STUDY - Technical - New Dacian's Medicine
Neck
pain (Classical / Allopathic Medicine)
Neck pain may
originate from any neck structure, ranging from the meninges
and cervical vertebrae to its blood vessels, muscles, and
lymphatic tissue. This symptom can also be referred to from
other areas of the body. Its location, onset, and pattern help
determine its origin and underlying causes. It usually results
from trauma or a degenerative, congenital, inflammatory,
metabolic, or neoplastic disorder.
ALERT:
If the patient's neck pain is due to trauma:
- examine the neck for abrasions, swelling, lacerations, erythema, and ecchymoses
- ensure proper cervical spine immobilization, preferably with a long backboard and a hard cervical collar (See Applying a Philadelphia collar.)
- take his vital signs, and perform a quick neurologic evaluation
- assess respiratory status, and institute emergency measures, if necessary
- ask him (or his companion, if the patient can't answer) how the injury occurred.
If the patient hasn't sustained trauma, perform a focused assessment.
If the patient's neck pain is due to trauma:
- examine the neck for abrasions, swelling, lacerations, erythema, and ecchymoses
- ensure proper cervical spine immobilization, preferably with a long backboard and a hard cervical collar (See Applying a Philadelphia collar.)
- take his vital signs, and perform a quick neurologic evaluation
- assess respiratory status, and institute emergency measures, if necessary
- ask him (or his companion, if the patient can't answer) how the injury occurred.
If the patient hasn't sustained trauma, perform a focused assessment.
Applying a
Philadelphia collar
A lightweight molded polyethylene collar designed to hold the neck straight with the chin slightly elevated and tucked in, the Philadelphia cervical collar immobilizes the cervical spine, decreases muscle spasms, and relieves some pain. It also prevents further injury and promotes healing.
When applying the collar, fit it snugly around the patient's neck and attach the Velcro fasteners or buckles at the back. Be sure to check the patient's airway and his neurovascular status to ensure that the collar isn't too tight. Also, make sure that the collar isn't placed too high in front, which can hyperextend the neck. In a patient with a neck sprain, hyperextension may cause the ligaments to heal in a shortened position; in a patient with a cervical spine fracture, it could cause serious neurologic damage.
HISTORY:
Ask the patient to describe the onset and severity of his neck pain.
Ask the patient where in his neck he feels pain. Does anything alleviate or aggravate it?
Ask the patient about the development of associated signs and symptoms such as headaches.
Review the patient's medical history, noting especially current and past illnesses and injuries.
Ask the patient about his diet.
Ask the patient if there's a family history of neck pain.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
A lightweight molded polyethylene collar designed to hold the neck straight with the chin slightly elevated and tucked in, the Philadelphia cervical collar immobilizes the cervical spine, decreases muscle spasms, and relieves some pain. It also prevents further injury and promotes healing.
When applying the collar, fit it snugly around the patient's neck and attach the Velcro fasteners or buckles at the back. Be sure to check the patient's airway and his neurovascular status to ensure that the collar isn't too tight. Also, make sure that the collar isn't placed too high in front, which can hyperextend the neck. In a patient with a neck sprain, hyperextension may cause the ligaments to heal in a shortened position; in a patient with a cervical spine fracture, it could cause serious neurologic damage.
HISTORY:
Ask the patient to describe the onset and severity of his neck pain.
Ask the patient where in his neck he feels pain. Does anything alleviate or aggravate it?
Ask the patient about the development of associated signs and symptoms such as headaches.
Review the patient's medical history, noting especially current and past illnesses and injuries.
Ask the patient about his diet.
Ask the patient if there's a family history of neck pain.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Inspect the neck, shoulders, and cervical spine for swelling, masses, erythema, and ecchymoses.
Palpate the cervical spine and paracervical area, checking for muscle spasms.
Assess the active range of motion in the patient's neck by having him perform selection, extension, rotation, and lateral side bending. Note the degree of pain that these movements produce.
Examine posture, and test muscle strength. Check the sensation in his arms, and assess his hand grasp and arm reflexes.
Attempt to elicit Brudzinski's and Kernig's signs, and palpate the cervical lymph nodes for enlargement.
Inspect the neck, shoulders, and cervical spine for swelling, masses, erythema, and ecchymoses.
Palpate the cervical spine and paracervical area, checking for muscle spasms.
Assess the active range of motion in the patient's neck by having him perform selection, extension, rotation, and lateral side bending. Note the degree of pain that these movements produce.
Examine posture, and test muscle strength. Check the sensation in his arms, and assess his hand grasp and arm reflexes.
Attempt to elicit Brudzinski's and Kernig's signs, and palpate the cervical lymph nodes for enlargement.
SPECIAL
CONSIDERATIONS:
Promote patient comfort by giving an anti-inflammatory and an analgesic, as needed.
Promote patient comfort by giving an anti-inflammatory and an analgesic, as needed.
PEDIATRIC
POINTERS:
The most common causes of neck pain in children are meningitis and trauma. A rare cause is a congenital torticollis.
The most common causes of neck pain in children are meningitis and trauma. A rare cause is a congenital torticollis.
PATIENT
COUNSELING?
Instruct the patient on what to expect from diagnostic testing, which may include X-rays, computed tomography scans, blood tests, and cerebrospinal fluid analysis.
Instruct the patient on what to expect from diagnostic testing, which may include X-rays, computed tomography scans, blood tests, and cerebrospinal fluid analysis.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.