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Self-Assessment Questions

Rheumatology


Answer 1
  1. Computed tomography scan of the cervical spine. Acceleration/deceleration injuries are common in motor vehicle accidents and in sports. Neck pain occurs within hours, and a 3-view cervical series is 93% sensitive for fractures. The most difficult areas to visualize are the odontoid and C7-T1 lateral view, especially in obese or heavily muscled persons. This patient has radicular symptoms in the C7 dermatome and a history of recent trauma that mandates performance of another imaging test using either computed tomography or magnetic resonance imaging (MRI) to reevaluate the lower cervical spine. When the pain is not trauma-related, is vague in location, and is not accompanied by the warning signs of infection or metastatic disease, use of an analgesic regimen, preferably nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy is a good therapeutic option. Generalized neck pain is quite common. The use of soft or semirigid collars has not been shown to significantly immobilize the neck. These collars can be useful for relief of muscle spasm and as a reminder not to perform movements that may exacerbate neck pain. The various medicines marketed as muscle relaxants are minor tranquilizers and can be useful in the treatment of soft tissue pain on a short-term basis.

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