Disease | History or finding, investigations |
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Intervertebral disc prolapse | Radiating neck pain or numbness of the fingers with a rapid onset. Central prolapse may cause symptoms of spinal cord compression. Intensive follow-up. If there are progressive motor deficit symptoms, consult a specialist. |
Myelopathy (spinal cord compression) | Symptoms in the lower extremities (to be remembered in association with walking difficulties in an elderly person), spasticity, bladder and bowel symptoms when advanced. Examine sensations and reflexes, including vibration sense and Babinski's sign. If the symptoms are progressive, consult a neurosurgeon. |
Malignancy | Deteriorated general condition, loss of weight, fatigue, fever, intractable pain not associated with strain. Basic investigations, MRI of the cervical spine. |
Inflammatory rheumatic disease | Rheumatoid arthritis: changes in the cervical spine usually appear later. Bending of the neck should be avoided because of the risk of atlantoaxial subluxation. Ankylosing spondylitis may stiffen the neck. Progression is periodic, to be remembered in episodic neck pain. |
Bacterial spondylitis | Possible underlying factors include e.g. intravenous drug abuse or immunosuppression. MRI of the cervical spine is the basic investigation. |
Arterial dissection | Dissection of the carotid or vertebral artery may, in addition to posterior or anterior neck pain, cause symptoms typical of a cerebrovascular disturbance (visual disturbances, lateralized neurological deficits, cognitive symptoms), Horner's syndrome, pulsating tinnitus or symptoms from the lower cranial nerves. |
Duration of pain | Localized neck pain | Radiating pain |
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1 If there are warning signs suggestive of serious disease, the required further investigations should be performed (e.g. ESR, basic blood count, CRP, plain x-ray) or the patient referred for further investigations. 2 If no emergency assessment by a specialist is required, basic investigations (e.g. ESR, basic blood count, CRP, plain x-ray or MRI) are recommended before assessment by the specialist. | ||
Acute | Basic investigations and measures
| Basic investigations and measures Required analgesia Emergency assessment by a specialist if there are progressive or significant motor deficit symptoms or if there is intolerable pain resistant to treatment |
1 week | - | Basic investigations and measures Assessment by a specialist if there are progressive or significant motor deficit symptoms or if there is intolerable pain resistant to treatment2 |
2-3 weeks | Basic investigations and measures | Basic investigations and measures Assessment by a specialist if there are progressive or significant motor deficit symptoms or if there is intolerable pain resistant to treatment |
4-6 weeks | - | Basic investigations and measures, as necessary Assessment by a specialist if there is pain causing significant harm or if there are progressive motor deficit symptoms |
8-12 weeks | Basic investigations and measures Multiprofessional workup, as necessary | Basic investigations and measures Assessment by a specialist if there is pain causing significant harm or if there are progressive motor deficit symptoms |
3-6 months | Physiotherapy increasing muscle strength or endurance, multiprofessional rehabilitation | Multiprofessional rehabilitation |