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ULY CLINIC

12 Septemba 2025, 02:19:18

Neck pain

Neck pain is a common symptom arising from any structure of the neck, including the cervical vertebrae, muscles, ligaments, meninges, blood vessels, and lymphatic tissue. Pain can also be referred from other areas such as the heart, lungs, or upper abdomen. Clinical evaluation of neck pain focuses on location, onset, severity, pattern, and associated symptoms. Common causes include trauma, degenerative disease, congenital anomalies, inflammatory disorders, metabolic conditions, and neoplasms.

Emergency interventions

Trauma: Immediately immobilize the cervical spine with a Philadelphia collar and long backboard.
Assess airway, breathing, and circulation; provide oxygen if necessary.
Perform a rapid neurologic assessment.
Prepare for intubation or tracheostomy in case of respiratory compromise.
Examine the neck for abrasions, swelling, lacerations, erythema, and ecchymoses.
Obtain mechanism-of-injury history from the patient or witness.

History and Physical Examination

History

Onset, location, and severity of pain.
Aggravating or relieving factors.
Associated symptoms: headache, limb weakness, numbness, dysphagia, dyspnea.
Past medical history, trauma, surgeries, medication, and family history.

Physical Examination

Inspect neck, shoulders, and cervical spine for swelling, masses, erythema, or ecchymosis.
Assess active range of motion (flexion, extension, rotation, lateral bending) and note pain.
Examine posture, bilateral muscle strength, arm sensation, hand grip, and reflexes.
Evaluate meningeal signs: Brudzinski’s and Kernig’s signs.
Palpate cervical lymph nodes for enlargement.

Philadelphia Collar Application

Designed to immobilize the neck, maintain neutral alignment, reduce muscle spasm, and prevent further injury.
Fit snugly, secure with Velcro or buckles, check airway and neurovascular status.
Avoid hyperextension to prevent ligament shortening or neurologic damage.

Medical causes of Neck pain

Condition	Clinical Features	Associated Findings
Ankylosing spondylitis	Intermittent moderate–severe neck pain, stiffness, restricted ROM	Morning stiffness, low back pain, limited chest expansion, malaise, fatigue, occasional iritis
Cervical extension injury	Anterior/posterior neck pain after whiplash	Tenderness, swelling, nuchal rigidity, occipital headache, muscle spasm, arm/back pain
Cervical spine fracture	Sudden severe neck pain	Restricted movement, occipital headache, quadriplegia, deformity, respiratory paralysis
Cervical spine tumor	Persistent pain, worsens with movement	Paresthesia, weakness, paralysis, bladder/bowel incontinence
Cervical spondylosis	Posterior neck pain, aggravated by movement	Pain radiating to arms, stiffness, paresthesia, weakness
Esophageal trauma	Mild neck/chest pain	Dysphagia, edema, hemoptysis
Herniated cervical disk	Variable neck pain	Dermatomal pain, paresthesia, arm weakness
Laryngeal cancer	Late-stage neck pain radiating to ear	Dysphagia, hoarseness, stridor, dyspnea, cervical lymphadenopathy
Lymphadenitis	Painful, enlarged cervical nodes	Fever, chills, malaise
Meningitis	Neck pain with nuchal rigidity	Fever, headache, photophobia, positive Brudzinski/Kernig signs, decreased LOC
Neck sprain	Pain, stiffness, restricted ROM	Minor: slight swelling; Severe: ligament rupture, ecchymosis, spasms, nuchal rigidity
Rheumatoid arthritis	Pain, stiffness in cervical joints	Warmth, swelling, tenderness, paresthesia, low-grade fever, fatigue, possible deformity
Spinous process fracture	Acute pain at cervicothoracic junction	Shoulder pain, swelling, tenderness, spasms, deformity
Subarachnoid hemorrhage	Severe neck pain	Headache (“worst headache of life”), nuchal rigidity, decreased LOC
Thyroid trauma	Mild–moderate neck pain	Local swelling, ecchymosis, dyspnea if hematoma forms
Torticollis	Severe unilateral neck pain	Muscle spasm, recurrent stiffness, head tilt
Tracheal trauma	Moderate–severe neck pain	Respiratory difficulty, hemoptysis, hoarseness, dysphagia

Special considerations

Provide analgesics and anti-inflammatory drugs for comfort.
Assist the patient to adopt pain-relieving positions.
Prepare for diagnostic tests: X-ray, CT scan, blood tests, cerebrospinal fluid analysis.
Monitor neurologic function and airway status closely in traumatic cases.

Patient counseling

Explain activity restrictions and reinforcement of prescribed exercises.
Teach correct use of cervical collars if indicated.
Advise on early reporting of worsening pain, numbness, or weakness.

Pediatric pointers

Most common causes: meningitis and trauma.
Rare cause: congenital torticollis.
Assess hydration and neurologic status in children.

Summary

Neck pain originates from multiple musculoskeletal, neurologic, or systemic causes, ranging from trauma to tumors. Early assessment, appropriate immobilization, and diagnostic evaluation are essential to prevent complications and guide effective treatment.

References

Buttaro, T. M., Tybulski, J., Bailey, P. P., & Sandberg-Cook, J. (2008). Primary Care: A Collaborative Practice (pp. 444–447). St. Louis, MO: Mosby Elsevier.
Colyar, M. R. (2003). Well-Child Assessment for Primary Care Providers. Philadelphia, PA: F.A. Davis.
Sarwark, J. F. (2010). Essentials of Musculoskeletal Care. Rosemont, IL: American Academy of Orthopaedic Surgeons.
Sommers, M. S., & Brunner, L. S. (2012). Pocket Diseases. Philadelphia, PA: F.A. Davis.