NEURO
BACK & NECK
PAIN DIAGNOSIS:
- A musculoskeletal problem is treated most effectively if the specific cause can be identified
- The gold standard for determining the cause of musculoskeletal pain is the physical examination,
complemented by a good history
- If an adult reports pain in more than one joint, a systemic process may be considered; however, the
older adult often have multiple mechanical problems in different sites of the body
THE HISTORY
- What symptoms accompany the pain?
- What brings on the pain? Is it exacerbated when going from lying to sitting, ascending or descending
stairs, standing, or walking?
- Is the pain worse in the morning, midday, or night?
- Does the pain radiate?
- Does the pain cause the patient to cease the activity associated with the pain?
- Was the pain acute at onset? Or has it worsened over time?
THE EXAM
- Carefully observe the patient’s mobility
- Manually examine joints and muscle groups, focusing on:
o Patterns of weakness
o Malalignment and swelling of joints (whether the swelling is soft tissue or bony enlargement)
o Decreased range of motion (ROM)
o Patterns of joint involvement consistent with specific conditions
- Order imaging and laboratory tests only after formulating a list of potential diagnoses
NECK PAIN
- Four general causes: systemic disease, cervical myelopathy, cervical radiculopathy, mechanical
neck disease
- Systemic disease
o Often associated with polymyalgia rheumatica, rheumatoid arthritis, and other
inflammatory conditions
o Systemic symptoms and signs, other joint complaints, and prolonged morning stiffness are
often present
o Typical: symmetric loss of ROM of the cervical spine
o Lab markers of inflammation, such as C-reactive protein and erythrocyte sedimentation rate, are
often increased
- Myelopathy produced by cervical stenosis
o Does not always cause neck pain
o Often characterized by spastic gait disturbance and weakness in the lower extremities with
upper motor neuron signs (eg, hyperreflexia, increased muscle tone, positive Babinski signs)
o Can also produce lower motor neuron findings in the upper extremities
o Bladder symptoms include urgency, frequency, or retention
- Cervical radiculopathy
o Characterized by pain in the neck and arm, sensory loss, loss of motor function, and reflex
changes in the affected nerve-root distribution
o Usually due to encroachment of the neuroforamina of the cervical spine; the C7 nerve root is
most frequently affected
, o Suggested by pain that is reproduced by rotating the head or bending it toward the symptomatic
side
o Most patients improve with symptomatic treatment, and only a relatively small number require
surgery
- Nonspecific mechanical disease of cervical spine: diagnosis
o Cervical disc displacement appears to be a frequent cause of neck pain in older adults
o Cervical spine disease can also produce local muscle spasm and tenderness, often mistaken for
the “trigger points” of fibromyalgia
o Typical: asymmetric loss of ROM of the cervical spine and weakness of the muscles
innervated by cervical nerve roots, such as elbow extension and finger abduction in patients
with C7, C8, and T1 disease
- Nonspecific mechanical disease of cervical spine: treatment
o Little hard data on the effectiveness of one therapy versus another
o Manual therapy and exercise are more effective than alternative strategies
o Surgery should be considered only for significant, persistent, and worsening neurologic signs
, Assessment of LBP in the Older Adult
BACK & NECK
PAIN DIAGNOSIS:
- A musculoskeletal problem is treated most effectively if the specific cause can be identified
- The gold standard for determining the cause of musculoskeletal pain is the physical examination,
complemented by a good history
- If an adult reports pain in more than one joint, a systemic process may be considered; however, the
older adult often have multiple mechanical problems in different sites of the body
THE HISTORY
- What symptoms accompany the pain?
- What brings on the pain? Is it exacerbated when going from lying to sitting, ascending or descending
stairs, standing, or walking?
- Is the pain worse in the morning, midday, or night?
- Does the pain radiate?
- Does the pain cause the patient to cease the activity associated with the pain?
- Was the pain acute at onset? Or has it worsened over time?
THE EXAM
- Carefully observe the patient’s mobility
- Manually examine joints and muscle groups, focusing on:
o Patterns of weakness
o Malalignment and swelling of joints (whether the swelling is soft tissue or bony enlargement)
o Decreased range of motion (ROM)
o Patterns of joint involvement consistent with specific conditions
- Order imaging and laboratory tests only after formulating a list of potential diagnoses
NECK PAIN
- Four general causes: systemic disease, cervical myelopathy, cervical radiculopathy, mechanical
neck disease
- Systemic disease
o Often associated with polymyalgia rheumatica, rheumatoid arthritis, and other
inflammatory conditions
o Systemic symptoms and signs, other joint complaints, and prolonged morning stiffness are
often present
o Typical: symmetric loss of ROM of the cervical spine
o Lab markers of inflammation, such as C-reactive protein and erythrocyte sedimentation rate, are
often increased
- Myelopathy produced by cervical stenosis
o Does not always cause neck pain
o Often characterized by spastic gait disturbance and weakness in the lower extremities with
upper motor neuron signs (eg, hyperreflexia, increased muscle tone, positive Babinski signs)
o Can also produce lower motor neuron findings in the upper extremities
o Bladder symptoms include urgency, frequency, or retention
- Cervical radiculopathy
o Characterized by pain in the neck and arm, sensory loss, loss of motor function, and reflex
changes in the affected nerve-root distribution
o Usually due to encroachment of the neuroforamina of the cervical spine; the C7 nerve root is
most frequently affected
, o Suggested by pain that is reproduced by rotating the head or bending it toward the symptomatic
side
o Most patients improve with symptomatic treatment, and only a relatively small number require
surgery
- Nonspecific mechanical disease of cervical spine: diagnosis
o Cervical disc displacement appears to be a frequent cause of neck pain in older adults
o Cervical spine disease can also produce local muscle spasm and tenderness, often mistaken for
the “trigger points” of fibromyalgia
o Typical: asymmetric loss of ROM of the cervical spine and weakness of the muscles
innervated by cervical nerve roots, such as elbow extension and finger abduction in patients
with C7, C8, and T1 disease
- Nonspecific mechanical disease of cervical spine: treatment
o Little hard data on the effectiveness of one therapy versus another
o Manual therapy and exercise are more effective than alternative strategies
o Surgery should be considered only for significant, persistent, and worsening neurologic signs
, Assessment of LBP in the Older Adult
