Orthopedics - Cervical Pain/Stiffness
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Cervical pain that is muscular, discogenic,
or arthritic in nature. Patient may be experiencing limited ROM of C-spine
or have pain referred to the trapezius or upper extremity.
Initial Diagnosis and Management
- History and physical examination.
- Radiograph of the spine if cervical pain
started with trauma.
- MRI/CT not indicated initially.
- Initial Management:
- Do not prescribe muscle relaxants as they
are not effective.
- Soft collar not recommended except for 1-5
days s/p high speed whiplash trauma (i.e., MVA).
- Appropriate activity limitations on
lifting, overhead work, heavy headgear, etc.
- Ice packs every 20 minute q2h x 72 hours -
then change to heat PRN.
- Encourage gentle, pain-free ROM.
Ongoing Management and Objectives
- Should observe a reduction in pain level
within 5-7 days.
- Chronic upper trapezius tension may persist
for up to 2 months.
- Expect increased AROM of C-spine and
decreased muscle spasm within 2 weeks, complete resolution will take
Indications for Specialty Care Referral
- Specialty Care Referral (Physical Therapy):
- No improvement after 7-10 days of initial
primary care management.
- If the patient has radicular symptoms.
- Specialty Care Referral (Orthopedic Spine
- If the patient has neurological findings
(motor, sensory, or reflex deficits) and/or has positive MRI findings.
Criteria for Return to Primary Care
Chronic conditions with a stable neurologic
exam in patients that have been evaluated by Orthopedics or Neurosurgery
and are not surgical candidates.