Differentials
Non-traumatic neck pain
SIGNS / SYMPTOMS
No history of trauma.
May have symptoms of secondary infection (pain with fever, tachycardia), neoplasia (e.g., unrelenting pain, especially at night), or inflammation (e.g., arthritides), or there may be no identifiable aetiology.
Infective aetiologies include meningitis, vertebral osteomyelitis, discitis, and epidural abscess.
Neoplastic lesions can be primary or metastatic, and any patient with a prior history of cancer should be evaluated for recurrence.
Patients with osteoarthritis and rheumatoid arthritis may have signs and symptoms of arthritis in other joints.
INVESTIGATIONS
Cervical spine x-ray or CT scan: cancer - single or multiple lesions with bony destruction; osteoarthritis - cervical spondylosis or normal.
Cervical spine MRI: cancer - single or multiple lesions with bony destruction; infection - infected areas of bone (vertebral osteomyelitis) or signs of abscess (epidural abscess).
Bone scan: metastatic neoplastic lesions in the spine.
ESR, CRP: elevated in infection, malignancy, or inflammatory arthritis.
FBC: elevated WBC in infection.
Degenerative cervical spine disease
SIGNS / SYMPTOMS
No history of trauma.
Symptoms may be similar to neck trauma, including axial neck pain and neurological complications such as radiculopathy and myelopathy.
INVESTIGATIONS
Cervical spine x-ray: presence of degenerative joint disease or degenerative disc disease.
Cervical MRI: bone destruction, spinal cord or nerve compression, intradural or epidural process.
Acquired torticollis
SIGNS / SYMPTOMS
No history of trauma.
Involuntary twisting or deviation of the neck, abnormal head posture, presence of sensory trick (patient can resolve symptoms by touching neck or face), normal neurological exam.
INVESTIGATIONS
Cervical spine x-ray: usually normal; may demonstrate C1-C2 subluxation.
CT cervical spine: may demonstrate rotatory subluxation.
MRI of the brain and cervical spine: usually normal. If chronic, may have cervical muscle asymmetry and nerve root compression.
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