Chapter 51. Neck Pain

A 57-year-old science teacher presents with right-sided neck pain. He describes intense discomfort in the back of his neck and upper back along the medial aspect of his right scapula. The pain has been present for 10 days and began after he had installed new overhead lighting in his basement workshop.

• What repetitive positions are most likely to aggravate the neck?
• What is the pattern of referred pain from cervical radicular root irritation?
• Which muscle groups are affected by cervical nerve root impingement?
• What symptoms require urgent imaging and/or surgical consultation?

Neck pain can be categorized by location and onset. Most neck pain originates in the back (posterior) portion of the neck in the muscular, neurologic, or bony structures. Patients may also describe pain as most intense in the neck or shoulders or the upper extremities along the distribution of a cervical nerve root.1,2 Pain in the back of the neck is generally axial, meaning along the midline or the paraspinous region, or radicular, meaning radiating to the shoulder or arm on one side or both sides.

Pain arising from muscular, vascular, and glandular structures, as well as the trachea and esophagus, commonly refers to the front (anterior portion) of the neck. Finally, pain may be referred from other parts of the body such as the chest, heart, and esophagus.