces electric shock like sensation in the legs. – This sign is mostly associated with multiple sclerosis.
- 16. • Neck painwith restriction in movements could be due to cervical spondylosis or mechanical neck pain • Diabetic mellitus as a comorbid condition
- 18. Investigations X-ray CT, MRI • Ifneurologic signs present or Red flag signs refer the patient for relevant speciality for further investigations or management • If the diagnosis is in doubt or if the patient is particularly requesting it, an X-ray of the cervical spine may be useful. • – Anteroposterior (AP) • – Lateral
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- 20. Management Non-pharmacological Pharmacological • NSAIDS • COX-2inhibitors like Celecoxib are preferred • Considering patient's socioeconomic status non-selective COX inhibitor with Proton pump inhibitor can be given • Cervical collar • Teach exercises to do at home • Physiotherapy
- 21. Prevention Primary prevention Secondary Prevention •Avoid long hours of working at the sewing machine • Adherence to treatment, regular follow up • Diabetic screening, drug compliance and regular clinic follow up • Proper health education and promotion to prevent abnormal posturing • Educating general public about importance of healthy diet and exercise
- 22. • In 4weeks and assess • Pain • Functional level • Exercise compliance
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- 24. Discussion Mechanical neck disorders •Causes • Motor vehicle collisions • Falls • Sports injuries • Work-related injuries • Strain injury, caused by an awkward position during sleep or prolonged abnormal head-neck positions during work or recreation. • Symptoms - Acute pain following trauma increased by movements of neck • Investigation: X-ray • Management: Cervical collar, Pain management
- 25. Discussion Cervical Spondylosis • Naturalwearing down of cartilage, disks, ligaments and bones in the neck • Main symptoms: Neck pain, stiffness, headache, pain in the shoulder or arms • At severe stages – difficulty in walking, loss of coordination • Risk factors: Age, Smoking, overweight, repetitive neck movements, genetics
- 26. Discussion Cervical Spondylosis • Examination: •Spurling sign – radicular pain increased by extension and lateral bending of the neck towards side of lesion causing foraminal compromise • Lhermitte sign – Neck flexion causes generalized electrical shock sensation
- 27. Discussion Cervical Spondylosis • Investigation:X-rays • Management: • Rest • Medications (NSAIDs, Corticosteroids, Muscle relaxants, antidepressants) • Ice, Heat • Physiotherapy • Exercise • Steroid based injections • Surgery
- 29. Discussion Cervical disk herniation •Nucleus pulposus protrudes through the posterior annulus fibrosis, producing an acute radiculopathy • Symptoms – Pain, weakness, numbness in the distribution of affected nerve
- 30. Discussion Cervical disk herniation •Most common level • C5-C6 (C6 nerve root) • C6-C7 (C7 nerve root)
- 31. Discussion Cervical disk herniation •Risk factors – Heavy weightlifting, smoking, operating vibrating equipment • Examination • Positive Spurling’s test • Positive distraction test • Cervical rotation > 600 • Investigations: MRI • Management (NSAIDs for pain, Physiotherapy, Referral for Surgery)
- 32. Discussion Spinal CA • 85%are metastasis • Any type of cancer can spread to bones, but most likely are • CA Lung, breast, prostate, thyroid • Primary: multiple myeloma, lymphoma • Symptoms: Neck pain associated with LOA, LOW, SOB, Hemoptysis, breast lump • Risk factors: Elderly, Past or family Hx of Malignancy, exposure to radiation etc. • Examination: neck lump, deformities, systemic examination • Investigations: MRI • Management: Surgery / Oncology referral
- 33. CREDITS: This presentationtemplate was created by Slidesgo, including icons by Flaticon and infographics & images by Freepik Do you have any questions? [email protected] THANKS!