History Cervical spine

The commonest symptoms of a patient with neck pathology are pain and difficulty turning the head and neck. The pain may be localised (o the head, neck, shoulder, arm, or interscapular region.

The patient may also report paraesthesiae in I he arm due to nerve root irritation or, less commonly when the spinal cord is involved, symptoms of lower limb weakness, difficulty walking, loss of sensation and sphincter control. Disease of the upper cervical spine affecting the atlantoaxial joints produces pain radiating into the occiput in the distribution of the C2 nerve root. Disease of the middle and lower cervical spine tends to cause pain radiating into the upper border of the trapezius, interscapular region or into the arms, often associated with local tenderness. Irritation of" the C6 and 7 nerve roots can give rise to widely referred pain in the interscapular region or into the radial lingers and thumb. Irritation of CK can produce pain on the ulnar side of the forearm and into the ring and little lingers.

Thus in any patient with neck pain, and especially after trauma, careful enquiry into the distribution of pain and associated upper and lower limb neurological symptoms is essential. Neck pathology should also be considered in any patient complaining of diffuse pain ill the arm (see Disorders box below), head, upper trunk or interscapular region, particularly if associated with sensory or other neurological disturbance.

DISORDERS

Causes of referred pain to the arm

Cervical spine pathology

Cervical rib

Apical lung neoplasm (Pancoast lesion)

Cardiac ischaemia

Hiatus hernia

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