Neck injury: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
[[X-ray]] of the cervical spine should be considered, especially if the patient fulfills any criteria from the Canadian C-Spine Rule [[clinical prediction rule]]: <ref name="pmid14695411">{{cite journal |author=Stiell IG, Clement CM, McKnight RD, ''et al'' |title=The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma |journal=N. Engl. J. Med. |volume=349 |issue=26 |pages=2510–8 |year=2003 |month=December |pmid=14695411 |doi=10.1056/NEJMoa031375 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=14695411&promo=ONFLNS19 |issn=}}</ref> | [[X-ray]] of the cervical spine should be considered, especially if the patient fulfills any criteria from the Canadian C-Spine Rule [[clinical prediction rule]]: <ref name="pmid14695411">{{cite journal |author=Stiell IG, Clement CM, McKnight RD, ''et al'' |title=The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma |journal=N. Engl. J. Med. |volume=349 |issue=26 |pages=2510–8 |year=2003 |month=December |pmid=14695411 |doi=10.1056/NEJMoa031375 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=14695411&promo=ONFLNS19 |issn=}}</ref><ref>{{Cite journal | ||
| doi = 10.1136/bmj.b4146 | |||
| volume = 339 | |||
| issue = oct29_4 | |||
| pages = b4146 | |||
| last = Stiell | |||
| first = Ian G | |||
| coauthors = Catherine M Clement, Jeremy Grimshaw, Robert J Brison, Brian H Rowe, Michael J Schull, Jacques S Lee, Jamie Brehaut, R Douglas McKnight, Mary A Eisenhauer, Jonathan Dreyer, Eric Letovsky, Tim Rutledge, Iain MacPhail, Scott Ross, Amit Shah, Jeffrey J Perry, Brian R Holroyd, Urbain Ip, Howard Lesiuk, George A Wells | |||
| title = Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial | |||
| journal = BMJ | |||
| accessdate = 2009-11-05 | |||
| date = 2009-10-29 | |||
| url = http://www.bmj.com/cgi/content/abstract/339/oct29_4/b4146 | |||
}}</ref> | |||
* Age 65 years or more | * Age 65 years or more | ||
* [[Paresthesia]]s in extremities | * [[Paresthesia]]s in extremities | ||
| Line 10: | Line 23: | ||
** ''Only test if'' "simple rear-end motor vehicle collision, sitting position in ED, ambulatory at any time since injury, delayed onset of neck pain, or absence of midline C-spine tenderness"<ref name="pmid11597285">{{cite journal |author=Stiell IG, Wells GA, Vandemheen KL, ''et al'' |title=The Canadian C-spine rule for radiography in alert and stable trauma patients |journal=JAMA |volume=286 |issue=15 |pages=1841–8 |year=2001 |month=October |pmid=11597285 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11597285 |issn=}}</ref> | ** ''Only test if'' "simple rear-end motor vehicle collision, sitting position in ED, ambulatory at any time since injury, delayed onset of neck pain, or absence of midline C-spine tenderness"<ref name="pmid11597285">{{cite journal |author=Stiell IG, Wells GA, Vandemheen KL, ''et al'' |title=The Canadian C-spine rule for radiography in alert and stable trauma patients |journal=JAMA |volume=286 |issue=15 |pages=1841–8 |year=2001 |month=October |pmid=11597285 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11597285 |issn=}}</ref> | ||
* [[Glasgow Coma Scale]] less than 15 (the Canadian C-Spine Rule was only designed for alert patients) | * [[Glasgow Coma Scale]] less than 15 (the Canadian C-Spine Rule was only designed for alert patients) | ||
==Treatment== | |||
[[Spinal manipulation]] and home exercises (http://www.annals.org/content/suppl/2011/12/29/156.1_Part_1.1.DC1/156-1-1-supplement.pdf) may help according to a [[randomized controlled trial]].<ref>{{Cite journal | doi = 10.1059/0003-4819-156-1-201201030-00002 | volume = 156 | issue = 1 Part 1 | pages = 1 -10 | last = Bronfort | first = Gert | coauthors = Roni Evans, Alfred V. Anderson, Kenneth H. Svendsen, Yiscah Bracha, Richard H. Grimm | title = Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain | journal = Annals of Internal Medicine | accessdate = 2012-01-03 | date = 2012-01-03 | url = http://www.annals.org/content/156/1_Part_1/1.abstract }}</ref> | |||
In patients with recent onset of cervical [[radiculopathy]], semi-hard collar and [[physiotherapy]] with exercise may reduce pain.<ref name="pmid19812130">{{cite journal| author=Kuijper B, Tans JT, Beelen A, Nollet F, de Visser M| title=Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial. | journal=BMJ | year= 2009 | volume= 339 | issue= | pages= b3883 | pmid=19812130 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19812130 | doi=10.1136/bmj.b3883 }}</ref> | |||
The role of electrotherapy such as pulsed electromagnetic field therapy (PEMF), repetitive magnetic stimulation (rMS) and [[transcutaneous electrical nerve stimulation]] (TENS) is not clear.<ref name="pmid19821322">{{cite journal| author=Kroeling P, Gross A, Goldsmith CH, Burnie SJ, Haines T, Graham N et al.| title=Electrotherapy for neck pain. | journal=Cochrane Database Syst Rev | year= 2009 | volume= | issue= 4 | pages= CD004251 | pmid=19821322 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19821322 | doi=10.1002/14651858.CD004251.pub4 }}</ref> | |||
Low-level laser therapy may help.<ref name="pmid19913903">{{cite journal| author=Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM| title=Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. | journal=Lancet | year= 2009 | volume= 374 | issue= 9705 | pages= 1897-908 | pmid=19913903 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19913903 | doi=10.1016/S0140-6736(09)61522-1 }}</ref> | |||
Surgery may provide 1-2 years of improvement for patients with cervical [[radiculopathy]] according to a randomized controlled trial.<ref name="pmid23778373">{{cite journal| author=Engquist M, Löfgren H, Oberg B, Holtz A, Peolsson A, Söderlund A et al.| title=Surgery Versus Nonsurgical Treatment of Cervical Radiculopathy: A Prospective, Randomized Study Comparing Surgery Plus Physiotherapy With Physiotherapy Alone With a 2-Year Follow-up. | journal=Spine (Phila Pa 1976) | year= 2013 | volume= 38 | issue= 20 | pages= 1715-1722 | pmid=23778373 | doi=10.1097/BRS.0b013e31829ff095 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23778373 }} </ref> | |||
===Medications=== | |||
It is not clear that [[ibuprofen]] 800 mg or [[cyclobenzaprine]] 5 mg three times a day is beneficial.<ref name="pmid20078917">{{cite journal| author=Khwaja SM, Minnerop M, Singer AJ| title=Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial. | journal=CJEM | year= 2010 | volume= 12 | issue= 1 | pages= 39-44 | pmid=20078917 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=20078917 }}</ref> | |||
===Neurotomy=== | |||
Neurotomy can help selected types of neck pain.<ref name="pmid8929263">{{cite journal| author=Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N| title=Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 23 | pages= 1721-6 | pmid=8929263 | doi=10.1056/NEJM199612053352302 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8929263 }} </ref> | |||
==Prognosis== | |||
Many patients with acute ''idiopathic'' neck pain have persistent symptoms.<ref name="pmid21458776">{{cite journal| author=Hush JM, Lin CC, Michaleff ZA, Verhagen A, Refshauge KM| title=Prognosis of acute idiopathic neck pain is poor: a systematic review and meta-analysis. | journal=Arch Phys Med Rehabil | year= 2011 | volume= 92 | issue= 5 | pages= 824-9 | pmid=21458776 | doi=10.1016/j.apmr.2010.12.025 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21458776 }} </ref> Most reduction in pain and disability occur within 76 weeks without much improvement after 6 weeks (at least among the types of patients studied).<ref name="pmid21458776"/> | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Latest revision as of 09:35, 8 May 2014
In medicine, neck injuries are "general or unspecified injuries to the neck. It includes injuries to the skin, muscles, and other soft tissues of the neck.'[1]
Diagnosis
X-ray of the cervical spine should be considered, especially if the patient fulfills any criteria from the Canadian C-Spine Rule clinical prediction rule: [2][3]
- Age 65 years or more
- Paresthesias in extremities
- Dangerous fall ("elevation >=3 ft or 5 stairs; an axial load to the head (e.g., diving); a motor vehicle collision at high speed (>100 km/hr) or with rollover or ejection; a collision involving a motorized recreational vehicle; or a bicycle collision")
- Inability to rotate the neck 45° to the right and left
- Only test if "simple rear-end motor vehicle collision, sitting position in ED, ambulatory at any time since injury, delayed onset of neck pain, or absence of midline C-spine tenderness"[4]
- Glasgow Coma Scale less than 15 (the Canadian C-Spine Rule was only designed for alert patients)
Treatment
Spinal manipulation and home exercises (http://www.annals.org/content/suppl/2011/12/29/156.1_Part_1.1.DC1/156-1-1-supplement.pdf) may help according to a randomized controlled trial.[5]
In patients with recent onset of cervical radiculopathy, semi-hard collar and physiotherapy with exercise may reduce pain.[6]
The role of electrotherapy such as pulsed electromagnetic field therapy (PEMF), repetitive magnetic stimulation (rMS) and transcutaneous electrical nerve stimulation (TENS) is not clear.[7]
Low-level laser therapy may help.[8]
Surgery may provide 1-2 years of improvement for patients with cervical radiculopathy according to a randomized controlled trial.[9]
Medications
It is not clear that ibuprofen 800 mg or cyclobenzaprine 5 mg three times a day is beneficial.[10]
Neurotomy
Neurotomy can help selected types of neck pain.[11]
Prognosis
Many patients with acute idiopathic neck pain have persistent symptoms.[12] Most reduction in pain and disability occur within 76 weeks without much improvement after 6 weeks (at least among the types of patients studied).[12]
References
- ↑ Anonymous (2024), Neck injury (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Stiell IG, Clement CM, McKnight RD, et al (December 2003). "The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma". N. Engl. J. Med. 349 (26): 2510–8. DOI:10.1056/NEJMoa031375. PMID 14695411. Research Blogging.
- ↑ Stiell, Ian G; Catherine M Clement, Jeremy Grimshaw, Robert J Brison, Brian H Rowe, Michael J Schull, Jacques S Lee, Jamie Brehaut, R Douglas McKnight, Mary A Eisenhauer, Jonathan Dreyer, Eric Letovsky, Tim Rutledge, Iain MacPhail, Scott Ross, Amit Shah, Jeffrey J Perry, Brian R Holroyd, Urbain Ip, Howard Lesiuk, George A Wells (2009-10-29). "Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial". BMJ 339 (oct29_4): b4146. DOI:10.1136/bmj.b4146. Retrieved on 2009-11-05. Research Blogging.
- ↑ Stiell IG, Wells GA, Vandemheen KL, et al (October 2001). "The Canadian C-spine rule for radiography in alert and stable trauma patients". JAMA 286 (15): 1841–8. PMID 11597285. [e]
- ↑ Bronfort, Gert; Roni Evans, Alfred V. Anderson, Kenneth H. Svendsen, Yiscah Bracha, Richard H. Grimm (2012-01-03). "Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain". Annals of Internal Medicine 156 (1 Part 1): 1 -10. DOI:10.1059/0003-4819-156-1-201201030-00002. Retrieved on 2012-01-03. Research Blogging.
- ↑ Kuijper B, Tans JT, Beelen A, Nollet F, de Visser M (2009). "Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial.". BMJ 339: b3883. DOI:10.1136/bmj.b3883. PMID 19812130. Research Blogging.
- ↑ Kroeling P, Gross A, Goldsmith CH, Burnie SJ, Haines T, Graham N et al. (2009). "Electrotherapy for neck pain.". Cochrane Database Syst Rev (4): CD004251. DOI:10.1002/14651858.CD004251.pub4. PMID 19821322. Research Blogging.
- ↑ Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM (2009). "Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials.". Lancet 374 (9705): 1897-908. DOI:10.1016/S0140-6736(09)61522-1. PMID 19913903. Research Blogging.
- ↑ Engquist M, Löfgren H, Oberg B, Holtz A, Peolsson A, Söderlund A et al. (2013). "Surgery Versus Nonsurgical Treatment of Cervical Radiculopathy: A Prospective, Randomized Study Comparing Surgery Plus Physiotherapy With Physiotherapy Alone With a 2-Year Follow-up.". Spine (Phila Pa 1976) 38 (20): 1715-1722. DOI:10.1097/BRS.0b013e31829ff095. PMID 23778373. Research Blogging.
- ↑ Khwaja SM, Minnerop M, Singer AJ (2010). "Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial.". CJEM 12 (1): 39-44. PMID 20078917.
- ↑ Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N (1996). "Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain.". N Engl J Med 335 (23): 1721-6. DOI:10.1056/NEJM199612053352302. PMID 8929263. Research Blogging.
- ↑ 12.0 12.1 Hush JM, Lin CC, Michaleff ZA, Verhagen A, Refshauge KM (2011). "Prognosis of acute idiopathic neck pain is poor: a systematic review and meta-analysis.". Arch Phys Med Rehabil 92 (5): 824-9. DOI:10.1016/j.apmr.2010.12.025. PMID 21458776. Research Blogging.