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imaging characteristics

The CORE Neck Tool: An Organized Approach to Neck Pain

Teaser: 

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,1
Pierre Côté DC, PhD,2
Dr. Hamilton Hall, MD, FRCSC,3

1 is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.
2Canada Research Chair in Disability Prevention and Rehabilitation; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT); Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation.
3 is a Professor in the Department of Surgery at the University of Toronto. He is the Medical Director, CBI Health Group and Executive Director of the Canadian Spine Society in Toronto, Ontario.

CLINICAL TOOLS

Abstract: Neck pain is a common presentation in primary care with an estimated one-year incidence ranging from 10.4-21.3% and a 25-50% recurrent rate.1 Guidelines have not included a specific approach to assessment although treatment recommendations have advised non-pharmacological and pharmacological management for optimal results. The CORE Neck Tool was designed as a comprehensive, user-friendly approach to clinical decision making for primary care providers assessing patients with neck pain. The key components of the tool include a high yield history, physical examination and a management matrix providing evidence-based recommendations for acute and chronic neck dominant and arm dominant pain patterns. Criteria is clearly described for investigations and referral management and patient key messages are embedded in the tool. This tool has been incorporated into the Ontario Quality Based Spine Pathway and is endorsed by the Ontario College of Family Physicians and the Nurse Practitioners Association of Ontario. A clinical case will be used to demonstrate the application of the tool to practice and instruct the reader on the key features.
Key Words: Spinal lesion, tumour, imaging characteristics, primary bone tumours.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

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1. Most neck pain is benign mechanical pain and serious pathology is uncommon.
2. Always assess the patient's headache symptoms first before proceeding with the neck assessment.
3. Cervical imaging is only required in patients with persistent arm dominant pain, positive neurological findings or a history of significant trauma.12
4. Neck pain is considered chronic if persisting greater than three months.
5. Exercise, education and postural advice are the best evidence-based treatment.
If the patient presents with shoulder dominant pain, do a complete shoulder examination versus if the patient presents with neck dominant pain, only a shoulder screen assessing range is necessary.
Palpation of the cervical nodes is a quick and necessary component of the neck examination to ensure that a red flag is not present.
Cervical myelopathy signs may include difficulty with hand fine motor tasks, tingling and/or numbness in the upper extremities and changes in gait steadiness and coordination.
Do not make the concurrent diagnosis of bilateral carpal tunnel syndrome, until cervical cord pathology has been excluded.
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Spinal Lesion: Benign or Malignant? When should you worry?

Teaser: 

Raphaële Charest-Morin, MD, FRCSC,1
Nicolas Dea, MD, MSc, FRCSC,2

1Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Québec, Laval University, QC.
2Spine Surgeon, Clinical Associate Professor of Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, BC.

CLINICAL TOOLS

Abstract: General practitioners are occasionally confronted to unknown lesions of the spine. Recognition of imaging characteristics and anatomic details from the different imaging modalities generally provides sufficient information to generate an appropriate differential diagnosis. Importantly, first line clinicians should recognize worrisome imaging characteristics and initiate timely referral when indicated. On the other hand, lesions expressing benign features should also be identified to avoid anxiety for the patient and overuse of diagnosis imaging studies. In a public health-care system, judicious utilization of imaging is of paramount importance. This article will review an approach to unknown bony lesions of the spine.
Key Words: Spinal lesion, tumour, imaging characteristics, primary bone tumours.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

A solitary spinal lesion warrants a careful investigation. Most of the time, local imaging and systemic staging provide diagnosis.
In patients over 40 years old, most tumours are malignant with metastases and multiple myeloma being the most frequent. Benign and incidental lesions such as bony islands and hemangiomas are, however, also frequently encountered in this age group.
In patients under 30 years old, tumours of the spine are uncommon and are generally benign with the exception of Ewing Sarcoma and Osteosarcoma.
Primary bone tumours of the spine are rare and should be referred to specialized centers.
Worrisome features on imaging include aggressive bony destruction, spinal canal invasion, soft tissue mass and multiple level involvement.
Pyogenic infections usually start in the disc space, whereas tumours generally spare the intervertebral disc.
Most aggressive lesions will initially present with non-specific clinical complaints and as such, a high level of suspicion is warranted. Systemic symptoms are rare with primary bone tumours.
Most incidental findings do not require any follow-up or further investigation.
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