NM703 - MUSCULOSKELETAL EXAM QUESTIONS AND
ANSWERS WITH COMPLETE SOLUTIONS
Cause of neck strains and sprains
overuse, stretching or tearing with no neurological symptoms in the acute phase
Cervical radiculopathy with neck pain
pinched nerve in the neck that can cause numbness, weakness, or pain in the arms or
hands
Cervical myelopathy of the neck
Occurs when the cervical spinal cord is compressed, causing sudden or gradually
worsening pain, sensory problems, loss of balance, or paralysis
**possible complication of cervical spondylosis
How do you differentiate between cervical radiculopathy vs cervical myelopathy?
- neck pain, diminished reflexes, and arm weakness = radiculopathy (urgent but not
emergent)
- hyperreflexive, positive babinski and clonus = myelopathy (emergent)
Red flags for neck apin
-hx cancer
-hx of (or risk for) osteoporosis
-progressive neuro deficit
- >6weeks without improvement
,Neck Pain objective
-gait and posture; structural abnormalities
-pain over spinous processes; paraspinous muscles for pain or spasm
-ROM (flexion, extension, rotation); strength
- sensation by dermatome
Neck Pain Diagnostics
usually none
MAYBE CBC, ESR, CRP if infection is being considered
Xray, CT, MRI, EMG
Management for neck sprain or strain
conservative care
heat for pain, ice for inflammation, massage
physical therapy for guided exercise
Pharmacological treatment for strains/sprains
NSAIDs
muscle relaxants
Lifestyle management for neck pain
work on appropriate posture (decrease screen use)
avoid repetitive movement/lifting >10lbs
What is a potential medication option for short-term management of neck pain?
A short course of opioids (2-3 days)
Which medication is an SSRI that can be used for neck pain management?
Duloxetine
, Name a muscle relaxant that can be used for neck pain management.
Tizanidine, baclofen, cyclobenzaprine
What medication will help with radiculopathy and restore sleep function?
Gabapentin
When is a referral warranted for neck pain?
- abrupt onset cervical myelopathy associated with gait disturbance
- upper motor neuron signs
- bowel and bladder incontinence
- Incapacitating neck pain refractory to conservative methods
- trauma
- fracture or instability of cervical spine
- epidural steroids
- surgery
Low back pain Mechanical patho
no primary source;
-direct injury, deformity, imbalance, or overuse of identifiable sources in the lumbar
spine
- Structural; wear and tear of the spine
Systemic medical illnesses for lower back pain
Inflammatory infection, neoplastic, visceral sources
Risk factors for low back pain
-Broad
-Genetics
ANSWERS WITH COMPLETE SOLUTIONS
Cause of neck strains and sprains
overuse, stretching or tearing with no neurological symptoms in the acute phase
Cervical radiculopathy with neck pain
pinched nerve in the neck that can cause numbness, weakness, or pain in the arms or
hands
Cervical myelopathy of the neck
Occurs when the cervical spinal cord is compressed, causing sudden or gradually
worsening pain, sensory problems, loss of balance, or paralysis
**possible complication of cervical spondylosis
How do you differentiate between cervical radiculopathy vs cervical myelopathy?
- neck pain, diminished reflexes, and arm weakness = radiculopathy (urgent but not
emergent)
- hyperreflexive, positive babinski and clonus = myelopathy (emergent)
Red flags for neck apin
-hx cancer
-hx of (or risk for) osteoporosis
-progressive neuro deficit
- >6weeks without improvement
,Neck Pain objective
-gait and posture; structural abnormalities
-pain over spinous processes; paraspinous muscles for pain or spasm
-ROM (flexion, extension, rotation); strength
- sensation by dermatome
Neck Pain Diagnostics
usually none
MAYBE CBC, ESR, CRP if infection is being considered
Xray, CT, MRI, EMG
Management for neck sprain or strain
conservative care
heat for pain, ice for inflammation, massage
physical therapy for guided exercise
Pharmacological treatment for strains/sprains
NSAIDs
muscle relaxants
Lifestyle management for neck pain
work on appropriate posture (decrease screen use)
avoid repetitive movement/lifting >10lbs
What is a potential medication option for short-term management of neck pain?
A short course of opioids (2-3 days)
Which medication is an SSRI that can be used for neck pain management?
Duloxetine
, Name a muscle relaxant that can be used for neck pain management.
Tizanidine, baclofen, cyclobenzaprine
What medication will help with radiculopathy and restore sleep function?
Gabapentin
When is a referral warranted for neck pain?
- abrupt onset cervical myelopathy associated with gait disturbance
- upper motor neuron signs
- bowel and bladder incontinence
- Incapacitating neck pain refractory to conservative methods
- trauma
- fracture or instability of cervical spine
- epidural steroids
- surgery
Low back pain Mechanical patho
no primary source;
-direct injury, deformity, imbalance, or overuse of identifiable sources in the lumbar
spine
- Structural; wear and tear of the spine
Systemic medical illnesses for lower back pain
Inflammatory infection, neoplastic, visceral sources
Risk factors for low back pain
-Broad
-Genetics
