There are three general types of neck pain:
- Acute. Pain that lasts less than 4 weeks.
- Subacute. Pain that lasts 4 to 12 weeks.
- Chronic. Pain that lasts 3 or more months.
For acute neck pain, a specific cause is oftentimes not known or even sought. The pain goes away within 4 weeks, so most people are just happy to get on with their lives and aren’t concerned with what specifically caused the temporary nuisance.
But when neck pain becomes subacute or chronic, then it’s likely that some form of medical treatment or guidance is needed to alleviate the pain. Depending on the cause, there may be more effective treatments for certain conditions.
Complete History of Patient
As a first step to diagnosing the specific cause of neck pain, typically a doctor will take a thorough history of the patient. In addition to learning about the person’s medical background, the doctor will ask the person questions about the following:
- Description of neck pain. When did the pain start? Does it come and go? Is the pain in one spot, or does it radiate into the shoulders, arms, or fingers? Are there any other symptoms in addition to neck pain?
- Occupation. What type of work does the person do? Does the person perform manual labor or sit in front of a computer all day? What is the commute like?
- Lifestyle. What type of hobbies or activities does the person enjoy? Does the person tend to be more active or sedentary—for instance, do hobbies include gardening, watching TV, or swimming?
- Posture. Does the person often slouch or tilt the head forward? What type of chairs are used?
- Sleep habits. Does the person usually sleep on the side, stomach, or back? What type of mattress and pillows are used?
- Recent injuries. Did the person do or feel anything unusual recently that might have led to this neck pain? Maybe the person had an accident or fall? Or perhaps the neck was tweaked while lifting something?
- Old injuries. Thinking further back in life, do any significant injuries stand out? Perhaps an old sports injury, car accident, or a fall that was particularly hard or scary?
The doctor does the complete history in order to better understand the nature of the patient’s pain, such as if the pain is worse at certain times of day or exacerbated by certain activities.
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Physical Exam of Patient
After taking the patient history, the doctor will do a physical examination. This typically involves:
- Observation. Examine the person’s posture, particularly the neck and shoulders; and inspect the neck for any lesions or abnormalities.
- Palpation. Feel along the neck’s soft tissue for signs of muscle spasms, tightness, or tenderness.
- Range of motion test. Check to see how the person’s neck moves side to side, up and down, and rotates compared to what would be considered normal. Even if the person has full range of motion, the doctor will note whether that is achieved with ease or if certain movements cause pain or struggles.
If the doctor suspects any chance of nerve compression, the following physical exams might also be performed for neurological status:
- Reflexes. Simple tests done with a rubber hammer can examine reflexes in the biceps, triceps, and forearm, which can show whether nerves in the neck are sending signals as intended.
- Muscle power. Testing various muscles for any signs of weakness, such as in the shoulders, arms, or hands.
- Sensation. Check for any unusual sensations, such as tingling that goes into the shoulders, arms, or fingers.
By obtaining a thorough history and performing a detailed physical examination, the doctor can narrow the list of likely diagnoses and point to the next course of action.
If neck pain is the result of trauma or if it keeps coming back despite treatment efforts, then a doctor will probably request diagnostic testing for more information about what might be the underlying medical cause. Diagnostic testing options could include:
- X-ray. Using electromagnetic radiation, an X-ray (radiograph) gives a good picture of the bones. This can be used to identify spinal degeneration, fractures, or even tumors.
- CT scan. This imaging method uses X-rays in conjunction with a computer to create better images. A CT scan provides a series of cross-section images, which enables better viewing of the bones than a regular X-ray. CT scans are better than MRI’s for identifying subtle bone changes.
- Myelogram. This test injects dye through a spinal tap, which enables better viewing of the spinal canal, discs, and neural foramina. When checking for a neck pain cause, a CT scan is often combined with a myelogram to get a view of what’s going on with the bones, discs, and nerves. Historically, this was a much more common spine test. It is not as often utilized secondary to the infection risks associated with a spinal tap as well as the radiation dose of the CT scan.
- MRI scan. Using radio waves and a strong magnet, an MRI detects variations in the anatomical structures of differing tissues to create a series of detailed cross-sections of the soft tissues and bones. Unlike an X-ray or CT scan, an MRI can show soft tissues and does not use radiation.
- Electrodiagnostic testing. A nerve conduction study could be performed to test the electrical activity of the nerves in the arms and legs; typically this test is immediately followed by an electromyogram, which tests the electrical activity of the muscles. These tests measure the speed at which electrical signals are being sent along nerves and can give clues as to the location of where a nerve might be having a problem. Electrodiagnostic testing has some operator-dependent factors that may not make the results as reliable as other forms of testing.
- Bone scan. Using a radioactive tracer, a bone scan can identify areas of increased bone activity. This can identify subtle fractures, as well as areas of bone degeneration, or boney areas affected by cancer. While it is a useful study, there is a significant radiation dose associated with bone scans. Physicians are becoming more cautious in using this study because of the concern for the long term effects of radiation.
Other tests could include laboratory blood tests for diseases, or somatosensory evoked potentials for possible spinal cord issues.
For most physicians, diagnostic testing is used to confirm the cause that is most likely, based on the information obtained during the patient history and the physical examination.
Depending on the specific neck complaints, sometimes the cause cannot be diagnosed with certainty. On the other hand, the more significant and serious problems are often the more straightforward problems to diagnose.