N30) Neck pain after trauma

Review the Learning Outcomes, Hx, PE and Labs, and begin the module with your Provisional Diagnosis. Keep hitting "Next" to move through the module.

Learning Outcomes

  1. Articulate your relationship with the consulting diagnostic radiologists in the evaluation of a trauma patient with neck pain.
  2. Review the role of different imaging modalities for evaluating patients with neck pain after trauma.


Physical Exam


Provisional Diagnosis

Select the Dx you believe is most appropriate
In a patient involved in an MVA with neck pain, soft tissue/ligamentous injury as well as the possibility of fractures must be investigated.
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Potential Acuity

What is your assessment of the likely acuity for this patient?

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There could be an unstable injury to the cervical spine. There is also the possibility of injury to the spinal cord.

First Imaging Study

What is the first imaging study you will order?

Radiographs are often obtained as the initial study particularly when the patient is still in a collar. If the exam adequately covers the cervical spine and C7-T1 junction and no abnormality is seen, the collar may be removed and further imaging obtained if symptoms persist. Many institutions obtain the CT scan as the initial exam. In this case, the radiographs were obtained first.
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Pertinent Imaging Observations

Click on the links below to view images from the study, and assess these key findings as best you can.

Second Imaging Study

What is the next imaging study you will order?

A CT scan is obtained to detail bony injuries. MRI can miss fractures especially if a fracture is not distracted, but is more sensitive to ligamentous, capsular, spinal cord, or other soft tissue injuries. Flexion and extension views would be contraindicated.
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Third Imaging Study

What is the next imaging study you will order?

The CT scan without contrast already shows significant injuries likely from hyperextension, axial loading, and rotatory mechanisms. It would not be repeated at this time. MRI is needed since it is more sensitive to spinal cord, synovial joint, or other soft tissue especially ligament injuries. CT angiography of the neck may be needed in the future if there is suspicion of vascular injury.

What is your Diagnosis now that you have seen the imaging results?

This case demonstrates how multiple mechanisms are often at play in any significant cervical trauma. In this case the C1 ring fractures and the upper cervical synovial joint effusion are axial-loading injuries, while the articular pillar and oblique dens fractures are likely rotary in nature. The MR helps delineate the extent of the synovial joint injuries.

Current Acuity

Initially, you selected and we suggested acuity.

Has your concern for this patient changed?

Neurosurgery would be consulted immediately (and likely was consulted early, given the initial radiographs).

Socioeconomic Factors: In this case, plain films were done initially. Much more commonly, especially in trauma centers, a CT will be the initial study of choice in a patient with neck pai following an MVA. MRI is typically reserved to further evaluate positive findings on CT scan or other circumstances that suggest a high risk of disc/ ligament/spinal cord injury.

That's the end of the module! Once you've reviewed the video(s), you can click here for another case challenge.

Robbie Slater, MD - Editor
Bayar Batmunh, MS - Coordinator