Podcast
Questions and Answers
What is a common symptom associated with neurological issues in the upper extremity?
What is a common symptom associated with neurological issues in the upper extremity?
Which of the following is NOT a mode of imaging used in the assessment?
Which of the following is NOT a mode of imaging used in the assessment?
Which test is used specifically for checking upper extremity neurovascular function?
Which test is used specifically for checking upper extremity neurovascular function?
Which condition is characterized by muscle atrophy in the upper limb?
Which condition is characterized by muscle atrophy in the upper limb?
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What is one of the provocation tests used in the assessment of upper extremity conditions?
What is one of the provocation tests used in the assessment of upper extremity conditions?
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Which symptom is least commonly associated with neurological conditions of the upper extremity?
Which symptom is least commonly associated with neurological conditions of the upper extremity?
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In which assessment would a blood pressure difference greater than 20mmHg be significant?
In which assessment would a blood pressure difference greater than 20mmHg be significant?
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Which of the following conditions is categorized as a congenital issue?
Which of the following conditions is categorized as a congenital issue?
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What is the primary purpose of the anesthetic block in assessment?
What is the primary purpose of the anesthetic block in assessment?
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Which of these conditions is most likely to cause acute upper extremity swelling?
Which of these conditions is most likely to cause acute upper extremity swelling?
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What is the first choice of management for Neurogenic Thoracic Outlet Syndrome (NTOS)?
What is the first choice of management for Neurogenic Thoracic Outlet Syndrome (NTOS)?
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When is surgical management particularly recommended for Thoracic Outlet Syndrome?
When is surgical management particularly recommended for Thoracic Outlet Syndrome?
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Which of the following is NOT a recommended conservative treatment option for NTOS?
Which of the following is NOT a recommended conservative treatment option for NTOS?
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Which exercise focus can help in the management of Thoracic Outlet Syndrome?
Which exercise focus can help in the management of Thoracic Outlet Syndrome?
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What percentage of patients typically show recovery from TOS within 24-36 months?
What percentage of patients typically show recovery from TOS within 24-36 months?
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Which factor is considered a negative prognostic indicator for recovery from TOS?
Which factor is considered a negative prognostic indicator for recovery from TOS?
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What follow-up approach is suggested for accurately diagnosing TOS?
What follow-up approach is suggested for accurately diagnosing TOS?
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In the presence of neurological symptoms of TOS, which approach is likely inappropriate for immediate intervention?
In the presence of neurological symptoms of TOS, which approach is likely inappropriate for immediate intervention?
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What type of factors may lead to false positive results in imaging for TOS?
What type of factors may lead to false positive results in imaging for TOS?
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What is one key characteristic of the clinical course of TOS regarding patient recovery?
What is one key characteristic of the clinical course of TOS regarding patient recovery?
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Which of the following conditions is a common cause of compression that could lead to TOS?
Which of the following conditions is a common cause of compression that could lead to TOS?
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What term describes the syndrome characterized by symptoms occurring due to compression at multiple points on a peripheral nerve?
What term describes the syndrome characterized by symptoms occurring due to compression at multiple points on a peripheral nerve?
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Which of the following may not be an effective intervention for TOS if no symptomatic improvement is observed?
Which of the following may not be an effective intervention for TOS if no symptomatic improvement is observed?
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What may indicate the presence of neural involvement even if electrodiagnostic studies seem normal?
What may indicate the presence of neural involvement even if electrodiagnostic studies seem normal?
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What is the prevalence of Carpal Tunnel Syndrome (CTS) in the upper quadrant?
What is the prevalence of Carpal Tunnel Syndrome (CTS) in the upper quadrant?
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What is a major risk factor associated with entrapment neuropathies?
What is a major risk factor associated with entrapment neuropathies?
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Which of the following statements regarding thoracic outlet syndrome (TOS) is true?
Which of the following statements regarding thoracic outlet syndrome (TOS) is true?
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What percentage of patients with carpal tunnel syndrome exhibit extradermatomal symptoms?
What percentage of patients with carpal tunnel syndrome exhibit extradermatomal symptoms?
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Which of the following is NOT a common characteristic of thoracic outlet syndrome?
Which of the following is NOT a common characteristic of thoracic outlet syndrome?
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Which condition is characterized by the prevalence of 1-3%?
Which condition is characterized by the prevalence of 1-3%?
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For patients with entrapment neuropathies, which systemic disease may serve as a predisposing factor?
For patients with entrapment neuropathies, which systemic disease may serve as a predisposing factor?
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What should clinicians consider when assessing entrapment neuropathies?
What should clinicians consider when assessing entrapment neuropathies?
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Which condition typically shows a prevalence of 21/100,000?
Which condition typically shows a prevalence of 21/100,000?
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Which factor is NOT linked to increased risk for entrapment neuropathies?
Which factor is NOT linked to increased risk for entrapment neuropathies?
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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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Description
This quiz explores the definitions and types of neck pain, focusing particularly on cervical radiculopathy and related conditions. Test your understanding of terms like radicular pain and referred pain, as well as their implications for upper extremity symptoms. Enhance your knowledge of the anatomy and pathology involved in neck pain.
