Acute Neck Injury

00:01 Hello and welcome to acute neck injury.

00:04 Here we’re going to explore common causes of acute neck injury and help differentiate which ones may be more dangerous than others.

00:11 We’ll be talking about whiplash and its long-term prognosis.

00:15 And then, we’ll be talking about therapies that make a difference.

00:18 And those where they’re routinely used, but not recommended for acute neck injury.

00:23 And I think those in particular will be important for answering questions on USMLE.

00:29 All right.

00:29 So, let's start with a case just to bring us up to speed.

00:33 I’m seeing a previously healthy 48-year-old man.

00:36 He was in a motor vehicle accident yesterday.

00:38 He was taken to the emergency department as a precaution because he did have some neck pain.

00:42 But his x-rays were negative for fracture.

00:44 He still has 8 out of 10 pain though and reduced range of motion in his neck today.

00:49 It’s not that unusual a case where patients get in an acute trauma, they end up going to the emergency department, and that's key here because the patient goes to the emergency department, particularly if I’ve got some kind of record that indeed their x-ray was done and it was negative, that’s going to be very, very important for me.

01:08 The patient who comes in fresh, within 24 hours after a major trauma such as a car accident, I'm going to be a lot more aggressive in recommending films for that patient because there is always a chance there could be a fracture that we’re missing in somebody with 8 out of 10 pain and limited range of motion.

01:25 But that's been taken care of in this case.

01:27 So, I think this case is a little bit more typical to what we might see in primary care.

01:31 And I just wanted to point out that the key is that they did go to the ED immediately afterwards.

01:37 So, let’s take a look at the epidemiology of acute neck pain.

01:42 It's really common.

01:43 About one in ten adults will develop neck pain at some point in their lifetime.

01:48 It's actually similar in terms of its prevalence to low back pain, but it doesn't get the attention of low back pain, particularly because it tends to be less chronic and there’s less disability associated with neck pain.

02:00 Still, there's more than 1 million cases of whiplash in the US annually.

02:05 That said, it's not usually whiplash which is related to an acute trauma.

02:09 The most common cause of neck pain is more repetitive injury, and that's happening more and more frequently.

02:17 It's not just in jobs that are highly physical in nature, although I certainly see in those jobs, it’s a lot of folks who spend a lot time at keyboards every day and aren’t necessarily thinking about the ergonomics of their workstations, can develop neck pain as well.

02:34 So, for whiplash specifically, it requires a history of acute injury.

02:39 So, it has to be a car accident, something that happened, maybe a slip and fall, a few other types of acute injury where – that's where the pain started.

02:49 The symptoms are pretty common to cause a neck pain.

02:53 Pain, reduced mobility and occipital headache.

02:57 It's actually not really well understood why whiplash occurs and why it can be so severe in terms of the stiffness, but the muscles definitely – there is an inflammatory component and the muscles react.

03:09 There is some minor swelling around them and that becomes so painful that the patient has a hard time moving his neck.

03:17 And imaging is frequently going to be negative for these patients.

03:21 You might see oftentimes some chronic degenerative changes, but nothing acute thankfully.

03:28 So, let's talk about cervical radiculopathy, and this is where there's a nerve involvement, emanating from the spinal cord that's complicating neck pain.

03:37 So, again, this, of course, maybe caused by an acute trauma.

03:40 Therefore, it's really important to consider a complete neurological exam for all patients with neck pain.

03:46 That includes motor, sensory and deep tendon reflexes in the upper and lower extremities.

03:52 Sperling's test can be helpful and that's where patients say if they're having right-sided symptoms, flexion of the neck to that side with a pressure over – the clinician stands over the patient and puts a downward pressure directly on the head, and that may reproduce symptoms.

04:09 And just remember that the radiculopathy may be caused by a trauma, but it may also be due to chronic disc damage as well, that bulging disc, usually between the levels of C6 and T1, can explain why patients are having radiculopathy.

04:25 And the distribution of their symptoms in terms of pain will tell you which nerve bridge is affected.