Neck Pain

Aka: Neck Pain

advertisement

II. Epidemiology

  1. Prevalence: As high as 20-30% per year
    1. However, only one in five present for medical evaluation for acute Neck Pain
  2. Gender: Females
  3. Age
    1. Peaks in middle age

III. History: General

  1. See Neck Pain Red Flag
  2. Timing: Acute or Chronic
    1. Acute Neck Pain <6 weeks
    2. Subacute Neck Pain 6 to 12 weeks
    3. Chronic Neck Pain >12 weeks
  3. Age
    1. Age <20 years old
      1. Congenital abnormalities (e.g. cervical Spina bifida, Scheuermann Disease)
      2. Spinal Infection
    2. Age 20 to 50 years old
      1. Cervical Disc Herniation
      2. Cervical Neck Strain
    3. Age >50 years old
      1. Cervical Spondylosis
      2. Tumors of the Spine
      3. Vertebral Fracture
      4. Vascular Neck Pain
        1. See Vertebral Artery Injury in Blunt Neck Trauma
        2. See Traumatic Carotid Dissection
  4. Pain characteristics
    1. Shooting, stabbing, burning or electrical-like pain (often with numbness or Paresthesias)
      1. Neuropathic Neck Pain (central spinal stenosis, Cervical Disc Herniation)
    2. Throbbing or aching pain
      1. Mechanical Neck Pain
  5. Pain Distribution
    1. Radicular pain is most common at C6 and C7 (pain in first 3 fingers)
  6. Pain, Paresthesias or weakness into Shoulder and arm
    1. Cervical Disc Disease (Cervical Radiculopathy)
    2. Thoracic Outlet Syndrome
    3. Brachial Plexopathy
    4. Peripheral Nerve Injury (Neuropraxia)
      1. See Overuse Syndromes of the Hand and Wrist
  7. Provocative Factors
    1. Rotating or bending the neck TOWARD the painful side (ipsilateral)
      1. Cervical Radiculopathy
      2. Facet Joint Pain
    2. Rotating or bending the neck AWAY from the painful side (contralateral)
      1. Myofascial Pain
    3. Neck extension
      1. Central spinal stenosis
    4. Neck flexion
      1. Cervical Disc Disease
    5. Coughing, sneezing, or straining
      1. Cervical Disc Disease (Cervical Radiculopathy)
      2. Epidural Abscess
  8. Palliative Factors
    1. Abduction of arm on painful, ipsilateral side (abduction relief sign)
      1. Cervical Radiculopathy
  9. Associated symptoms
    1. Headaches
    2. Back Pain
    3. Arthralgias
    4. Depressed Mood

IV. History: Red Flags

  1. Intractable, unrelenting pain
    1. Tumors of the Spine
    2. Primary neurologic conditions
    3. Spinal Infections
  2. Fever
    1. Spinal Infection (e.g. Spinal Osteomyelitis, Spinal Epidural Abscess, Discitis)
    2. Meningitis
    3. Tumors of the Spine (e.g. Spine Metastases, Multiple Myeloma, chordoma)
  3. Morning Stiffness or Polyarthritits
    1. Facet joint Osteoarthritis
    2. Rheumatoid Arthritis
    3. Spondyloarthropathy
      1. Ankylosing Spondylitis
      2. Psoriatic Arthritis
      3. Reactive Arthritis
      4. Spondyloarthropathy due to Inflammatory Bowel Disease
  4. Upper Motor Neuron Deficit (hyperreflexia, Clasp-knife spasticity, positive Babinski Reflex), Ataxia, bowel/Bladder dysfunction
    1. Myelopathy (spinal tract related neurologic defects)
    2. See Transverse Myelitis
    3. See Spinal Cord Syndrome
    4. See Central Cord Syndrome
    5. See Amyotrophic Lateral Sclerosis
  5. Central Neurologic Symptoms (TIA, Drop Attacks, Vertigo, Diplopia, Headache)
    1. See Vertebral Artery Injury in Blunt Neck Trauma
    2. See Traumatic Carotid Dissection

V. Risk Factors: General

  1. Obesity
  2. Cervical Spine Injury
  3. Traumatic Brain Injury
  4. Sports associated with neck injury
    1. Wrestling
    2. Ice hockey
    3. Football
  5. Occupations associated with neck injury
    1. Office and computer work
    2. Manual labor
    3. Healthcare
  6. Lifestyle and mental health
    1. Major Depression
    2. Anxiety Disorder
    3. Somatization
    4. Tobacco Abuse
    5. Sleep Disorders
    6. Low job satisfaction or perceived poor work environment

VI. Risk Factors: Serious Neck Pain Causes

  1. Comorbidity associated with more serious neck injuries (including Vertebral Fractures)
    1. See Cervical Spine Injury
    2. Rheumatoid Arthritis
    3. Trisomy 21 (Atlantoaxial Instability)
    4. Marfan Syndrome
    5. Elderly patient with fall from standing
  2. Conditions Associated with Spinal Infection
    1. Intravenous Drug Abuse
    2. Immunodeficiency (e.g. AIDS, Diabetes Mellitus, AIDS, Alcoholism, Malignancy)
    3. Recent spinal procedure (Spinal surgery, Epidural Anesthesia)
    4. Concurrent other infections (Parapharyngeal Abscess, Genitourinary infection, Skin Infection)
    5. Hemodialysis
    6. Poor Dentition

VII. Causes

  1. See Neck Pain Causes (includes Neck Pain Red Flag)
  2. Cervical Disc Related Symptoms
    1. Neck tight or stiff
    2. Radicular pain, Paresthesias or weakness into Shoulder and arm
    3. Worse with activity, on awakening, with neck extension and with coughing, sneezing, or straining
  3. Spondylosis
    1. Older patients with disc Degeneration, disc space narrowing with osteophytes and nerve root compression
    2. Disc pain is worse with Cervical Spine flexion, while facet pain is worse with extension
  4. Cervical Neck Strain (or Whiplash)
  5. Vertebral Compression Fracture

VIII. Exam

  1. See Neck Exam

IX. Imaging

  1. See Cervical Spine Imaging in Neck Pain

X. Labs

  1. Not routinely indicated
  2. Indicated in Neck Pain Red Flags (esp. Spinal Infection, Tumors of the Spine, Spondyloarthropathy)
    1. C-Reactive Protein (C-RP)
    2. Erythrocyte Sedimentation Rate (ESR)
    3. Complete Blood Count (CBC)
    4. Blood Cultures

XI. Management

  1. Symptomatic management for suspected musculoskeletal causes
    1. NSAIDs
    2. Acetaminophen
    3. Maintain Cervical Spine range of motion
  2. Follow protocols for specific causes
    1. See Cervical Disc Disease

XII. Prognosis

  1. Most patients improve over time
    1. Cervical Radiculopathy significantly improves without deficit and without surgery in 80-90% by 4 weeks
    2. Radhakrishnan (1994) Brain 117: 325-35 [PubMed]
  2. Acute Neck Pain persists or frequently recurs in 50% of patients
    1. Women
    2. Older Age
    3. Mental Illness
    4. Cervical Radiculopathy

XIII. References

  1. Childress (2020) Am Fam Physician 102(3): 150-56 [PubMed]
  2. Cohen (2015) Mayo Clin Proc 90(2):284-99 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Neck Pain." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Related Topics in Symptoms

advertisement