Acute Neck Pain
Clinical Assessment
- Trauma
- Constitutional: Fever, night sweats, weight loss, history of cancer, immunosuppression, pain elsewhere, illicit drug use
- Iatrogenic: Recent surgery, catheterisation, venipuncture, manipulation
- Awkward posture
- Exotic exposure or recent overseas travel
- Neurological: Symptoms/signs, vomiting
- Cardiovascular: Risk factors, anticoagulants
- Genitourinary/Reproductive: UTI, haematuria, retention, uterine, breast
- Endocrine: Corticosteroids, diabetes, hyperparathyroid
- Gastrointestinal: Dysphagia
- Integumentary: Infections, rashes
- Respiratory: Cough, haemoptysis
It is rarely possible to establish a patho-anatomic diagnosis in acute neck pain, and so the diagnostic process is one of exclusion.
The first step is evaluating whether the patient has neurological symptoms or signs. If they do then they should be assessed under a neurological disorders framework rather than an acute neck pain framework as the neurological disorder takes precedence. Neurological disorders include spinal cord injury, myelopathy, and radiculopathy.
In the event of trauma, the Canadian C-spine rule should be used, and any fracture managed as appropriate.
Diagnosis
For patients with no history of injury the diagnosis used by the Australian Acute Musculoskeletal Guidelines is "idiopathic neck pain," while for those with neck pain following a motor vehicle accident the diagnosis is "whiplash-associated neck pain." For ACC medicolegal purposes the coding that should be used is normally "cervical sprain," but this is not a meaningful label in a medical sense as it lacks legitimacy as a diagnosis.
Bibliography
- Bogduk, Nikolai, and Brian McGuirk. Management of acute and chronic neck pain : an evidence-based approach. Edinburgh New York: Elsevier, 2006.
