Neck

Pain
How to treat?

ARR 2018
 Some Facts…
• Most people will have experienced neck pain in their lifetime.
• Population studies have estimated that the 1-year incidence of neck
pain ranges from 10.4–21.3%.
• While the recurrence rate in general practice settings are estimated to
be just less than 50%.
• The mean overall prevalence of neck pain tends to be greater in
females than males, and is also greater in higher- income countries
and in urban rather than rural areas.

Andrew J Teichtahl, Geoffrey McColl. An approach to neck pain for the family physician. Australian family physician Vol. 42, no. 11, November 2013
üMany patients preferred self-care measures for the management of neck
pain and they sought professional help only when those measures failed.
üPatients mentioned several obstacles for doctor visits such as long waiting
times or disagreement with the treatments suggested by their GP.
üHowever, most patients were not dissatisfied with not knowing a concrete
diagnosis as they primarily focused on pain relief and success of the
therapies suggested.
 Red Flag Potential Pathological Process
1. Significant trauma (eg. fall in 1. Bony/ligamentous disruption of the
osteoporotic patient, motor vehicle cervical spine.
accident).
2. History of rheumatoid arthritis. 2. Atlanto-axial disruption.
3. Infective symptoms (eg. fever, 3. Infection.
meningism, history of
immunosuppression or intravenous
drug use).
4. Constitutional symptoms (eg. 4. Malignancy/infiltrative process.
fevers, weight loss, anorexia, past
or current history of malignancy).
5. Neurology (eg. signs or symptoms 5. Cervical cord compression
of upper motor neuron pathology). Demyelinating process
6. Concurrent chest pain, shortness of 6. Myocardial ischaemia.
breath, diaphoresis.

Andrew J Teichtahl, Geoffrey McColl. An approach to neck pain for the family physician. Australian family physician Vol. 42, no. 11, November 2013
Please consider these 5 questions
before analgesia
1. Is there any functional dysfunction
(fine motoric movement)?
Cervical Myelopathy
• The combination of either
Hoffman’s reflex and/or
walking Romberg was
positive in 96% of
patients
• Common causes:
• Cervical spondylosis
• OPLL
• Congenital stenosis

Gordon F. G. Findlay, Birender Balain, Jayesh M. Trivedi, David C.

Jaffray. Does walking change the Romberg sign? Eur Spine J
(2009) 18:1528–1531
Hoffman’s reflex
2. Is there any radiculating pain
(dermatomal)?
Cervical Radiculopathy
• Provocative tests:
• Spurling test
• Shoulder abduction test
• Common causes:
• Disc herniation
• Cervical spondylosis
Spurling test
3. Is there any persistent pain
(pain while rest)?
 Tumor
Infection
4. Is there any history of trauma?
5. Is there any deformity?
Conclusion
• The medical interview, rather than the physical examination or
imaging, is the most important part of the assessment of neck pain.
• Classifying neck pain into acute or chronic patterns may help stratify
the need for intervention and the likely prognosis of neck pain
• Complete resolution of acute neck pain is not as common as
previously reported, and the efficacy of conservative therapies such
as physical therapy and exercise attenuates with time.
Thank You