Simple Overview of the Neck

Differentials

When it comes to spine pain, exposing pain generators (a la CRISP, if you will) can be very helpful to match treatment:

  • Neurogenic: Myelopathy, Radiculopathy, some headaches

  • Disc: Typical IVD presentation. Extent of damage variable

  • Muscles/Joint: Posterior and lateral pretty straightforward… remember the deep anterior neck flexors!

  • Systemic/Other: Rheumatic (AS, RA, DISH), Vascular, esophagitis, angina. Rule’em out!

Anatomy

Thoughts

Most common cause of neck symptoms are biomechanics: Axial, WAD, Cervical Radiculopathy.

Axial neck pain has a high rate of spontaneous resolution. Presents similar to WAD except - WAD has associated trauma, often presenting with discopathy and possible radiculopathy.

Quebec Classification of WAD - 4 Categories

  • Grade 1 : general symptoms without objective findings

  • Grade 2 : general symptoms with musculoskeletal findings

  • Grade 3 : neck complaints with neurologic signs

  • Grade 4 : neck pain with fracture/dislocation

*Imaging recommended for WAD Grades 3 & 4, blunt trauma, axial pain unresponsive to 6-8 weeks of care. MRI recommended for suspected myelopathy, infection, CA, radicular pain with motor reflex deficit, radicular pain not resolved in 6 - 8 weeks (recommendation Grade B)

Radiculopathy presents with sharp & dermatomal distribution of symptoms (*Recall radicular pain vs. radiculopathy).

*TOS offered in separate blog

Assessments

Progressive cervical compression testing (Spurling’s) or each of each component parts assesses radicular symptoms. Pair with nerve tension testing - central & peripheral - for agreement.

End-range loading progressions for disc involvement.

Extension-Rotation testing for provocative joint mechanics.

O’Donaghue’s for evaluation of passive and active component of the region

Management

Review of Conservative Management for WAD grade II (low rating)

  • more effective for pain @ 6 mo, and 1-3 years

  • improved Cap mobility (horizontal plane) @ less than 3 months

  • active better than passive care @ 6 mo, and 1-3 years

  • no difference between early and late interventions

Mathew DiMondrehab, cervical, neck, chiropractic, WAD, Conservative