Evaluation & Imaging of the Head, Face and Neck

The Screening Model for the Head and Neck

100

Questions to Ask 

Cancer history?

Trauma?

Cardiac History? 

Recent surgery?

200

Red Flags

night pain 

5D And 3Ns

300

Causes of pain 

inflammation 

metabolic 

vascular 

degenerative 

tumor 

400

Assessment of Pain and Patterns 

location 

onset 

description 

intensity 

duration 

500

Associated Signs and Symptoms 

GI symptoms 

Constitutional Ss/Sx 

Headaches

100

Types 

Primary and Secondary 

200

Tension Description 

described as pressure, mild to moderate tightness, dull ache, sensation of band or vise around head 

300

Migraines Description 

unilateral, around or behind one eye, associated with N/V 

400

Cluster HA Description 

boring, stabbing, comes in intervals 

500

Cervicogenic HA location 

starts in occipital regions and spreads anteriorly towards frontal area

Cervical Spine Pain

100

Primary cause 

traumatic

degenerative 

200

Cardiovascular causes of neck pain 

acute coronary insufficiency, MI, thoracic aortic aneurysm 

300

Diaphragm and Lung conditions that lead to neck pain 

pain in shoulder/lateral neck 

breathing changes affect symptoms 

sharp pleuric pain in axilla, s/s worse with coughing, deep breathing 

400

S/S of Cervical Myelopathy

loss of hand dexterity

visible changes in handwriting

positive babinskis and hoffmans 

500

Cervical Spine Views

 Specialized- Swimmers view, Flexion and Extension stress view, oblique view 

Imaging

100

Canadian C- Spine Rules

1. high risk factors 

2. low risk factors

3.actively rotate 

200

MRI 

advanced imaging for C-Spine 

300

When to request MRI 

1. Acute cervical pain with neuro involvement OR instability

2. Chronic pain with neurological symptoms

3. Pattern of infection or malignancy

400

Open mouth views

Fractures

• Lateral masses of C1

• Odontoid process

• Vertebral body of C2

• Jefferson Fracture

500

Oblique Views 

• Foraminal encroachment

• DDD / disc space narrowing

• Facet joint abnormalities

Fracture

100

what is a jeffersons fracture 

• Burst fracture of the C1 vertebrae

200

Odontoid Fracture 

Type I: Avulsion of tip

• Caused by alar or apical ligament stress

• Type II: Fracture of junction of dens and body

• Most common and most difficult to heal, unstable

• Type III: Fracture deep below junction

• Heals readily

300

hangmans fracture 

Bilateral fractures of C2 pars interarticularis

• “traumatic spondylolysis”

• Causes dislocation of C2 on C3

• Usually associated with hyperextension injury

(common in hanging)

400

clay shoveler's fracture 

Fracture of posterior spinous process

• Stable fx as posterior ligaments remain intact

• Occurs at C6, C7,T1 or T2

500

C-Spine Degenerative Changes

Decreased disc height leads to:

• Vertebral endplate approximation

• Friction at uncovertebral joints

• Osteophyte formation

• Schmorl’s nodes

• Vacuum phenomenon