Subacromial pain — SCE Rheumatology MCQ
Instant feedback + full explanation. One question, done properly.
Educational content. Not a substitute for clinical judgement or local policy.
Reveal the answer and explanation
Correct answer: A — Arrange urgent cervical MRI and spinal surgical opinion for possible rheumatoid myelopathy
Explanation lettering: C = shown as B · E = shown as C · B = shown as E
A is correct. Upper-motor-neurone signs, hand dysfunction and Lhermitte-type symptoms in established rheumatoid arthritis raise concern for atlantoaxial or subaxial instability with cord compression. NICE requires urgent MRI and surgical opinion when cervical myelopathy is suspected. Normal or minimally abnormal neutral plain films do not exclude dynamic instability or soft-tissue pannus. B risks neurological deterioration through manipulation. C investigates peripheral rather than cord pathology. D delays imaging while treating disease activity as a surrogate for mechanical compression. E may have a temporary protective role after specialist assessment, but neither a collar nor delayed radiography addresses the immediate risk of irreversible myelopathy.
Reference: NICE NG100: rheumatoid arthritis in adults — recommendations: https://www.nice.org.uk/guidance/ng100/chapter/Recommendations