Diagnosing Neck Pain

When neck pain does not improve after a few days or weeks, some medical treatment or guidance is likely needed to alleviate symptoms. Getting an accurate medical diagnosis for the cause of neck pain can help set up a more effective treatment plan.

Complete Medical History

A thorough medical history is the first step in diagnosing the specific cause of neck pain. In addition to learning about the person’s health history, the doctor asks questions about:

• Current symptoms. 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? Is the day spent performing manual labor or sitting in front of a computer? What is the commute like?
• Lifestyle. Does the person tend to be more active or sedentary? For instance, do hobbies include more moving around, such as gardening or swimming, or more sitting, such as watching TV or reading?

Many other topics may be reviewed, such as posture, sleep habits, and recent or old injuries. As more information is collected, the doctor can narrow the list of likely diagnoses and point to the next course of treatments.

Physical Exam for Diagnosing Neck Pain

After a medical history, the doctor performs a physical examination that includes:

• Observation. Examine the 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 neck moves side to side, up and down, and rotates compared to what would be considered normal. Even if the neck has full range of motion, the doctor will note whether that is achieved with ease or if certain movements cause pain or struggles.
• Reflexes. Perform simple tests with a rubber hammer to examine reflexes in the biceps, triceps, and forearm, which can show whether nerves in the neck are sending signals as intended.
• Muscle power. Test muscles in the shoulder, arms, or hands for any signs of weakness.
• Sensation. Check for unusual sensations, such as tingling that goes into the shoulders, arms, or fingers.

Many cases of neck pain are diagnosed based on the patient’s medical history and physical exam. When more information is need, advanced diagnostics may be needed to reach an accurate diagnosis.

Imaging Studies

Various imaging technologies are available to give a better view of what might be causing neck pain.

• X-ray. Using electromagnetic radiation, an x-ray (radiograph) shows a good picture of the neck’s bones. X-ray images can be used to identify spinal degeneration, vertebral fractures, or even certain tumors.
• CT scan. A CT scan uses x-rays and a computer to provide a series of cross-section images, which enables better viewing of the bones than a regular x-ray. CT scans are particularly useful for identifying subtle bone changes. Sometimes CT scans are performed with myelogram, which involves injecting dye into the spinal column to get a better view of the size of the nerve passages (foramina), the central canal, and whether the problem is caused by bone or soft tissue (disc).
• MRI scan. An MRI uses radio waves and a strong magnet to create a series of detailed cross-sections of the soft tissues and bones. If available, MRI is typically the first imaging option for viewing soft tissues because it does not have the risks associated with the additional radiation dose and myelography.

Other imaging options are available, such as a bone scan or ultrasound. Sometimes an imaging study can show damage or degeneration at a spinal level that does not correspond to the reported symptoms. In such cases, it is important to treat the symptoms and not the imaging study.

Diagnostic Injections

For a diagnostic injection test, an anesthetic solution is injected into the cervical spine to isolate a specific structure, such as a facet joint (cervical facet block injection) or a nerve (selective nerve root injection). These injections are carefully placed using x-ray guidance (fluoroscopy) and contrast dye. If the injection temporarily alleviates pain, it signals that the joint or nerve root in question is likely the pain source.

While diagnostic injections tend to be safe and effective, they have the potential for serious side effects and are typically one of the last diagnostic tests performed. Spinal injections can also be therapeutic, and may provide enough pain relief to allow nonsurgical conservative care to progress.

See Injections for Neck and Back Pain Relief

Electrodiagnostic and Other Testing

Electrodiagnostic tests measure the speed at which electrical signals travel along nerves and can give clues as to where a nerve might be affected.

• A nerve conduction study (NCS) examines electrical activity of nerves in the arms and legs
• An electromyogram (EMG) tests electrical activity in the actual muscles

Electrodiagnostic testing has some operator-dependent factors that may not make the results as reliable as other forms of testing.

Other tests could include laboratory blood tests for diseases, or somatosensory evoked potentials for possible spinal cord issues.

Depending on the specific neck complaints, sometimes the cause cannot be diagnosed with certainty. Although, when neck pain is caused by a serious underlying medical condition, the diagnosis tends to be more straightforward.

See 2 Neck Pain Symptoms That Require Immediate Medical Attention