Non-mechanical disorders: Warning signs


Non-mechanical disorders

Warning signs


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

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).

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Jun 5, 2016 | Posted by in ORTHOPEDIC | Comments Off on Non-mechanical disorders: Warning signs

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