Acute Neck Pain continued

Physical Examination

Physical examination does not provide a patho-anatomic diagnosis of acute idiopathic or whiplash-associated neck pain as clinical tests have poor reliability and lack validity.

*LEVEL III: Gross et al. 1996; Fjellner et al. 1999; Smedmark et al. 2000; Nansel et al. 1989; De Boer et al. 1985; Mior et al. 1985; Youdas et al. 1991; Viikari-Juntura 1987

Despite limitations, physical examination is an opportunity to identify features of potentially serious conditions.

CONSENSUS: Review Group and Steering Committee

Tenderness and restricted cervical range of movement correlate well with the presence of neck pain, confirming a local cause for the pain.

*LEVEL III: Sandmark and Nisell 1995

Ancillary Investigations

Plain radiography is not indicated for the investigation of acute neck pain in the absence of a history of trauma, or in the absence of clinical features of a possible serious disorder.

*LEVEL III: Based on radiological surveys (Heller et al. 1983; Johnson and Lucas 1997; Hoffman et al. 2000)

In symptomatic patients with a history of trauma, radiography is indicated according the Canadian C-Spine Rule.

*LEVEL III: Based on a large epidemiological survey (Stiell et al. 2001)

CT is indicated only when: plain films are positive, suspicious or inadequate; plain films are normal but neurological signs or symptoms are present; screening films suggest injury at the occiput to C2 levels; there is severe head injury; there is severe injury with signs of lower cranial nerve injury, or pain and tenderness in the sub-occipital region.

CONSENSUS: Based on published consensus views (El Khoury et al. 1995; Kathol 1997)

Acute neck pain in conjunction with features alerting to the possibility of a serious underlying condition is an indication for MRI.

CONSENSUS: Consensus view (El Khoury et al. 1995)

Terminology

Except for serious conditions, precise identification of the cause of neck pain is unnecessary.

CONSENSUS: Review Group and Steering Committee

Once serious causes have been recognised or excluded, terms to describe acute neck pain can be either 'acute idiopathic neck pain' or 'acute whiplash-associated neck pain'.

CONSENSUS: Review Group and Steering Committee

Was this article helpful?

0 0
Project Management Made Easy

Project Management Made Easy

What you need to know about… Project Management Made Easy! Project management consists of more than just a large building project and can encompass small projects as well. No matter what the size of your project, you need to have some sort of project management. How you manage your project has everything to do with its outcome.

Get My Free Ebook


Post a comment