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Neck Pain Care Pathway

Date of last update: February, 2024

Clinical Examination

Clinical Cornerstone:

  • It’s important to view the patient holistically, considering the biopsychosocial aspects of the patient’s condition. When re-evaluating existing patients, especially those presenting with new complaints, a thorough assessment is just as imperative.

Useful for arriving at a diagnosis:

  • Observations: Abnormalities, asymmetries, posture, gait, movements, facial expression.

  • Red Flags: Examination of signs or symptoms that might indicate a more serious underlying condition (see 'Red Flags' Section).

  • Range of Motion: Cervical spine's active and passive ROM in all planes (flexion, extension, lateral flexion, and rotation). Consider regional and segmental hypomobility, hypermobility and abherrant movement patterns.

  • Neurological Examination:
    • Motor Strength: Test the strength of the upper extremities.

    • Sensory Examination: Check for any sensory deficits in the upper extremities..

    • Reflexes: Test the biceps, triceps, and brachioradialis reflexes.

    • Cranial Nerves: Check for facial numbness, facial movements (smile, tongue deviation, oculomotor), shoulder shrug.

    • Upper Motor Neuron Testing: If cervical myelopathy is a clinical consideration, tests such as Hoffman’s and Romberg’s can be informative.

  • Imaging/laboratory tests: As indicated (e.g., red flags are present, progressive neurological deficits, non-response to care).

 

May help guide treatment:

  • Palpation: Cervical spine and surrounding musculature to identify areas of tenderness, etc.

  • Special/Orthopedic Tests: Select tests to use alongside a fulsome clinical examination, since the specificity and sensitivity of these tests vary. Examples include: Spurling’s test, Neck Distraction test, Cervical Kemps, Spinous percussion, and Bakody’s Sign. Select tests to inform the differential list, for example Upper Limb Tension Tests to help differentiate radicular symptoms from brachial plexus symptoms.

  • Documentation: Record all findings in the patient record.

Conduct patient assessment

Red flags present

Red flags present

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Refer to appropriate emergency or healthcare provider

  • Structured patient education

  • Exercise (strength, range of motion)

  • Manual therapies (e.g., spinal manipulation or mobilization, massage)

  • Low-level laser therapy

  • Psychological / social support

  • Medicines

  • Referral

Major symptom/sign change

Goals not achieved

Re-evaluate

Adjust treatment and management plan or refer

References or links to primary sources

 

 

 

 

 

 

Contact information for further inquiries or feedback

carolina.cancelliere@ontariotechu.ca

Disclaimer:

These care pathways are intended to provide information to practitioners who provide care to people with musculoskeletal conditions. The care pathways on this website are 'living' documents, reflecting the state of clinical practice and research evidence to our best knowledge at the time of development. As knowledge and healthcare practices evolve, these pathways may be updated to ensure they remain current and evidence driven. These pathways are not intended to replace advice from a qualified healthcare provider.

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