查看颈痛来源:临床实践指南

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您请求的操作仅限于组中的用户:==分类==临床医生应将颈椎和上胸区域的活动受限、颈椎疼痛相关[[头痛]]的存在、创伤史、转诊或放射性上肢疼痛作为有用的临床表现，将NP患者分为以下几类: *伴有活动能力缺陷的颈部疼痛*伴有运动协调障碍的颈部疼痛*伴有头痛的颈部疼痛*伴有放射性疼痛的颈部疼痛根据检查结果，临床医生应将NP患者分为上述四组之一，以便提供最合适的治疗方案。为了对患者进行分组，临床医生应该进行适当的主观和客观检查(推荐等级:C)。以下是在将患者分为这些类别时需要评估的主要发现。然而，所概述的分类并不详尽，因此，指定患者需要根据检查结果进行个人临床判断。===颈部疼痛伴活动障碍:=== *中枢性和/或单侧颈部疼痛*颈部活动受限，反复出现症状*可能存在相关(提及)[[肩]]腰带或上肢疼痛*颈部活动受限*在主动和被动运动末端重现颈部疼痛*颈椎和胸椎节段活动受限*节段间活动测试显示特征性受限*颈部和胸椎节段疼痛在受累的颈椎或胸椎受到刺激时重现*亚急性或慢性颈部疼痛患者可出现颈肩胸椎力量和运动控制缺陷===''伴有运动协调障碍的颈部疼痛(包括鞭扭伤相关疾病):'' === *与创伤或鞭扭伤有关的发病机制*与肩带或上肢相关的(参考)疼痛*相关的各种非特异性[[脑震荡的评估和处理]]体征和症状*头痛、注意力不集中或记忆困难;混乱;过敏的:对机械、热、声、气味或光刺激过敏的; heightened affective distress * Positive craniocervical flexion test * Positive neck flexor muscle endurance test * Positive pressure algometry * Strength and endurance deficits of the neck muscles * Neck pain with mid-range motion that worsens with end-range positions * Point tenderness may include myofascial trigger points * Sensorimotor impairment may include altered muscle activation patterns, proprioceptive deficit, postural balance or control * Neck and referred pain reproduced by provocation of the involved cervical segments ==='''Neck pain with headaches (cervicogenic headaches)'''=== * Non-continuous, unilateral neck pain and associated (referred) headache * Headache is precipitated or aggravated by neck movements or sustained positions/postures * Positive cervical flexion rotation test * Headache reproduced with provocation of the involved upper cervical segments * Limited cervical ROM * Restricted upper cervical segmental mobility * Strength, endurance, and coordination deficits of the neck muscle ==='''Neck pain with radiating pain (radicular)'''=== * Neck pain with radiating (narrow band of lancinating) pain in the involved extremity * Upper extremity dermatomal paresthesia or numbness, and myotomal muscle weakness * Neck and neck-related radiating pain reproduced or relieved with radiculopathy testing: positive test cluster includes upper-limb nerve mobility, Spurling’s test, cervical distraction, cervical ROM * May have upper extremity sensory, strength, or reflex deficits associated with the involved nerve roots

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