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Neck Pain Care Pathway

Date of last update: November, 2024

8. Diagnostic Criteria for Neck Pain Amenable to Conservative Care

Overview: Diagnosis requires a thorough understanding of the patient's condition, integrating their history, clinical findings, risk factors, and the physical, psychological, social, and environmental aspects of pain.

Common Neck Pain Categories

Common neck pain represents the most frequent causes of neck pain with similar mechanisms, clinical symptoms and signs in a primary care setting. Evidence suggests that identifying the specific nociceptive cause of common neck pain is difficult. However, breaking down common neck pain into different categories helps in guiding treatment strategies and managing patient expectations.

 

Cervical Facet Joint Irritation / Mechanical Cervicalgia

  • Common in middle-aged and older adults.

  • Localized neck pain, possibly radiating to shoulders or arms.

  • Symptoms worsen with extension or turning the head; morning stiffness relieved by rest.

  • Exam findings include tenderness over facet joints, pain with extension/rotation, and positive tests (e.g., cervical Kemp’s, compression); no significant neurological deficits.

 

Whiplash (WAD I, II) / Cervical Strain/Sprain

  • Common following motor vehicle collisions, sporting injuries, or falls.

  • Neck pain with possible radiation to the head or upper extremities; associated symptoms may include headache, dizziness, jaw pain, or psychological distress.

  • Exam findings include tenderness over cervical musculature, restricted range of motion, and positive tests (e.g., cervical Kemp’s, compression); no significant neurological deficits.

 

Osteoarthritis

  • Common in older adults.

  • Chronic neck pain, localized or referred, with episodic flare-ups.

  • Pain worsens with activity, improves with rest; morning stiffness is common.

  • Exam findings include reduced range of motion, crepitus, joint swelling, and positive tests (e.g., cervical compression, Spurling’s); no significant neurological deficits unless advanced.

 

Myofascial Pain Syndrome

  • Common in adults with sedentary lifestyles or repetitive motion activities.

  • Chronic muscle pain in the neck/shoulders, often with referred pain patterns.

  • Trigger points in muscles are painful upon compression.

  • Exam findings include taut muscle bands and trigger points; no significant neurological deficits.

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