Neck pain differential diagnosis

Overview

There is extensive differential diagnosis for neck pain.Varity of diseases manifest as neck pain.The most causes are biomechanical axial neck pain, whiplash associated disorder (WAD),radiculopathy, cervical myelopathy, infection, neoplasm, rheumatic causes, trauma, referred pain and fibromyalgia.

Differentiating neck pain from other Diseases

There is extensive differential diagnosis for neck pain.Varity of diseases manifest as neck pain.The most causes are biomechanical axial neck pain, whiplash associated disorder (WAD),radiculopathy, cervical myelopathy, infection, neoplasm, rheumatic causes, trauma, referred pain and fibromyalgia.^[1]

Differentiating neck pain from other diseases


Diseases	symptoms	physical examination
			Cervical strain	Pain , stiffness on neck movement	Tenderness on palpation of neck and trapezius muscles
			“Whiplash” injury	Pain on neck movement following an abrupt extension–flexion type injury ,headache, shoulder or back pain, dizziness, paresthesias, fatigue	Decreased range of motion associated with neck spasm
			Cervical discogenic pain	Pain , stiffness on neck movement,cervical radicular symptoms	Decreased range of motion with pain
Cervical myofascial pain	Focal pain and pressure sensitivity;accompanied by a sensation of burning or stinging	Localized tenderness
Cervical radiculopathy	Pain, numbness,tingling in a dermatomal distribution,weakness in upper extremity	Decreased or altered sensation, diminished deep tendon reflexes
Cervical spondylotic myelopathy	Lower extremity weakness, gait or coordination difficulties, and bowel or bladder dysfunction	Focal neurologic signs in upper and/or lower, Lhermitte’s sign
Ossification of the posterior longitudinal ligament	neck pain, progressive radiculopathy, myelopathy symptoms	Focal neurologic signs in upper and/or lower extremities
Tension headache	Bilateral headache, which may be associated with neck pain; no other neurologic symptoms	Localized tenderness on palpation of scalp and neck,no neurologic abnormalities
Coronary artery disease	Chest pain with radiation to neck	Normal
Infection	Fever,depending on nature of infection	depending on nature of infection
Malignancy	Unexplained weight loss	Localized tenderness on palpation of spine
Referred shoulder pain	Shoulder pain with radiation to neck	Localized tenderness on shoulder exam
Polymyalgia rheumatica	morning stiffness in shoulders	Decreased range of motion of joints
Fibromyalgia	Diffuse musculoskeletal pain with fatigue	Multiple soft tissue “tender points
Thoracic outlet syndrome	Upper extremity neurologic paresthesias,swelling, pain in the hand	Focal neurologic signs in upper extremities, sensory deficits, swelling, cyanosis or pallor
Esophageal obstruction	Dysphagia	Normal

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References

↑ ^1.0 ^1.1 Douglass AB, Bope ET (2004). “Evaluation and treatment of posterior neck pain in family practice”. J Am Board Fam Pract. 17 Suppl: S13–22. doi:10.3122/jabfm.17.suppl_1.s13. PMID 15575026.
↑ Binder AI (2008). “Neck pain”. BMJ Clin Evid. 2008. PMC 2907992. PMID 19445809.
↑ Binder A (2007). “The diagnosis and treatment of nonspecific neck pain and whiplash”. Eura Medicophys. 43 (1): 79–89. PMID 17369782.
↑ Capó-Juan MA (2015). “[Cervical myofascial pain syndrome. Narrative review of physiotherapeutic treatment]”. An Sist Sanit Navar. 38 (1): 105–15. doi:10.23938/ASSN.0058. PMID 25963463.

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[pmid15575026-1] 1.0 ^1.1 Douglass AB, Bope ET (2004). “Evaluation and treatment of posterior neck pain in family practice”. J Am Board Fam Pract. 17 Suppl: S13–22. doi:10.3122/jabfm.17.suppl_1.s13. PMID 15575026.

[pmid19445809-2] Binder AI (2008). “Neck pain”. BMJ Clin Evid. 2008. PMC 2907992. PMID 19445809.

[pmid17369782-3] Binder A (2007). “The diagnosis and treatment of nonspecific neck pain and whiplash”. Eura Medicophys. 43 (1): 79–89. PMID 17369782.

[pmid25963463-4] Capó-Juan MA (2015). “[Cervical myofascial pain syndrome. Narrative review of physiotherapeutic treatment]”. An Sist Sanit Navar. 38 (1): 105–15. doi:10.23938/ASSN.0058. PMID 25963463.

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