Approach to neck pain

Neck pain: diagnostic strategy model

Probability diagnosis 

• vertebral dysfunction 
• traumatic strain or sprain 
• cervical spondylosis

Serious disorders not to be missed

• Cardiovascular
• angina
• subarachnoid haemorrhage
• arterial dissection 
• Neoplasia
• primary 
• metastasis --> breast, prostate and lung. also kidney, thyroid and melanoma.
• Pancoast tumour --> Horner's syndrome
• Severe infections
• osteomyelitis
• meningitis
• Vertebral fractures or dislocation

Pitfalls

• Disc prolapse
• Myelopathy
• Cervical lymphadenitis
• Fibromyalgia syndrome 
• Outlet compression syndrome 
• Polymyalgia rheumatica
• Ankylosing spondylitis
• Rheumatoid arthritis
• Oesophageal foreign bodies and tumours
• Paget disease

Red Flags

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