II. Epidemiology
-
Prevalence: As high as 20-30% per year
- However, only one in five present for medical evaluation for acute Neck Pain
- Gender: Females
- Age
- Peaks in middle age
III. History: General
- See Neck Pain Red Flag
- Timing: Acute or Chronic
- Acute Neck Pain <6 weeks
- Subacute Neck Pain 6 to 12 weeks
- Chronic Neck Pain >12 weeks
- Age
- Age <20 years old
- Congenital abnormalities (e.g. cervical Spina bifida, Scheuermann Disease)
- Spinal Infection
- Age 20 to 50 years old
- Age >50 years old
- Age <20 years old
- Pain characteristics
- Shooting, stabbing, burning or electrical-like pain (often with numbness or Paresthesias)
- Neuropathic Neck Pain (central spinal stenosis, Cervical Disc Herniation)
- Throbbing or aching pain
- Mechanical Neck Pain
- Shooting, stabbing, burning or electrical-like pain (often with numbness or Paresthesias)
- Pain Distribution
- Radicular pain is most common at C6 and C7 (pain in first 3 fingers)
- Pain, Paresthesias or weakness into Shoulder and arm
- Provocative Factors
- Rotating or bending the neck TOWARD the painful side (ipsilateral)
- Rotating or bending the neck AWAY from the painful side (contralateral)
- Neck extension
- Central spinal stenosis
- Neck flexion
- Coughing, sneezing, or straining
- Palliative Factors
- Abduction of arm on painful, ipsilateral side (abduction relief sign)
- Associated symptoms
- Headaches
- Back Pain
- Arthralgias
- Depressed Mood
IV. History: Red Flags
- Intractable, unrelenting pain
- Tumors of the Spine
- Primary neurologic conditions
- Spinal Infections
-
Fever
- Spinal Infection (e.g. Spinal Osteomyelitis, Spinal Epidural Abscess, Discitis)
- Meningitis
- Tumors of the Spine (e.g. Spine Metastases, Multiple Myeloma, chordoma)
- Morning Stiffness or Polyarthritits
-
Upper Motor Neuron Deficit (hyperreflexia, Clasp-knife spasticity, positive Babinski Reflex), Ataxia, bowel/Bladder dysfunction
- Myelopathy (spinal tract related neurologic defects)
- See Transverse Myelitis
- See Spinal Cord Syndrome
- See Central Cord Syndrome
- See Amyotrophic Lateral Sclerosis
- Central Neurologic Symptoms (TIA, Drop Attacks, Vertigo, Diplopia, Headache)
V. Risk Factors: General
- Obesity
- Cervical Spine Injury
- Traumatic Brain Injury
- Sports associated with neck injury
- Wrestling
- Ice hockey
- Football
- Occupations associated with neck injury
- Office and computer work
- Manual labor
- Healthcare
- Lifestyle and mental health
- Major Depression
- Anxiety Disorder
- Somatization
- Tobacco Abuse
- Sleep Disorders
- Low job satisfaction or perceived poor work environment
VI. Risk Factors: Serious Neck Pain Causes
- Comorbidity associated with more serious neck injuries (including Vertebral Fractures)
- See Cervical Spine Injury
- Rheumatoid Arthritis
- Trisomy 21 (Atlantoaxial Instability)
- Marfan Syndrome
- Elderly patient with fall from standing
- Conditions Associated with Spinal Infection
- Intravenous Drug Abuse
- Immunodeficiency (e.g. AIDS, Diabetes Mellitus, AIDS, Alcoholism, Malignancy)
- Recent spinal procedure (Spinal surgery, Epidural Anesthesia)
- Concurrent other infections (Parapharyngeal Abscess, Genitourinary infection, Skin Infection)
- Hemodialysis
- Poor Dentition
VII. Causes
- See Neck Pain Causes (includes Neck Pain Red Flag)
- Cervical Disc Related Symptoms
- Neck tight or stiff
- Radicular pain, Paresthesias or weakness into Shoulder and arm
- Worse with activity, on awakening, with neck extension and with coughing, sneezing, or straining
-
Spondylosis
- Older patients with disc Degeneration, disc space narrowing with osteophytes and nerve root compression
- Disc pain is worse with Cervical Spine flexion, while facet pain is worse with extension
- Cervical Neck Strain (or Whiplash)
- Vertebral Compression Fracture
VIII. Exam
- See Neck Exam
IX. Imaging
X. Labs
- Not routinely indicated
- Indicated in Neck Pain Red Flags (esp. Spinal Infection, Tumors of the Spine, Spondyloarthropathy)
XI. Management
- Symptomatic management for suspected musculoskeletal causes
- NSAIDs
- Acetaminophen
- Maintain Cervical Spine range of motion
- Follow protocols for specific causes
XII. Prognosis
- Most patients improve over time
- Cervical Radiculopathy significantly improves without deficit and without surgery in 80-90% by 4 weeks
- Radhakrishnan (1994) Brain 117: 325-35 [PubMed]
- Acute Neck Pain persists or frequently recurs in 50% of patients
- Women
- Older Age
- Mental Illness
- Cervical Radiculopathy
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Definition (MSHCZE) | Nepříjemný pocit nebo intenzivnější formy bolesti, které jsou lokalizovány v krční oblasti. Tento termín obecně odkazuje na bolest v zadní nebo postranní části krku. |
Definition (NCI) | Painful sensation in the neck area. |
Definition (NCI_CTCAE) | A disorder characterized by marked discomfort sensation in the neck area. |
Definition (MSH) | Discomfort or more intense forms of pain that are localized to the cervical region. This term generally refers to pain in the posterior or lateral regions of the neck. |
Concepts | Sign or Symptom (T184) |
MSH | D019547 |
ICD9 | 723.1 |
ICD10 | M54.2 |
SnomedCT | 81680005, 268078004, 156641005, 202764005 |
English | Cervicalgia, CERVICAL PAIN, Cervicodynia, Ache, Neck, Aches, Neck, Neck Ache, Neck Aches, Neck Pains, Neckache, Neckaches, Pain, Neck, Pains, Neck, Nonspecific pain in the neck, Pain In Neck, Neck Pain, neck pain, neck pain (symptom), cervicalgia (diagnosis), cervicalgia, Pain neck, Cervical Pain, Cervical Pains, Pain, Cervical, Pains, Cervical, Cervicalgias, Cervicodynias, Neck Pain [Disease/Finding], neckache, neck aches, pain in neck, Pain;neck, cervicodynia, neck ache, painful neck, cervical pain, (Cervicalgia) or (neck pain NOS) (disorder), Neck pain NOS, Cervicalgia - pain in neck, (Cervicalgia) or (neck pain NOS), NECK PAIN, PAIN, NECK, Neck pain, Painful neck, Cervical pain, Neck ache, Nonspecific pain in the neck region, Neck pain (finding), neck; pain, pain; neck, Pain in neck |
French | DOULEUR CERVICALE, Douleur au cou, Cervicalgie, Douleur cervicale, Cervicodynie, Douleur du cou |
Dutch | cervicalgie, pijn nek, cervicale pijn, cervicodynie, hals; pijn, pijn; hals, nekpijn, Cervicale pijn, Cervicalgie, Nekpijn, Pijn in de nek, Pijn, nek- |
German | Schmerz im Nacken, Zervikalgie, Zervikodynie, SCHMERZ NACKEN, Zervikalneuralgie, Nackenschmerzen, Nackenschmerz |
Italian | Cervicodinia, Cervicalgia, Dolore al collo, Dolore cervicale |
Portuguese | Dor do pescoço, Cervicodinia, DOR CERVICAL, Dor na Nuca, Dor cervical, Cervicalgia, Dor Cervical, Dor no Pescoço |
Spanish | Cervicodinia, Dolor cervical, Dolor de cuello, CERVICAL, DOLOR, Cervicalgia, cervicalgia, cervicodinia (hallazgo), cervicodinia, cuello doloroso, dolor de cuello, Cuello Doloroso, Dolor Cervical, Dolor de Cuello |
Swedish | Nacksmärta |
Japanese | ケイブツウ, 頸痛, 頸部痛, 頚部疼痛, 頚部痛, 頸部疼痛 |
Finnish | Niskakipu |
Russian | SHEIA, BOLI, ШЕЯ, БОЛИ |
Czech | Krční bolest, Bolest krku, Cervikodynie, Cervikalgie, bolest krku, krk - bolest |
Korean | 경추통 |
Polish | Ból karku |
Hungarian | Nyaki fájdalom, Cervicalgia, Cervicodynia |
Norwegian | Nakkesmerter, Cervikalgi, Nakkesmerte |