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Neck pain is a common musculoskeletal symptom, accounting for millions of visits to physicians annually in the United States. Of individuals with neck pain, more than 80% are between the ages of 18 and 64 years. Mechanical disorders cause 90% of neck pain episodes. Mechanical neck pain is defined as that which is caused by overuse of a normal anatomic structure, by deformity of an anatomic structure, or by trauma (Figure 7–1). Mechanical disorders are characterized by exacerbation and alleviation of pain in direct correlation with particular physical activities. Neck pain due to mechanical disorders decreases within 2–4 weeks in more than 50% of patients, and symptoms usually resolve entirely within 2–3 months.
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The goal of the initial evaluation is to differentiate patients with probable mechanical disorders from those with neck pain that requires more thorough immediate evaluation (Figure 7–2). A history and physical examination should be performed in all patients with new-onset neck pain. The neurologic portion of the examination is designed to determine whether there are any signs of cervical nerve root or cervical cord involvement (ie, spastic weakness, hyperreflexia, clonus, and positive Babinski signs).
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Laboratory tests and imaging studies are not necessary during the initial evaluation of patients with probable mechanical neck pain. These tests, however, are indicated for patients whose history and physical findings suggest persistent compression of the spinal cord or nerve roots or raise the possibility of neck pain as a component of an underlying systemic disease.
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The history should establish the onset, location, and character of the pain, and determine if the pain is associated with radiation to ...