II. Causes: Serious and Neck Pain Red Flags
- See Low Back Pain Red Flag
-
General higher risks for non-musculoskeletal cause
- Patient under age 20 years or over age 50 years
- Systemic disease signs or symptoms
-
Cervical Spine Trauma
- See Cervical Spine Injury
- See Pediatric Cervical Spine Injury
- Vertebral Fracture
- Spinal Cord Syndrome
- For those at risk, minor Trauma may cause significant Spinal Injury (Vertebral Fractures, ligamentous instability)
- Rheumatoid Arthritis
- Trisomy 21 (Atlantoaxial Instability)
- Marfan Syndrome
- Elderly patient with fall from standing
- C-Spine Trauma with MRI demonstrating Ligamentous Injury (e.g. children with SCIWORA)
-
Spinal Infection (e.g. Spinal Osteomyelitis, Spinal Epidural Abscess, Discitis) or Meningitis
- Fever
- Meningismus
- Nuchal Rigidity without neck injury
- Risk Factors (e.g. Intravenous Drug Abuse, AIDS, Hemodialysis, Alcoholism, Parapharyngeal Abscess)
- Rheumatologic Conditions
- Tumors of the Spine (e.g. Spine Metastases, Multiple Myeloma, chordoma)
-
Myelopathy (spinal tract related neurologic defects)
- See Transverse Myelitis
- See Spinal Cord Syndrome
- See Central Cord Syndrome
- See Amyotrophic Lateral Sclerosis
- See Upper Motor Neuron Deficit (hyperreflexia, Clasp-knife spasticity, positive Babinski Reflex)
- Deep aching Neck Pain (with or without radicular pain)
- Muscle Weakness
- Ataxia or other Abnormal Gait
- Bowel or Bladder dysfunction
- Tremor
- Vascular Neck Pain (or associated CNS symptoms)
- See Vertebral Artery Injury in Blunt Neck Trauma
- See Traumatic Carotid Dissection
- Vertebrobasilar Dissection (e.g. following Chiropractic Manipulation)
- Carotid Stenosis
- Neck Sensation of ripping or tearing pain
- Diplopia
- Headache
- Syncope
- Vertigo
- Tranisent Ischemic Attack Symptoms
- Cognitive changes (e.g. Altered Level of Consciousness)
-
Thoracic Outlet Syndrome
- Paresthesias or pain worse with use
- Unilateral symptoms in most cases
- Vascular involvement is uncommon (<5%), but may be associated
- Referred Neck Pain
- Coronary Artery Disease
- Biliary Colic or Cholecystitis (typically pain radiates to right Shoulder)
- Herpes Zoster (Shingles)
- Pneumothorax
- Pulmonary Embolism
III. Causes: Musculoskeletal Neck Pain
-
Cervical Disc Disease
- 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
-
Cervical 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)
-
Acute Calcific Tendonitis of the Longus Colli (ACTLC)
- May present with Dysphagia or Globus Hystericus
- Vertebral Compression Fracture
- Cervical Spine Fracture (see above)