THE 5 MINUTE CERVICAL SPINE CONSULT IN FAMILY MEDICINE

Background & Aim The cervical spine pathology represents one of the most prevalent issues in the Family Medicine (FM) consult. Most of the patients that will need referral to the Orthopaedics consult will either have Cervical Spondylotic Mielopathy (CSM) or Cervical Radiculopathy (due to an Herniated Disc Compression). Nevertheless, many are the pain generators in the cervical spine, and so, the picture might be confusional. The purpose of this presentation is to make the FM able to do a quick and systematic evaluation of the patient with spine pain, and choose between conservative treatment or orthopaedic referral. Method Presentation of an example of Cervical Spine Pain evaluation. Results The first step is to exclude the “red flags” that need an urgent referral: Trauma, Suspicion of Neoplasic or Infectious disease and Neurologic Deficits. After that it is important to clearly characterize pain but also pay attention to other classic symptons. CSM will present itself with axial neck pain, occipital headache, extremity paresthesias, clumbsiness in hands and gait imbalance. Cervical Radiculopathy will present itself with sensory or motor symptons in the upper extremity. Simple tricks like the shoulder abduction test or the Hoffman test will provide valid information to, for example, distinguish this clinic from shoulder pain. Conclusions We purpose a simple algorithm and systematic evaluation for FM practice, that together with the feedback from the orthopaedic consult, should easen the assessment of a patient with cervical spine pain and pathology.