Aspecifieke nekpijn: diagnose en behandeling - KCE
Aspecifieke nekpijn: diagnose en behandeling - KCE
Aspecifieke nekpijn: diagnose en behandeling - KCE
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AANBEVELING -<br />
KLINISCHE VRAGEN<br />
I Diagnostiek - approach<br />
<strong>KCE</strong> Reports 119 Non-Specific Neck Pain: diagnosis and treatm<strong>en</strong>t 57<br />
APPENDIX 6: RECOMMENDATIONS COMPARED TO EXISTING GUIDELINES<br />
De op basis van AGREE geselecteerde<br />
richtlijn<strong>en</strong>:<br />
Aanbeveling 1 Aanbeveling 2 Aanbeveling 3 Aanbeveling 4<br />
Kernboodschapp<strong>en</strong> Evid<strong>en</strong>ti<strong>en</strong>iveau * Boodschap Kernboodschapp<strong>en</strong> Evid<strong>en</strong>ti<strong>en</strong>iveau * Boodschap Kernboodschapp<strong>en</strong> Evid<strong>en</strong>ti<strong>en</strong>iveau * Boodschap Kernboodschapp<strong>en</strong> Evid<strong>en</strong>ti<strong>en</strong>iveau *<br />
adapter<strong>en</strong>?<br />
adapter<strong>en</strong>?<br />
adapter<strong>en</strong>?<br />
(ja / ne<strong>en</strong>)<br />
(ja / ne<strong>en</strong>)<br />
(ja / ne<strong>en</strong>)<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 neck pain?<br />
neck pain?<br />
or nerve root pain (radiculopathy) and possible * Exclude non-musculoskeletal causes, such as cardiovascular, respiratory,<br />
facet joint spinal pain.<br />
and oesophageal diseases, and acute upper respiratory tract infection and<br />
sore throat.<br />
* Look for 'red flags' (that suggest a serious spinal abnormality). If pres<strong>en</strong>t,<br />
refer urg<strong>en</strong>tly for investigations and further assessm<strong>en</strong>t.<br />
* If the neck pain and other symptoms follow rec<strong>en</strong>t sudd<strong>en</strong> or excessive<br />
hyperext<strong>en</strong>sion, flexion, or rotation of the neck, see CKS topic on Neck painwhiplash<br />
injury.<br />
* If the neck pain is due to acute spasm with no obvious underlying cause,<br />
see the CKs topic on Neck pain- acute torticollis.<br />
* If the neck varies with differ<strong>en</strong>t physical activities and with time, or is related<br />
to an awkward movem<strong>en</strong>t, poor posture, or overuse, suspect non-specific neck<br />
pain.<br />
* If there is unilateral neck, shoulder, or arm pain that aproximates to a<br />
dermatome, suspect cervical radiculopathy, see the CKS topic on Neck Paincervical<br />
radiculopathy. there may be altered s<strong>en</strong>sation or numbness, or<br />
weakness in related muscles. However, the pres<strong>en</strong>ce of pain or parasthesia<br />
radiating into the arm is not specific for nerve root pain and may be pres<strong>en</strong>t in<br />
people with non-specific neck pain.<br />
* Id<strong>en</strong>tify risk factors for developing neck pain: 1) workplace associated risks<br />
(awkward neck postures, neck flexion, arm force, arm posture, duration of<br />
sitting, twisting or b<strong>en</strong>ding of the trunk, had-arm vibration, and some<br />
workplace designs.) 2) excessive use of pillows.<br />
* Id<strong>en</strong>tify psychosocial factors that may indicate increased risk for chronicity<br />
and disability. Id<strong>en</strong>tify any excessive concerns about the neck pain,<br />
unrealistic expectations of treatm<strong>en</strong>t, disbling sickness behaviour, and<br />
problems with comp<strong>en</strong>sation, work, family, mood and emotions.<br />
* Cervical X-rays and other imaging studies and investigations are not routinely<br />
required to <strong>diagnose</strong> or assess neck pain with radiculopathy and non-specific<br />
neck pain.<br />
2 What are the diagnostic procedures • No evid<strong>en</strong>ce for diagnostic accuracy of<br />
to be performed to <strong>diagnose</strong> non- history talking is found.<br />
specific neck pain?<br />
• No evid<strong>en</strong>ce for diagnostic imaging for<br />
pati<strong>en</strong>ts with non-specific neck pain is<br />
found.<br />
Older age and cocomitant low back pain are<br />
indicators of a less favourable prognosis of neck<br />
pain.<br />
Radiological findings are not associated with<br />
worse diagnosis, but the severity of pain and a<br />
history of previous attacks however seem to be<br />
associated with worse diagnosis.<br />
The ‘Acute Low Back Pain Scre<strong>en</strong>ing instrum<strong>en</strong>t’<br />
seems to be a reliable instrum<strong>en</strong>t in scre<strong>en</strong>ing<br />
pati<strong>en</strong>ts with non-specific neck pain 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 Argum<strong>en</strong>ts to confirm radiculopathy :<br />
*Positive Spurling Test<br />
*Positive Traction Distraction test<br />
*Positive Vasalva manoevre<br />
*Positive Shoulder Abduction test<br />
o Argum<strong>en</strong>ts to exclude radiculopathy:<br />
*Negative Upper Limb T<strong>en</strong>sion test.<br />
How do I assess someone with neck pain?<br />
* Exclude non-musculoskeletal causes, such as<br />
cardiovascular, respiratory, and oesophageal diseases,<br />
and acute upper respiratory tract infection and sore<br />
throat.<br />
* Look for 'red flags' (that suggest a serious spinal<br />
abnormality). If pres<strong>en</strong>t, refer urg<strong>en</strong>tly for investigations<br />
and further assessm<strong>en</strong>t.<br />
* If the neck pain and other symptoms follow rec<strong>en</strong>t<br />
sudd<strong>en</strong> or excessive hyperext<strong>en</strong>sion, flexion, or rotation<br />
of the neck, see CKS topic on Neck pain-whiplash<br />
injury.<br />
* If the neck pain is due to acute spasm with no obvious<br />
underlying cause, see the CKs topic on Neck pain-<br />
acute torticollis.<br />
* If the neck varies with differ<strong>en</strong>t physical activities and<br />
with time, or is related to an awkward movem<strong>en</strong>t, poor<br />
posture, or overuse, suspect non-specific neck pain.<br />
* If there is unilateral neck, shoulder, or arm pain that<br />
aproximates to a dermatome, suspect cervical<br />
radiculopathy, see the CKS topic on Neck Pain-<br />
cervical radiculopathy. there may be altered s<strong>en</strong>sation<br />
or numbness, or weakness in related muscles.<br />
However, the pres<strong>en</strong>ce of pain or parasthesia radiating<br />
into the arm is not specific for nerve root pain and may<br />
be pres<strong>en</strong>t in people with non-specific neck pain.<br />
* Id<strong>en</strong>tify risk factors for developing neck pain: 1)<br />
workplace associated risks (awkward neck postures,<br />
neck flexion, arm force, arm posture, duration of sitting,<br />
twisting or b<strong>en</strong>ding of the trunk, had-arm vibration, and<br />
some workplace designs.) 2) excessive use of pillows.<br />
* Id<strong>en</strong>tify psychosocial factors that may indicate<br />
C<br />
C<br />
C<br />
C Exclude facet joint spinal<br />
pain. If a working<br />
<strong>diagnose</strong> 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 pain.<br />
B