Neck Pain

Differential Overview

Posterior

❑ Musculoligamentous strain

❑ Cervical spondylosis

❑ Cervical root compression

❑ Posterior cervical lymphadenopathy

❑ Meningeal inflammation

❑ Cervical fracture

❑ Atlantoaxial subluxation

Anterior

❑ Anterior cervical lymphadenopathy

❑ Thyroiditis

❑ Myocardial ischemia

Diagnostic Approach

With neck pain after trauma, a cervical fracture must always be ruled out and the patient’s neck immobilized until this is ascertained.

Assess radicular signs of nerve compression as a marker for more serious pathology. The Spurling sign, production of radicular pain with extension and lateral neck rotation, suggests narrowing of the neural foramen. The Lhermitte sign, an electrical sensation radiating down the spine with neck flexion, is a sign of a spinal cord lesion.

With neck pain in the presence of headache or fever, actively consider meningitis.

Clinical Findings

Musculoligamentous strain  Strain will usually have a traumatic origin, e.g., whiplash. Symptoms of pain with neck motion, stiffness, and spasm gradually increase over several hours. There should be no neurological deficit. Spasm may occur, with unilateral tension causing torticollis with the head turned to one side.

Cervical spondylosis  Trauma or osteoarthritic changes in the facet joints may cause subluxation or ankylosis with decreased mobility, chronic stiffness, and recurrent mild aching. Pain may radiate to the occiput, shoulders, or arms when there is compromise of the neural foramen.

Cervical root compression  Pain or numbness radiating into the distribution of C5 (anterolateral shoulder and upper arm, with decreased biceps reflex), C6 (dorsoradial forearm and thumb, with decreased brachioradialis reflex), or C7 (midhand, with decreased triceps reflex) are most common. It usually results from cervical disc herniation or osteoarthritis-associated facet hypertrophy/osteophyte formation.

Posterior cervical lymphadenopathy  Discrete, tender lymph nodes occur most commonly in infectious mononucleosis.

Meningeal inflammation  Meningitis, with headache and fever, and subarachnoid hemorrhage, with sudden-onset severe headache, are serious causes that must be considered. There will be involuntary spasm of the neck muscles, and forward flexion will produce neck stiffness and pain (Kernig sign).

Cervical fracture  Suspect fracture in a traumatic injury, such as with diving, or with sudden deceleration, such as a motor vehicle accident. The neck will be very tender over the midline. Radiating pain or numbness increases the likelihood of significant injury.

Atlantoaxial subluxation  Occurring in rheumatoid arthritis, the neck is stiff and unable to rotate, and the head is bent forward with the chin down.

Anterior cervical lymphadenopathy  Tender discrete enlarged lymph nodes in the anterior cervical chain occur with viral or streptococcal pharyngitis.

Thyroiditis  The thyroid gland will be exquisitely tender, associated with tachycardia and low-grade fever.

Myocardial ischemia  Exertional neck pain should raise the possibility of angina, even without concomitant chest pain. An acute myocardial infarction may on occasion present with nonexertional neck/jaw pain.  

Pictures

Book Source Details

• Book Title: Field Guide to Bedside Diagnosis
• Author(s): David S. Smith
• Year of Publication: 2007
• Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Neck swelling: Introduction (review 117 causes)
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More About This Book: Title: Field Guide to Bedside Diagnosis Authors: David S. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-78178-165-5

 » Next page: Jugular vein distention (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

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