Orthopedics Book


Neck Pain

Aka: Neck Pain
  1. See Also
    1. Neck Pain Causes
    2. Chronic Neck Pain
    3. Cervical Spine Injury
    4. Pediatric Cervical Spine Injury
    5. Cervical Neck Strain
    6. Cervical Disc Disease
    7. Cervical Spine Imaging in Neck Pain
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. Exam
    1. See Neck Exam
  9. Imaging
    1. See Cervical Spine Imaging in Neck Pain
  10. 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
  11. 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
  12. 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
  13. References
    1. Childress (2020) Am Fam Physician 102(3): 150-56 [PubMed]
    2. Cohen (2015) Mayo Clin Proc 90(2):284-99 [PubMed]

Neck Pain (C0007859)

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
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
Derived from the NIH UMLS (Unified Medical Language System)

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