|
"Your Legal Nurse"
|
| |
|
|
|
 |
|
 |
 |
 |
|
 |
|
| |
Atraumatic vs. Traumatic Neck Injury
There are several types of conditions that affect the cervical spine. The following will be a brief summary
of what is called atraumatic and traumatic neck injury.
Atraumatic neck pain (stiff neck):
•Complain of pain at rest that is worse with motion and acute pain, with acute generally unilateral.
•There may or may not be decreased range of motion with a negative physical examination but it is useful to rule out a more serious condition (see Red Flags at end of article).
•No motor or sensory deficit should be present, although pain may radiate to proximal shoulder.
Traumatic neck pain: in cervical strain (whiplash) patient usually gives report of:
•Being in front seat of vehicle as passenger or as driver at rest when vehicle struck.
•Does not complain of pain until about 72 hours.
•Afterward describe feeling of tightness and neck discomfort that may increase over several days.
•Variation of symptoms may also include discomfort in shoulders, arms, or back of head.
•Headache is common complaint and can occur anywhere in the head.
•Neurologic complaints can occur, with most common involving numbness or paresthesias down one or both arms –usually non-dermatomal.
•Other commonly reported symptoms are:
blurring of vision tension
tinnitus restlessness
light-headedness inability to concentrate
vertigo irritability
nausea
emotional labiality
fatigue
loss of libido
insomnia
Exam of cervical strain:
•Usually completely negative, with mild, if any, tenderness demonstrable.
•Hours to days after injury may have palpable anterior and posterior muscle.
•Tenderness, often more on one side than another, with the discomfort localizing posterior as the symptoms evolve.
•Numbness, weakness are often reported but are not usually reproduced on exam and rarely follow any known pattern of nerve distribution.
•Subjective complaints of headache and dizziness are fairly common but there are few objective findings to support or explain.
•Exam of head, eyes, cranial nerves, peripheral motor function and sensation, and deep tendon reflexes are almost always normal.
•CT and MRI have failed to disclose a CNS injury that would explain these symptoms.
Diagnostics and treatment with expected outcomes:
•Atraumatic neck pain in otherwise healthy adult with normal physical and neurologic examination does not require radiographs.
•In cervical strain injuries x-ray is used to demonstrate there are no fractures or significant radiographically detectable pathologic conditions present. In typical cervical strain, cervical spine x-ray films show, at the most, some loss of normal lordotic curve, which is generally believed to be a normal variant or result of patient position.
Patients with neck pain, whether or not they have antecedent trauma, should be treated as for any soft tissue injury using basic modalities of:
•Adequate analgesia.
•Early, increasing levels of activity (has shown better results than use of cervical collars – no more than 10 days – mostly at night).
•Aspirin, acetaminophen or any of the non-steroidal anti-inflammatory drugs.
•Severe cases short course of opioid analgesia may be required.
•Ice first 48 hours and after that followed with heat.
•Physiotherapy and chiropractic manipulation appear to be equal in benefits, but neither has shown to have greater benefit after a period of 4 weeks in treatment.
Red Flags
•Over 50 years old (increased risk of malignancy, compression fracture).
•Unrelenting night pain or pain at rest (increased incidence of clinically significant pathology).
•History or suspicion of cancer (rule out metastatic disease).
•Fever above 100.4 degrees if for longer than 48 hours.
•Osteoporosis.
•Neuromotor deficit.
•Chronic oral steroids.
•Serious accident or injury (fall from heights, blunt trauma, motor vehicle accident-this does not include twisting or lifting injury unless other risk factors, e.g., history of osteoporosis, are present).
•Failure to respond to 4 to 6 weeks of conservative therapy.
•Drug or alcohol abuse (increased incidence of osteomyelitis, trauma, and fracture).
•Clinical suspicion of ankylosing spondylitis.
Melisa Bailey RN
Bailey Consultants
Houston, Texas
 |
|
|
|
|
|
|
|
|
|
