Approach to neck pain

Key points:

- The commonest cause of neck pain is idiopathic dysfunction of the facet joints without a history of injury.

- Again with most of conditions, history is the key.

- Try to determine whether it is non specific neck pain, discogenic or neck pain caused by serious pathology.

- Most of the neck pain will resolve by itself. Beware of the red flag pointers.

- Red flag pointers for neck pain

• History of major trauma 
• Age > 50 years
• Constant pain (day and night)
• Fever > 38 
• Anterior neck (throat) pain 
• History of cancer
• Unexplained weight loss 
• Neurological deficit 
• Radicular pain in arm 
• Rheumatoid arthritis
• Down syndrome: hypoplastic odontoid process 

- When to refer 

• Persisting radicular pain in an arm despite conservative treatment
• Evidence of involvement of more than one nerve root lesion in the arm 
• Evidence of myelopathy, such as weakness, numbness, or clumsiness of the upper limbs
• Evidence, clinical or radiological, of cervical instability in post-accident victims, or people with Down syndrome or rheumatoid arthritis 

References:

John Murtagh 5th edition