The Curbsiders Internal Medicine Podcast #435 Neck Pain with Dr. Anthony Mikula
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Apr 15, 2024 Orthopedic surgeon Dr. Anthony Mikula from Mayo Clinic shares insights on neck pain evaluation, management, and surgical considerations. Topics include differentiating radiculopathy, myelopathy, and mechanical neck pain, indications for imaging, terminology like DISH and spondylolisthesis, physical examination for radiculopathy, interventions, and recognizing cervical myelopathy. Detailed discussions on diagnostic work-up, treatment options, surgical considerations, and the natural history of myelopathy are included.
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Keeping A Living Phone Notebook
- Dr. Anthony Mikula keeps clinical notes on his phone for procedures and cases to quickly review later.
- He updates these living notes to look prepared and share practical tips with colleagues.
Bilateral Pain Suggests Non‑Radicular Cause
- Bilateral shoulder pain reduces suspicion for radiculopathy since radicular symptoms are usually unilateral.
- C5 pain maps to the shoulder, C6 to thumb/index, C7 to middle finger, and C8 to the little finger.
Delay MRI For Most Radiculopathies
- For cervical radiculopathy, wait about 6 weeks before MRI unless there is profound or progressive weakness.
- Offer conservative care (PT, gabapentin, injections) since ~90% improve in 6–12 weeks.