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A. Epidemiologynavigator

  1. Very common problem
  2. Prevalence is 13% overall
  3. ~50% of adults will have neck pain at some point in their lives
  4. Majority of cases are musculoskeletal

B. Causesnavigator

  1. Severe
    1. Meningitis
    2. Encephalitis
    3. Cervical spine fracture
  2. Chronic
    1. Muscle spasm
    2. Sprained ligaments
    3. Osteoarthritis
    4. Spondyloarthropathies
    5. Neoplasm - primary tumor or metastases
    6. Abscess - very uncommon

C. Diagnosis navigator

  1. History and physical are critically important
  2. Must rule out severe causes
  3. Any history of trauma should prompt consideration for radiography
    1. Standard neck films may miss small fractures
    2. Computerized tomographic (CT) scan is more sensitive
    3. Magnetic resonance imaging (MRI) for soft tissue disease
  4. For chronic disease, need to rule out infection, inflammation, neoplasm
    1. Fever, night sweats, lethargy, malaise may indicate severe cause
    2. Pain worse at night or progressively worse may indicate tumor or abscess
    3. Erythrocyte sedimentation rate (ESR) or C-reactive protein for infection or inflammation
    4. Complete blood count with differential
    5. Radiography to rule out mass effect is recommended

D. Treatmentnavigator

  1. For severe disease, specific intervention is required acutely
  2. For chronic disease, rule out non-musculoskeletal causes
  3. Modalities for Musculoskeletal Neck Pain
    1. Manual (chiropractic) therapy
    2. Physical therapy
    3. Neck brace / collar
    4. Pharmacologic agents: analgesics, "anti-spasm" agents
  4. Manual (Chiropractic) Therapy
    1. Coordination and stabilization techniques
    2. Muscular and joint mobilization techniques
  5. Physical Therapy
    1. Active strength, range-of-motion, postural, stretching exercises
    2. "Functional" and "relaxation" techniques
  6. Manual therapy appears most effective modality [2]
    1. Improved patient symptoms compared with physical therapy and general care
    2. Reduced use of analgesics compared with physical therapy and general care
    3. Manual therapy may have emotional benefits beyond physiological benefits
  7. Pharmacologic therapy as for low back pain
  8. Soft neck collar may be very effective and is effective when worn only at night

References navigator

  1. Posner J and Glew C. 2002. Ann Intern Med. 136(10):758 abstract
  2. Hoving JL, Koes BW, de Vet HCW, et al. 2002. Ann Intern Med. 136(10):713 abstract