9 Non-mechanical disorders Warning signs Chapter contents Warning signs Warning signs disclosed by the history Warning signs disclosed by the functional examination Pathology: see the online content Most cervical spine syndromes are activity-related or mechanical. They result from disc lesions and/or degeneration of the spine. Syndromes that are not activity-related are called non-mechanical disorders. They stem from inflammatory diseases, tumours and metabolic disorders. Though they can influence mobility, they are intrinsic diseases of the cervical structures and do not have a mechanical origin. Warning signs Mechanical lesions of the cervical spine usually demonstrate very typical behaviour. They present with so-called ‘inherent likelihoods’ – the sequence of symptoms and signs that make up the clinical picture of a certain pathological disorder and that are likely to be found. Hence, when symptoms and signs come forward during the clinical assessment which show rather unlikely behaviour, examiners should be on their guard. Such symptoms and signs are called ‘warning’ signs. The examiner should consider them as the hallmark of a (serious) non-mechanical disorder until there is proof to the contrary. An unusual disorder is immediately suspected and further complementary investigations (blood tests, radiography, CT scan, bone scan, MRI) should be requested. Warning signs disclosed by the history Gradually increasing pain Mechanical lesions tend to present with acute pain, as episodic pain that comes and goes in a rather irregular way, or as a constant, unchanged pain over a considerable length of time. Sometimes with a disc lesion, pain gradually increases over a short period of time, after which it remains unaltered for a certain period and then diminishes again. If, in contrast, the intensity of the pain increases progressively over a couple of weeks, then a serious lesion is likely. Expanding pain Pain typically changes location with a disc lesion. In a discodural conflict the pain moves within the zone of multisegmental reference, and when the conflict becomes discoradicular it shifts from the neck or scapular area to the arm. In other words, it shifts from one area to another. In the case of expanding pain, however, the evolution is different: for example, the pain starts in the centre of the neck, then becomes bilateral and spreads to the scapular area, and may finally radiate down one upper limb or both limbs. Another possibility is pain that develops in one dermatome and gradually spreads beyond its borders into other dermatomes. Increasing scapular pain together with an increase of brachial pain is also suspect. Pain that expands very often indicates a lesion that expands (a tumour or metastasis). First-time neck pain in an elderly person A middle-aged or elderly patient who, for the first time in life, complains of neck pain or who describes rapidly increasing pain and neck stiffness, coming on in the course of 1 or 2 months, should be suspected of having malignancy in the cervical spine. Bilateral arm pain A discal lesion seldom causes pain in both arms. Either the disorder is discodural, causing bilateral cervicoscapular pain, or there is a discoradicular conflict, in which case pain will be felt in one arm only. A disc displacement that is large enough to cause pain in both arms would certainly also threaten the spinal cord. Other possibilities are: large osteophytes at one particular level and other bony lesions of the cervical spine. Bilateral arm pain is therefore a warning sign for a serious disorder. Arm pain in a person younger than 30 Root pain as the result of pressure by an ordinary cervical disc is very rare in people under the age of 30. Therefore, if there is evidence of radicular pain and the patient is younger than 30, another cause has to be sought. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Interpretation of the clinical examination of the knee Principles of treatment pain of the thoracic cage and abdomen Connective tissue Disorders of the contractile structures Stay updated, free articles. Join our Telegram channel Join Tags: A System of Orthopaedic Medicine Jun 5, 2016 | Posted by admin in ORTHOPEDIC | Comments Off on Non-mechanical disorders: Warning signs Full access? Get Clinical Tree
9 Non-mechanical disorders Warning signs Chapter contents Warning signs Warning signs disclosed by the history Warning signs disclosed by the functional examination Pathology: see the online content Most cervical spine syndromes are activity-related or mechanical. They result from disc lesions and/or degeneration of the spine. Syndromes that are not activity-related are called non-mechanical disorders. They stem from inflammatory diseases, tumours and metabolic disorders. Though they can influence mobility, they are intrinsic diseases of the cervical structures and do not have a mechanical origin. Warning signs Mechanical lesions of the cervical spine usually demonstrate very typical behaviour. They present with so-called ‘inherent likelihoods’ – the sequence of symptoms and signs that make up the clinical picture of a certain pathological disorder and that are likely to be found. Hence, when symptoms and signs come forward during the clinical assessment which show rather unlikely behaviour, examiners should be on their guard. Such symptoms and signs are called ‘warning’ signs. The examiner should consider them as the hallmark of a (serious) non-mechanical disorder until there is proof to the contrary. An unusual disorder is immediately suspected and further complementary investigations (blood tests, radiography, CT scan, bone scan, MRI) should be requested. Warning signs disclosed by the history Gradually increasing pain Mechanical lesions tend to present with acute pain, as episodic pain that comes and goes in a rather irregular way, or as a constant, unchanged pain over a considerable length of time. Sometimes with a disc lesion, pain gradually increases over a short period of time, after which it remains unaltered for a certain period and then diminishes again. If, in contrast, the intensity of the pain increases progressively over a couple of weeks, then a serious lesion is likely. Expanding pain Pain typically changes location with a disc lesion. In a discodural conflict the pain moves within the zone of multisegmental reference, and when the conflict becomes discoradicular it shifts from the neck or scapular area to the arm. In other words, it shifts from one area to another. In the case of expanding pain, however, the evolution is different: for example, the pain starts in the centre of the neck, then becomes bilateral and spreads to the scapular area, and may finally radiate down one upper limb or both limbs. Another possibility is pain that develops in one dermatome and gradually spreads beyond its borders into other dermatomes. Increasing scapular pain together with an increase of brachial pain is also suspect. Pain that expands very often indicates a lesion that expands (a tumour or metastasis). First-time neck pain in an elderly person A middle-aged or elderly patient who, for the first time in life, complains of neck pain or who describes rapidly increasing pain and neck stiffness, coming on in the course of 1 or 2 months, should be suspected of having malignancy in the cervical spine. Bilateral arm pain A discal lesion seldom causes pain in both arms. Either the disorder is discodural, causing bilateral cervicoscapular pain, or there is a discoradicular conflict, in which case pain will be felt in one arm only. A disc displacement that is large enough to cause pain in both arms would certainly also threaten the spinal cord. Other possibilities are: large osteophytes at one particular level and other bony lesions of the cervical spine. Bilateral arm pain is therefore a warning sign for a serious disorder. Arm pain in a person younger than 30 Root pain as the result of pressure by an ordinary cervical disc is very rare in people under the age of 30. Therefore, if there is evidence of radicular pain and the patient is younger than 30, another cause has to be sought. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Interpretation of the clinical examination of the knee Principles of treatment pain of the thoracic cage and abdomen Connective tissue Disorders of the contractile structures Stay updated, free articles. Join our Telegram channel Join Tags: A System of Orthopaedic Medicine Jun 5, 2016 | Posted by admin in ORTHOPEDIC | Comments Off on Non-mechanical disorders: Warning signs Full access? Get Clinical Tree
