Like most symptoms, Neck Pain is usually caused by Strains, Sprains, and other common conditions which pose no threat to health, and get better on their own, sometimes soon, sometimes slowly. The clinician’s job is to rule out the rare but potentially paralyzing diseases, and then sort through the others in systematic fashion. See Diagram — Anatomy of the Spine & Its Nerves.
Causes of Neck Pain
| xxxxxxCommon | xxxRare but Very Serious |
|---|---|
| โข Muscle Strain / Ligament Sprain โข Muscle Spasm (Torticollis; “Wry Neck”) โข Herniated Disk โข Osteoarthritis โข Ankylosing Spondylitis (rather uncommon) | โข Spinal Cord Compression โข Bone Disease โข Cervical Artery Tear (“dissection”) โข Epidural Bleeding (if on “blood thinners”) xxx |
The following is how clinicians approach Neck Pain.
1. If suggestion of Spinal Cord Compression (very rare), we send to an ER:
- Electric shock runs down body when bending neck forward (Lhermitte’s Sign)
- Numb or Tingling around genitals or anus
- Incontinent of urine / stool (large amounts), or can’t urinate all through the day
- Weakness in legs (new trouble walking tiptoe or hopping)
- Fever, with pain in one certain area of the neck (could be an epidural abscess)
Diagnosed by MRI (not X-ray, not CT Scan). Assuming none of the aboveโฆ
2. We press, then tap, on each bone in the cervical spine.
- If one, & only one, is especially tender, we get a cervical spine (neck) X-ray for Bone Diseases. Send to E.R. if recent trauma to rule out fracture.
Otherwise, we seek the common causes of Neck Pain:
3. Consider a Herniated Disk (“pinched nerve,” “slipped disk”)
- Ask about pain or tingling running down part of one arm
- Examine muscle strength in all parts of the arms, for localized weakness
- Check reflexes in the arms (for one side less than the other)
- Diagnosed by MRI (not X-ray, not CT Scan). But we only get an MRI if:
- There’s true muscle weakness; OR BOTH
- a) Pain has been going on 3 months, AND b) patient would consider surgery
4. Consider Arthritis if more gradual onset of pain (weeks or months)
- If older age, Plain X-Ray for Osteoarthritis
- If age <40, pain worst in early morning lasts at least 30-60 min. before easing, consider inflammatory Ankylosing Spondylitis, order blood tests for Sed Rate / CRP and CBC.
- May see on Plain X-ray, but MRI is better
5. If none of above, the patient most likely has a simple Strain / Sprain. Or
xxxxMuscle Spasm if neck tends to stay tilted in one direction.
- If acute Neck Muscle Spasm, send to E.R. if fever, drooling, neurologic abnormalities on exam, to rule out serious throat infections or diseases or brain / spinal cord [all very rare]
6. Also consider very rare possibilities (we send to ER if suspicious):
- New one-sided neck pain with Neurological symptoms in the face (esp. a droopy eyelid & tiny pupil on one side, or can’t stick tongue out straight) could be a Torn Artery (dissection).
- Patients taking “blood thinners” (not just aspirin) can have Epidural Bleeding around the spinal cord
- Fever, esp. if immunocompromised or IV Drug User, may indicate rare deep Infections. Need blood tests (CBC, ESR) and maybe MRI
See Neck Pain โ Full Text for more in-depth explanations and discussions.