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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AANBEVELING -<br />
KLINISCHE VRAGEN<br />
I Diagnostiek - approach<br />
<strong>KCE</strong> Reports 119 <strong>Non</strong>-Specific Neck Pain: <strong>diagnosis</strong> <strong>and</strong> <strong>treatment</strong> 57<br />
APPENDIX 6: RECOMMENDATIONS COMPARED TO EXISTING GUIDELINES<br />
De op basis van AGREE geselecteerde<br />
richtlijnen:<br />
Aanbeveling 1 Aanbeveling 2 Aanbeveling 3 Aanbeveling 4<br />
Kernboodschappen Evidentieniveau * Boodschap Kernboodschappen Evidentieniveau * Boodschap Kernboodschappen Evidentieniveau * Boodschap Kernboodschappen Evidentieniveau *<br />
adapteren?<br />
adapteren?<br />
adapteren?<br />
(ja / neen)<br />
(ja / neen)<br />
(ja / neen)<br />
Guideline CKS Guideline BMJ GRADE Guideline CKS Guideline BMJ GRADE Guideline CKS Guideline BMJ GRADE Guideline CKS Guideline BMJ GRADE<br />
1 How do you assess someone with Exclude "red flags" , serious spinal pathology How do I assess someone with <strong>neck</strong> <strong>pain</strong>?<br />
<strong>neck</strong> <strong>pain</strong>?<br />
or nerve root <strong>pain</strong> (radiculopathy) <strong>and</strong> possible * Exclude non-musculoskeletal causes, such as cardiovascular, respiratory,<br />
facet joint spinal <strong>pain</strong>.<br />
<strong>and</strong> oesophageal diseases, <strong>and</strong> acute upper respiratory tract infection <strong>and</strong><br />
sore throat.<br />
* Look for 'red flags' (that suggest a serious spinal abnormality). If present,<br />
refer urgently for investigations <strong>and</strong> further assessment.<br />
* If the <strong>neck</strong> <strong>pain</strong> <strong>and</strong> other symptoms follow recent sudden or excessive<br />
hyperextension, flexion, or rotation of the <strong>neck</strong>, see CKS topic on Neck <strong>pain</strong>whiplash<br />
injury.<br />
* If the <strong>neck</strong> <strong>pain</strong> is due to acute spasm with no obvious underlying cause,<br />
see the CKs topic on Neck <strong>pain</strong>- acute torticollis.<br />
* If the <strong>neck</strong> varies with different physical activities <strong>and</strong> with time, or is related<br />
to an awkward movement, poor posture, or overuse, suspect non-<strong>specific</strong> <strong>neck</strong><br />
<strong>pain</strong>.<br />
* If there is unilateral <strong>neck</strong>, shoulder, or arm <strong>pain</strong> that aproximates to a<br />
dermatome, suspect cervical radiculopathy, see the CKS topic on Neck Paincervical<br />
radiculopathy. there may be altered sensation or numbness, or<br />
weakness in related muscles. However, the presence of <strong>pain</strong> or parasthesia<br />
radiating into the arm is not <strong>specific</strong> for nerve root <strong>pain</strong> <strong>and</strong> may be present in<br />
people with non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong>.<br />
* Identify risk factors for developing <strong>neck</strong> <strong>pain</strong>: 1) workplace associated risks<br />
(awkward <strong>neck</strong> postures, <strong>neck</strong> flexion, arm force, arm posture, duration of<br />
sitting, twisting or bending of the trunk, had-arm vibration, <strong>and</strong> some<br />
workplace designs.) 2) excessive use of pillows.<br />
* Identify psychosocial factors that may indicate increased risk for chronicity<br />
<strong>and</strong> disability. Identify any excessive concerns about the <strong>neck</strong> <strong>pain</strong>,<br />
unrealistic expectations of <strong>treatment</strong>, disbling sickness behaviour, <strong>and</strong><br />
problems with compensation, work, family, mood <strong>and</strong> emotions.<br />
* Cervical X-rays <strong>and</strong> other imaging studies <strong>and</strong> investigations are not routinely<br />
required to diagnose or assess <strong>neck</strong> <strong>pain</strong> with radiculopathy <strong>and</strong> non-<strong>specific</strong><br />
<strong>neck</strong> <strong>pain</strong>.<br />
2 What are the diagnostic procedures • No evidence for diagnostic accuracy of<br />
to be performed to diagnose non- history talking is found.<br />
<strong>specific</strong> <strong>neck</strong> <strong>pain</strong>?<br />
• No evidence for diagnostic imaging for<br />
patients with non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong> is<br />
found.<br />
Older age <strong>and</strong> cocomitant low back <strong>pain</strong> are<br />
indicators of a less favourable prognosis of <strong>neck</strong><br />
<strong>pain</strong>.<br />
Radiological findings are not associated with<br />
worse <strong>diagnosis</strong>, but the severity of <strong>pain</strong> <strong>and</strong> a<br />
history of previous attacks however seem to be<br />
associated with worse <strong>diagnosis</strong>.<br />
The ‘Acute Low Back Pain Screening instrument’<br />
seems to be a reliable instrument in screening<br />
patients with non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong> at risk for<br />
prolonged sick leave.<br />
• Exclude 'radiculopathy'. With<br />
combinations of the following test,<br />
radiculopathy can be confirmed or excluded:<br />
o Arguments to confirm radiculopathy :<br />
*Positive Spurling Test<br />
*Positive Traction Distraction test<br />
*Positive Vasalva manoevre<br />
*Positive Shoulder Abduction test<br />
o Arguments to exclude radiculopathy:<br />
*Negative Upper Limb Tension test.<br />
How do I assess someone with <strong>neck</strong> <strong>pain</strong>?<br />
* Exclude non-musculoskeletal causes, such as<br />
cardiovascular, respiratory, <strong>and</strong> oesophageal diseases,<br />
<strong>and</strong> acute upper respiratory tract infection <strong>and</strong> sore<br />
throat.<br />
* Look for 'red flags' (that suggest a serious spinal<br />
abnormality). If present, refer urgently for investigations<br />
<strong>and</strong> further assessment.<br />
* If the <strong>neck</strong> <strong>pain</strong> <strong>and</strong> other symptoms follow recent<br />
sudden or excessive hyperextension, flexion, or rotation<br />
of the <strong>neck</strong>, see CKS topic on Neck <strong>pain</strong>-whiplash<br />
injury.<br />
* If the <strong>neck</strong> <strong>pain</strong> is due to acute spasm with no obvious<br />
underlying cause, see the CKs topic on Neck <strong>pain</strong>-<br />
acute torticollis.<br />
* If the <strong>neck</strong> varies with different physical activities <strong>and</strong><br />
with time, or is related to an awkward movement, poor<br />
posture, or overuse, suspect non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong>.<br />
* If there is unilateral <strong>neck</strong>, shoulder, or arm <strong>pain</strong> that<br />
aproximates to a dermatome, suspect cervical<br />
radiculopathy, see the CKS topic on Neck Pain-<br />
cervical radiculopathy. there may be altered sensation<br />
or numbness, or weakness in related muscles.<br />
However, the presence of <strong>pain</strong> or parasthesia radiating<br />
into the arm is not <strong>specific</strong> for nerve root <strong>pain</strong> <strong>and</strong> may<br />
be present in people with non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong>.<br />
* Identify risk factors for developing <strong>neck</strong> <strong>pain</strong>: 1)<br />
workplace associated risks (awkward <strong>neck</strong> postures,<br />
<strong>neck</strong> flexion, arm force, arm posture, duration of sitting,<br />
twisting or bending of the trunk, had-arm vibration, <strong>and</strong><br />
some workplace designs.) 2) excessive use of pillows.<br />
* Identify psychosocial factors that may indicate<br />
C<br />
C<br />
C<br />
C Exclude facet joint spinal<br />
<strong>pain</strong>. If a working<br />
diagnose by manual<br />
examination procedures<br />
fails, than local<br />
anesthetic block can be<br />
used for proving or<br />
excluding facet joint<br />
spinal <strong>pain</strong>.<br />
B