Neck Pain and Radiculopathy Quiz

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Questions and Answers

What is a common symptom associated with neurological issues in the upper extremity?

  • Cyanosis
  • Upper extremity paresthesia (correct)
  • Chest pain
  • Acute upper extremity swelling

Which of the following is NOT a mode of imaging used in the assessment?

  • MRI
  • Ultrasound
  • CT
  • Electrocardiogram (correct)

Which test is used specifically for checking upper extremity neurovascular function?

  • EMG
  • Sonography
  • Wright's test (correct)
  • Anesthetic block

Which condition is characterized by muscle atrophy in the upper limb?

<p>Cervical radiculopathy (A)</p> Signup and view all the answers

What is one of the provocation tests used in the assessment of upper extremity conditions?

<p>Costoclavicular maneuver (B)</p> Signup and view all the answers

Which symptom is least commonly associated with neurological conditions of the upper extremity?

<p>Cyanosis (B)</p> Signup and view all the answers

In which assessment would a blood pressure difference greater than 20mmHg be significant?

<p>Physical examination (B)</p> Signup and view all the answers

Which of the following conditions is categorized as a congenital issue?

<p>Cervical rib (B)</p> Signup and view all the answers

What is the primary purpose of the anesthetic block in assessment?

<p>To relieve pain and confirm diagnosis (B)</p> Signup and view all the answers

Which of these conditions is most likely to cause acute upper extremity swelling?

<p>Cancer (C)</p> Signup and view all the answers

What is the first choice of management for Neurogenic Thoracic Outlet Syndrome (NTOS)?

<p>Conservative management (D)</p> Signup and view all the answers

When is surgical management particularly recommended for Thoracic Outlet Syndrome?

<p>When Neurogenic Thoracic Outlet Syndrome does not respond to conservative treatment (C)</p> Signup and view all the answers

Which of the following is NOT a recommended conservative treatment option for NTOS?

<p>Injection of botulinum toxin (B)</p> Signup and view all the answers

Which exercise focus can help in the management of Thoracic Outlet Syndrome?

<p>Breathing and stretching (A)</p> Signup and view all the answers

What percentage of patients typically show recovery from TOS within 24-36 months?

<p>78% (C)</p> Signup and view all the answers

Which factor is considered a negative prognostic indicator for recovery from TOS?

<p>Higher baseline neck pain intensity (D)</p> Signup and view all the answers

What follow-up approach is suggested for accurately diagnosing TOS?

<p>Combining clinical context with imaging and examination (D)</p> Signup and view all the answers

In the presence of neurological symptoms of TOS, which approach is likely inappropriate for immediate intervention?

<p>Immediate electrodiagnostic studies (C)</p> Signup and view all the answers

What type of factors may lead to false positive results in imaging for TOS?

<p>Compressions unrelated to clinical symptoms (B)</p> Signup and view all the answers

What is one key characteristic of the clinical course of TOS regarding patient recovery?

<p>Most improvement occurs within the first 4-6 months (C)</p> Signup and view all the answers

Which of the following conditions is a common cause of compression that could lead to TOS?

<p>Spondylosis (B)</p> Signup and view all the answers

What term describes the syndrome characterized by symptoms occurring due to compression at multiple points on a peripheral nerve?

<p>Double crush syndrome (A)</p> Signup and view all the answers

Which of the following may not be an effective intervention for TOS if no symptomatic improvement is observed?

<p>Decompression surgery (B)</p> Signup and view all the answers

What may indicate the presence of neural involvement even if electrodiagnostic studies seem normal?

<p>Significant patient-reported symptoms (D)</p> Signup and view all the answers

What is the prevalence of Carpal Tunnel Syndrome (CTS) in the upper quadrant?

<p>3% (D)</p> Signup and view all the answers

What is a major risk factor associated with entrapment neuropathies?

<p>Genetic susceptibility (C)</p> Signup and view all the answers

Which of the following statements regarding thoracic outlet syndrome (TOS) is true?

<p>It describes compression of the neurovascular bundle. (A)</p> Signup and view all the answers

What percentage of patients with carpal tunnel syndrome exhibit extradermatomal symptoms?

<p>64-70% (A), Up to 70% (C)</p> Signup and view all the answers

Which of the following is NOT a common characteristic of thoracic outlet syndrome?

<p>Capsulated condition (B)</p> Signup and view all the answers

Which condition is characterized by the prevalence of 1-3%?

<p>Cervical radiculopathy (C), Thoracic Outlet Syndrome (D)</p> Signup and view all the answers

For patients with entrapment neuropathies, which systemic disease may serve as a predisposing factor?

<p>Diabetes (D)</p> Signup and view all the answers

What should clinicians consider when assessing entrapment neuropathies?

<p>Extradermatomal symptom distribution (B)</p> Signup and view all the answers

Which condition typically shows a prevalence of 21/100,000?

<p>Cubital Tunnel Syndrome (A)</p> Signup and view all the answers

Which factor is NOT linked to increased risk for entrapment neuropathies?

<p>High levels of sedentary behavior (A)</p> Signup and view all the answers

Flashcards

Thoracic Outlet Syndrome (TOS)

A condition characterized by pressure on the brachial plexus, a network of nerves in the shoulder and neck, leading to various symptoms like numbness, pain, and weakness in the upper limb.

Whiplash Injury

Injury typically caused by a sudden forceful movement, such as a car accident, causing damage to the neck muscles, ligaments, and nerves.

Etiology

The study of the causes of disease.

Cervical Rib

A condition where a bone in the neck, known as the cervical rib, grows abnormally, compressing the nerves and blood vessels in the shoulder.

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Clinical Presentation

The study of how diseases present and manifest themselves in the body.

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Electromyography (EMG)

A medical test that measures the electrical activity of muscles and nerves.

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Anesthetic Block

A temporary injection of anesthetic to block nerve signals for diagnostic or therapeutic purposes.

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Roos Test (Elevated Arm Stress Test)

A test where the arm is raised and held overhead, causing pressure on the brachial plexus, used to diagnose TOS.

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Adson's Test

A test where the arm is held straight, causing pressure on the brachial plexus, used to diagnose TOS.

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Wright's Test

A test where the arm is rotated inward, causing pressure on the brachial plexus, used to diagnose TOS.

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Double Crush Syndrome

A condition characterized by the compression of a peripheral nerve at two or more locations, leading to synergistic symptom intensification.

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Multifocal Neuropathy

A term often used interchangeably with Double Crush Syndrome, indicating neuropathy affecting multiple sites along a nerve.

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Conservative Management for TOS

The initial preferred approach for treating Neck-related arm disorders, particularly the non-surgical type (NTOS).

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Surgical Treatment for TOS

Surgical intervention for TOS, frequently considered for those with the Vascular TOS (VTOS) and those who do not respond to conservative treatment.

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TOS Recovery at 6-12 months

The recovery rate for TOS after 6-12 months of treatment.

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Education for TOS Patients

A key aspect of TOS management, involving providing patients with information about the disorder, its potential outcomes, and strategies to promote active participation in recovery.

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Manual Therapy for TOS

A crucial part of conservative management, involving skilled techniques to improve joint mobility and soft tissue health.

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Exercise for TOS

Exercises specifically designed to improve neurological function, joint range of motion, and strength; including neural mobilization, dynamic stretching, and load capacity exercises.

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NSAIDs for TOS

A class of medications used to reduce inflammation and pain, often prescribed as part of conservative TOS management.

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Spondylosis

Spinal degeneration, commonly affecting older individuals.

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Disc Herniation

Protrusion of a disc in the spinal column, frequently affecting younger individuals.

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Radiculopathy

Pain arising from irritation or compression of a nerve root in the spinal column.

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Somatic Referred Pain

Pain originating in the body and referred to another location, often due to underlying issues in the spine or muscles.

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Nerve Mechanosensitivity

Nerve hyperexcitability or pain triggered by gentle touch or pressure; a hallmark of nerve damage.

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Sensory Perception

The ability to perceive sensation, often impaired in nerve damage.

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Entrapment Neuropathy

A condition where a nerve is compressed in a narrow space usually affecting the arms, hands, or legs. The compression can be caused by various factors, including repetitive motions, injuries, and anatomical abnormalities.

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Carpal Tunnel Syndrome

A condition where a nerve is compressed in a narrow space causing pain, numbness, weakness, and tingling in the upper extremity, particularly in the hand and forearm. This is commonly caused by inflammation, overuse, and anatomical variations.

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Thoracic Outlet Syndrome

A condition where a nerve is compressed in the space between the collarbone and the first rib, leading to pain, numbness, tingling, and weakness in the arm, hand, and shoulder. Typically caused by anatomical variations, repetitive movements, and injuries.

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Cubital Tunnel Syndrome

A condition where a nerve is compressed in the elbow, leading to pain, numbness, tingling, and weakness in the forearm and pinky finger. The compression is often caused by overuse, trauma, or anatomical variations.

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Dermatomal Distribution

The path that a nerve takes in the body, with the affected area corresponding to the nerve damage. It helps clinicians identify the source of the problem.

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Extradermatomal Symptom Distribution

A condition where nerve compression causes symptoms in areas that don't directly match the affected nerve's pathway. Often occurs in entrapment neuropathies like carpal tunnel syndrome and cervical radiculopathy.

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Cervical Radiculopathy

A condition where the nerve roots in the neck are compressed causing pain, numbness, tingling, and weakness in the arm and hand. It's a common source of neck pain with radiating pain.

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Risk Factors for Entrapment Neuropathies

Factors that increase the risk of developing entrapment neuropathies. These include obesity, diabetes, hypothyroidism, genetics, heavy manual labor, previous injuries, and smoking.

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Pathophysiology of Entrapment Neuropathies

The study of how diseases and disorders develop and progress. Understanding the pathophysiology of entrapment neuropathies helps us understand the root causes and potential treatments.

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Study Notes

Neck Pain with Radiating Pain

  • Definition: Cervical radiculopathy is a disease process marked by nerve compression from herniated disk material or arthritic bone spurs. This impingement typically leads to neck pain, radiating arm pain, numbness, sensory deficits, or motor dysfunction in the neck and upper extremities. (Eubanks, 2010)

Types of Neck Pain

  • Cervical radiculopathy
  • Cervicobrachial pain
  • Cervical nerve root injury
  • Radicular pain
  • Radicular syndrome

Other Definitions

  • Radicular pain: Pain perceived as arising from a limb or trunk wall caused by ectopic activation of nociceptive afferent fibers in a spinal nerve or its roots. Pain is lancinating in quality and travels along a narrow band.
  • Referred pain: Pain perceived as occurring in a region of the body topographically different from the actual source location. This is distinct from radicular pain and cervical or spinal pain.

Radiculopathy vs. Radicular Pain vs. Referred Pain

  • Radiculopathy: Nerve conduction block causing neurological signs.
  • Radicular pain: Ectopic impulse generation causing symptoms (pain).
  • Referred pain: Nociceptive pain from primary pain site stimulation. Radiculopathy and radicular pain may coexist, but are distinct from referred pain.

Neck Pain with Radiating Pain (Radicular)

  • Common symptoms: Neck pain with radiating pain (narrow band lancinating pain) on involved extremity, upper extremity dermatomal paresthesia or numbness, and myotomal muscle weakness.

Common Causes of Neck Pain with Radiating Pain

  • Cervical radiculopathy
  • Thoracic Outlet Syndrome (TOS)
  • Cervical herniation
  • Cervical stenosis

Thoracic Outlet Syndrome (TOS)

  • A blanket term encapsulating various clinical conditions involving compression of neurovascular structures exiting the thoracic outlet.
  • It's one of the most controversial topics in musculoskeletal (MSK) science.
  • Classification: Based on involved structures - Neurological, Vascular, or Neurovascular (Combined).
  • Etiology: Traumatic (fractures, whiplash), Acquired (cancer, repetitive work/activities), Congenital (cervical rib, soft tissue abnormalities)

Clinical Presentation of TOS

  • Neurological: Upper extremity paresthesia, neck pain, trapezius pain, shoulder/arm pain, supraclavicular pain, chest/occipital headache.
  • Vascular: Acute upper extremity swelling, cyanosis, heaviness, pain, Raynaud's (unilateral).

Assessment and Diagnosis of Neck Pain with Radiating Pain

  • Diagnostic modalities: EMG, anesthetic block, X-ray, MRI, CT, sonography, angiography.
  • Differential diagnosis: Cervical radiculopathy, upper limb nerve entrapment syndromes.
  • Physical examination: Assess upper extremity and cervical spine for muscle atrophy, skin temperature discrepancies, color, hair distribution, swelling, Blood pressure difference (should be >20mmHg), pulse.
  • Provocation tests: Roos test (Elevated arm stress test), Adson test, Wright's test, Costoclavicular maneuver, Cervical rotation lateral flexion test, Supraclavicular pressure, ULNTTS

Double Crush Syndrome and Multifocal Neuropathy

  • A distinct type of compression at multiple locations along a peripheral nerve, or "Multifocal neuropathy". Also characterized by increased symptom intensity.
  • Compressions at multiple sites can lead to treatment failure at a single site.

Treatment of TOS

  • Conservative is the initial treatment choice (education, self-efficacy promotion, manual therapy [mobilization/manipulation, myofascial work], exercises: neurodynamics, postural correction, breathing, stretching, pharmacological [injection of botulinum toxin, NSAIDS]).
  • Surgical intervention (decompression surgery) is recommended in cases of worsening neurological symptoms.

Clinical Course of Cervical Radiculopathy

  • About 50% recovery at 6-12 months
  • About 78% recovery at 24-36 months
  • Improvement occurs mainly in the first 4-6 months

Prognostic Factors of Cervical Radiculopathy

  • Presence of paresthesia at baseline
  • Greater active rotation towards the affected side
  • Longer duration of symptoms
  • Higher baseline neck pain intensity
  • Higher baseline disability score

Etiology of Cervical Radiculopathy

  • Spondylosis (older patients)
  • Disc herniation (younger patients)
  • Compressive, or non-compressive (infection, inflammatory, neoplastic).

Key Muscle Testing

  • Nerve root-specific muscle tests are crucial.
  • Extensor pollicis longus weakness can indicate issues with C8 or the radial nerve.
  • Muscle testing requires proper grading for accurate diagnosis.

Reflexes

  • Biceps (C5-C6)
  • Brachioradialis (C5-C6)
  • Triceps (C7)

Sensory Testing

  • Sensory testing assesses the integrity of nerve fibers involved in pain and/or sensation, looking for subtle deficits, loss or alteration of sensation.

Objective Examination

  • Neurological examination: assess nerve integrity and function (conduction).
  • Provocative tests: designed to elicit and/or reproduce symptoms (Spurling's test, ULNTs, Arm squeeze, distraction test, & shoulder abduction sign.)

Electrodiagnostic Tests

  • May be normal in some patients
  • Important for peripheral nerve entrapment syndromes.
  • Only assess large myelinated fibers.

Neuropathic/Radicular Symptoms

  • Related to nerve damage and/or sensitization.
  • Characterized by loss of function and/or heightened mechanosensitivity.

Additional Notes

  • Neural mobilization: Techniques to address nerve restrictions.
  • Screening tools for neuropathic pain (e.g., painDETECT) - adjunct to clinical exam.
  • Wainner's cluster of 4 tests for cervical radiculopathy and its limitations.

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Neck Pain With Radiating Pain - Seri2024 PDF

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