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For further information, see CMDT Part 43-03: Spine Problems

KEY FEATURES

Essentials of Diagnosis

  • Chronic neck pain is mostly caused by degenerative joint disease

  • Whiplash often follows a traumatic neck injury, and responds to conservative treatment

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

  • 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 discs, facet joints, and ligamentous structures

  • Poor posture and repetitive motions over time can lead to work-related neck symptoms

  • Acute neck injuries can occur due to trauma, such as whiplash from motor vehicle accidents

  • Neck fractures are serious traumatic injuries that can lead to osteoarthritis in the long term

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

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

  • Neck pain may be associated with headaches and shoulder pain

  • 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

  • Neck pain

    • May be localized to the posterior region

    • May radiate segmentally to the occiput, anterior chest, shoulder girdle, arm, forearm, and hand depending on the level of the symptomatic joint

    • 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 discs to herniate posteriorly

  • Limitation of cervical movements is the most common objective finding

DIAGNOSIS

Imaging Studies

  • Radiographs of the cervical spine

  • Include the anteroposterior and lateral view

    • Odontoid view may be added to rule out traumatic fractures and congenital abnormalities

    • Oblique views of the cervical spine can provide further information about arthritis changes and assess the neural foramina for narrowing

    • Plain radiographs may appear normal in patients with acute cervical strain, but comparative reduction in height of the involved disc space and osteophytes are common findings in degenerative changes

    • Loss of cervical lordosis is commonly seen but is nonspecific

  • MRI is the best method to assess the cervical spine since the soft tissue structures can be evaluated

  • CT and MRI should be obtained urgently if the patient has signs of cervical radiculopathy with motor weakness

  • CT scanning is the most useful when bony abnormalities, such as fractures, are suspected

Diagnostic Procedures

  • The ...

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