Non-specific neck pain: diagnosis and treatment - KCE
Non-specific neck pain: diagnosis and treatment - KCE
Non-specific neck pain: diagnosis and treatment - KCE
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14 <strong>Non</strong>-Specific Neck Pain: <strong>diagnosis</strong> <strong>and</strong> <strong>treatment</strong> <strong>KCE</strong> Reports 119<br />
Table 2: Clinical tests for the <strong>diagnosis</strong> of cervical radicular<br />
<strong>pain</strong>/radiculopathy 16 en 27<br />
Clinical tests Description<br />
Spurling’s Test or <strong>neck</strong><br />
compression test 16<br />
The cervical spine is turned to the <strong>pain</strong>ful shoulder <strong>and</strong> then an<br />
axial compression is performed. Reproduction of <strong>pain</strong> in the<br />
shoulder or arm might suggest a nerve compression.<br />
Shoulder abduction test or<br />
shoulder abduction relief sign) 16<br />
The patient elevates his h<strong>and</strong> above his head. When radicular<br />
<strong>pain</strong> decreases or disappears the test is positive.<br />
Axial manual traction test 16 Traction on the <strong>neck</strong> is performed while patient is lying on his<br />
back. The traction is around 10 to 15kg. If the radicular <strong>pain</strong><br />
decreases or disappears the test is positive.<br />
Upper limb tension test (ULTT) 27 The manoeuvre is performed to mechanically stress the<br />
cervical nerve roots <strong>and</strong> upper limb nerves to test their<br />
involvement in suspected radicular <strong>pain</strong>/radiculopathy. The<br />
plexus brachialis can be tested in general, but also the median,<br />
radial <strong>and</strong> ulnar nerve can be tested separately.<br />
3.3 ASSESSMENT OF PAIN AND DISABILITY<br />
Key messages regarding <strong>pain</strong> <strong>and</strong> disability assessment<br />
• To assess self-rated disability of patients with <strong>neck</strong> <strong>pain</strong>: the “Neck Disability<br />
index” is the most strongly validated instrument for self-rated disability.<br />
Evidence from the literature<br />
Four publications 17, 18, 28, 29 investigated <strong>pain</strong> <strong>and</strong> disability assessment (including<br />
questionnaires) in non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong>.<br />
A small study 29 including 18 <strong>neck</strong> patients <strong>and</strong> 22 asymptomatic controls aimed at<br />
examining the diagnostic value of <strong>pain</strong> assessment using a Visual Analogue Scale (VAS), a<br />
short form history using the Bournemouth Questionnaire (BQ) <strong>and</strong> a selection of tests,<br />
both manual <strong>and</strong> instrumental. The VAS <strong>and</strong> BQ resulted in a high percentage of<br />
correctly identified patients <strong>and</strong> controls (≥77,5%) <strong>and</strong> a high <strong>specific</strong>ity (90,9%) 29 .<br />
The manual examination procedures (MEPs) included a manual examination of both<br />
rotations on the C0-2 – C6-7 levels, the adapted Spurling test was performed, starting<br />
at the C1-2 proceeding downwards to C6-7 levels performed bilaterally. The<br />
percentages of correct identifications based on the manual rotation <strong>and</strong> adapted<br />
Spurling were high (82,5%) as their sensitivity <strong>and</strong> <strong>specific</strong>ity (respectively 72,2 <strong>and</strong> 90,9<br />
%). Using CROM (Professional Medical Technologies, inc., 702, North McRoll road,<br />
McCallen, TX 78504, USA) for the instrumental mobility examination all identification<br />
percentages were around 50%, indicating a lesser diagnostic value. The combination of<br />
the VAS, BQ <strong>and</strong> MEPs resulted in a sensitivity <strong>and</strong> <strong>specific</strong>ity of 100% <strong>and</strong> 86,4%,<br />
respectively 29 . (Grade C).<br />
In a group of unskilled women (20-45 yrs) performing monotonous work, Björksten et<br />
al 28 evaluated a questionnaire (a modification of the Nordic Questionnaire) on<br />
musculoskeletal <strong>pain</strong> <strong>and</strong> conditions by means of clinical assessment. Sensitivity of the<br />
Questionnaire for <strong>neck</strong> <strong>pain</strong> during the last 3 months <strong>and</strong> 7 days was high (100% resp.<br />
92%), but the <strong>specific</strong>ity was low (41 resp. 62%) 28 . (Grade B)<br />
The “Neck Disability Index” (NDI) is the most widely used <strong>and</strong> most strongly validated<br />
instrument for assessing self-rated disability in patients with <strong>neck</strong> <strong>pain</strong>. It has been used<br />
effectively in both clinical <strong>and</strong> research settings in the <strong>treatment</strong> of this very common<br />
problem 17, 18 . (Grade A). This is confirmed in a recent review provided by the validation<br />
experts 30 .