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For further information, see CMDT Part 43-03: Spine Problems
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Essentials of Diagnosis
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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
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General Considerations
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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
Amyotrophic lateral sclerosis, multiple sclerosis, syringomyelia, spinal cord tumors, and Parsonage-Turner syndrome (brachial neuritis) can mimic myelopathy from cervical arthritis
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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
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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
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Diagnostic Procedures
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