Diagnostic Tests for Neck pain

Diagnostic Test list for Neck pain:

The list of diagnostic tests mentioned in various sources as used in the diagnosis of Neck pain includes:

• Physical examination
  • General appearance - e.g. pale and sweating must consider heart attack; photophobia (dislike for light) must consider meningitis or subarachnoid hemorrhage.
  • Examine for painful neck stiffness (which suggests meningitis or subarachnoid hemorrhage) or painless neck resistance (may be found with cervical spine spondylosis)
  • Inspection of neck, noting willingness to move head and neck, level of shoulders, any tendency to hold neck to side and the contour of neck form the side - e.g. person with torticollis (wry neck) holds head away from the painful side; person with whiplash or cervical spondylosis (degeneration) tends to hold the neck stiff, the head forward and tends to turn the body rather than turn the head.
  • Feel the neck including each cervical vertebral bone and joint. Also feel the front of the neck looking for signs of enlarged tender neck lymph nodes, muscle spasm and thyroid disease
  • Examine the movement of the neck and notice any reduced range of movement and pain associated with the movements
  • Full neurological examination including power, reflexes and sensation. If abnormalities must consider a cervical spine fracture, herniated disk, spinal cord tumor, cervical spondylosis (degeneration) and Pancoast's tumor (cancer in the tip of the lung)
• Blood tests
  • Full blood count and ESR
  • Electrolytes
  • Calcium, phosphate and alkaline phosphatase
  • Thyroid function tests
  • Prostatic specific antigen (PSA) in males if appropriate
  • HLA-B27 antigen test for Ankylosing Spondylitis (occasionally affect the neck, especially in young person)
  • Rheumatoid factor for Rheumatoid arthritis
  • Serum electrophoresis for Multiple myeloma
  • Blood culture for vertebral osteomyelitis
• Urine tests
  • Urinalysis
• Radiological investigations
  • X-Ray of cervical spinal - can detect arthritis changes, fractures, reduced bone mass, reduced bone height.
  • CT or MRI of cervical spine - perform if radiation of pain into arms or if the person has persistent neck pain. Can detect spinal canal stenosis or nerve root compression.
  • CT Brain, if there is neck stiffness and suspect meningitis or subarachnoid hemorrhage
  • Bone scan - can detect the early development of malignant disease, osteomyelitis and inflammatory disease before changes are apparent on plain X-Ray.
  • Bone densitometry - can predict an increased risk of osteoporosis.
  • Thyroid Radioisotope scan may demonstrate de Quervain's thyroiditis
• Electromyographic (EMG) studies and Nerve conduction studies - to screen arm pain and differentiate neurological diseases from nerve compression syndromes.
• Spinal tap (after a CT Scan of brain) - if there is neck stiffness.
• Mantoux test - if suspect Skeletal tuberculosis (more commonly occurs in middle back, knees and hips).
• Electrocardiogram - may help detect angina, heart attack.
• Exercise tolerance test - may help diagnose angina.

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