NECK PAIN

Neck pain is a common problem. In most cases it is difficult to establish the exact cause. Treatment is conservative in most cases.

DIFFERENTIAL DIAGNOSIS:

	Cervical spondylosis
	Neck strain/sprain
	Radiculopathy
	Cervical Myelopathy
	Rheumatoid arthritis
	Torticollis
	Trauma
	Chronic pain syndrome
	Neoplasm
	Vertebral osteomyelitis
	Referred pain
	Ankylosing spondylitis
	Paget’s disease
	Fibromyalgia
	Meningitis

HISTORY:

• Duration, onset of pain?
• Trauma (type, severity, etc.)?
• Character of the pain? Does it radiate to shoulders, arms, hands? Is there associated burning, numbness or weakness?
• Do certain activities make the pain better or worse? Is pain relieved by rest?
• Is there loss of bowel or bladder control?
• Has there been recent illness, infection, fever, or other medical problems?
• History of cancer?

Most neck pain lasts for days or a few weeks and is nonradiating. Muscle strain and spasm are common causes and are relieved by rest physical measures and medication.

CLINICAL FINDINGS:

• Tenderness, loss of motion of neck and shoulders.
• Numbness or weakness of upper or lower extremities.
• Hyporeflexia or hyperreflexia.
• Sensory changes

Neck pain without neck tenderness, loss of neck motion or pain with neck motion may suggest a referred cause.

TESTS:

• Cervical X-rays (AP and lateral)
• Magnetic resonance imaging (MRI) or computed tomography (CT)
• Bone scan
• Electromyography (EMG)/Nerve conduction velocity studies (NCVs)
• Laboratory studies as indicated

MANAGEMENT:

• Pain relief; rest, medications (analgesics, muscle relaxants), physical modalities (heat or cold, ultrasound)
• Nerve blocks (cervical epidural steroid injections) (CESI)
• Surgery-occasionally indicated
• Watch for systemic symptoms, neurologic changes or unremitting pain

Unremitting pain suggests neoplasm or infection. Cervical myelopathy  presents with lower extremity symptoms (ataxia, hyperreflexia and/or hypertonicity)