Neck pain

• What is Neck Pain
• Statistics on Neck Pain
• Risk Factors for Neck Pain
• Progression of Neck Pain
• Symptoms of Neck Pain
• Clinical Examination of Neck Pain
• How is Neck Pain Diagnosed?
• Prognosis of Neck Pain
• How is Neck Pain Treated?
• Neck Pain References

What is Neck Pain

Neck pain can present in any of the seven cervical vertebrae (back bones) connecting the base of skull to the thoracic cage. As well as the cervical spine, muscles, ligaments, and soft tissues can also be a source of neck pain. In addition, other structures likethe trachea (wind pipe), blood vessels, thyroid gland, and lymph nodes are also found in the neck and can be a source of pain.Sometimes pain in the neck can result from structures (e.g. lung, heart) that are not in the neck) – this is called referred pain.

Statistics on Neck Pain

Neck pain is very common:

• Around 10% of the adult population at any one time is suffering from a stiff neck;
• X-ray signs (but not necessarily symptoms) of Osteoarthritis of the neck (cervical spondylosis) are present in as much as 50% of those over 50.
• Disc problems are present in as many as 40% of males, and 28% of females between the ages of 55 and 64.

Risk Factors for Neck Pain

The most common causes of neck pain are:

• Cervical dysfunction
• Traumatic strains or sprains
• Cervical spondylosis (osteoarthritis of the neck vertebrae)
• Disc prolapse
• Fibromyalgia syndrome
• Ankylosing spondylitis
• Cervical lymphadenitis

As well as the above, there are some serious disorders which are less common with neck pain, but should not be missed:

• Cardiovascular – angina, myocardial infarction (heart attack) and subarachnoid haemorrhage;
• Cancers – lung tumour, tumours arising in or spreading to shoulder bones;
• Severe infections – septic arthritis, osteomyelitis
• Rheumatoid arthritis.

Progression of Neck Pain

The natural histories of neck pain will differ depending on the cause. Importantly, the following clues can be useful in deciding the cause:

• If the neck pain is present day and night and is constant – a malignancy may be present, especially when associated with weight loss – and this requires urgent assessment.
• Neck pain of gradual onset (days) that is worse in the morning or after inactivity is suggestive of inflammation.
• Patients often wake up with a sore and stiff neck due to acute torticollis (wry neck).
• A preceding injury/trauma may be a causative factor for muscular ligamentous strains or sprains, fracture etc.
• The rapid onset of pain, with fever, with severe restriction of movements is suggestive of an infection.

How is Neck Pain Diagnosed?

• Full blood count (white cells, haemoglobin) and ESR – looking for inflammation/infection
• Rheumatoid factor
• HLA B27 antigen

Prognosis of Neck Pain

The natural histories of neck pain depends on the cause, and when the problem is diagnosed (the latter in the case of serious diagnoses – infection, cancer).
The majority of cases are due to benign causes. In one study 70% of patients seeking medical consultation with neck pain had recovered within one month.

How is Neck Pain Treated?

Neck pain treatment depends on the cause. Most patients with minor sprains are treated successfully with rest, medication, immobilization (soft collar), physical therapy, exercise, activity modifications or a combination of these methods.
For specific neck pain treatment for the following conditions – please see the separate sections:

• Cervical dysfunction
• Osteoarthritis (cervical spondylosis)

Neck Pain References

1. Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002;
2. Murtagh, J. General Practice. Second Ed. McGraw-Hill, 1998.