Neck Pain

Key Features

Essentials of Diagnosis

• Most chronic neck pain is caused by degenerative joint disease and responds to conservative treatment

• Cervical radiculopathy symptoms can be referred to the shoulder, arm, or upper back

• Whiplash is the most common type of traumatic injury to the neck

• Poor posture is often a factor for persistent neck pain

General Considerations

• Most neck pain, especially in older patients, is due to mechanical degeneration involving the cervical disks, facet joints, and ligamentous structures

• Many degenerative conditions of the neck result in cervical canal stenosis or neural foraminal stenosis, sometimes affecting underlying neural structures

• Cervical radiculopathy, usually involving the C5–C7 disks, can cause neurologic symptoms in the upper extremities

• Other causes of neck pain

  • Rheumatoid arthritis

  • Fibromyalgia

  • Osteomyelitis

  • Neoplasms

  • Polymyalgia rheumatica

  • Compression fractures

  • Pain referred from visceral structures (eg, angina)

  • Functional disorders

• Amyotrophic lateral sclerosis, multiple sclerosis, syringomyelia, spinal cord tumors, and Parsonage-Turner syndrome (brachial neuritis) can mimic myelopathy from cervical arthritis

Clinical Findings

Symptoms and Signs

• Headaches

• Shoulder pain

• Pain may be limited to the posterior region or, depending on the level of the symptomatic joint, may radiate segmentally to the occiput, anterior chest, shoulder girdle, arm, forearm, and hand

• May be intensified by active or passive neck motions

• The general distribution of pain and paresthesias corresponds roughly to the involved dermatome in the upper extremity

• Patients with discogenic neck pain often complain of pain with flexion, which causes cervical disks to herniate posteriorly

• Extension of the neck usually affects the neural foraminal and facet joints of the neck

• Rotation and lateral flexion of the cervical spine should be measured both to the left and the right

• Radiating pain in the upper extremity is often intensified by hyperextension of the neck and deviation of the head to the involved side

• Limitation of cervical movements is the most common objective finding

• Neurologic signs depend on the extent of compression of nerve roots or the spinal cord

• Compression of the spinal cord may cause long-tract involvement resulting in paraparesis or paraplegia

ACUTE OR CHRONIC CERVICAL MUSCULOTENDINOUS STRAIN

• Acute episodes are associated with pain, decreased cervical spine motion, and paraspinal muscle spasm, resulting in stiffness of the neck and loss of motion

• Local tenderness is often present in acute but not chronic strain

HERNIATED NUCLEUS PULPOSUS

• Rupture or prolapse of the nucleus pulposus of the cervical disks into the spinal canal causes pain that radiates to the arms at the level of C6–C7

• When intra-abdominal pressure is increased by coughing, sneezing, or other movements, symptoms are aggravated, and cervical muscle spasm may often occur

• Neurologic abnormalities may include decreased biceps and triceps deep tendon reflexes and ...