Diagnosing Neck Pain

Neck pain ranges from mild to severe and is either acute (lasting days to weeks) or chronic (lasting longer than three months). Common causes of neck pain include muscle strain, osteoarthritis, bone spurs, compressed nerves, or injuries, such as whiplash.

The treatment of neck pain is dependent on the cause, severity, personal medical history, and several other factors. Some causes of neck pain, such as muscle strain due to poor posture, can be treated with nonsurgical interventions. Other causes of chronic neck pain may require surgical treatment (e.g., spinal stenosis) or aggressive medical treatment (e.g., meningitis).

The diagnostic process to determine the cause of neck pain includes the following:

Medical history and symptom review

The diagnostic process typically begins with a thorough medical history and symptom review. Questions regarding the location, severity, and duration of pain are asked during symptom review. A health care provider may also ask if the pain is dull, achy, sharp, or stabbing and if any tingling or numbness in the arms or hands is present. Lifestyle, occupation, sleep habits, etc., may also be reviewed.

Physical exam

During a physical exam, the neck, shoulders, arms, and hands are tested for tenderness, numbness, or muscle weakness. Neck mobility is also accessed. If a medical history and a physical exam do not provide a clear diagnosis, other diagnostic testing may be ordered.

Imaging tests

Depending on the findings of a physical exam and medical history review, imaging tests may be ordered to determine the cause of neck pain.

• X-ray
  An X-ray is a special type of photo that is created using electromagnetic energy beams. X-rays can be used to detect bone spurs, spinal fractures, or other structural issues in the cervical spine.
• CT scan
  A computed tomography scan, or CT scan, provides several X-ray images taken from multiple angles to obtain cross-sectional views of the inside of the neck. This provides more detail of the structures in the neck than an X-ray can provide.
• MRI
  A magnetic resonance imaging scan, or MRI, uses a strong magnetic field and radio waves to provide very detailed images. An MRI of the neck can detect abnormalities not only with the vertebrae in the cervical spine, but also the soft tissues, such as muscles, nerves, ligaments, and cervical discs.
• Myelogram
  A myelogram, or myelography, uses either X-ray technology or a CT scan in combination with the injection of contrast dye. It allows providers to see the spinal canal and nerve roots more clearly.

Blood tests

Blood tests may be ordered if an infection is suspected as the cause of neck pain. Blood tests can detect infections or other illnesses.

Electromyogram (EMG)

An electromyogram, or electromyography, involves the insertion of a needle electrode into a muscle to record electrical activity. This test detects the small amount of electricity that muscle cells make when stimulated, which helps determine if nerves are damaged or compressed by a condition such as spinal stenosis or a herniated disc.

Diagnostic injections

A diagnostic injection involves injecting an anesthetic solution into a specific structure (such as a specific nerve or joint) using X-ray guidance (fluoroscopy). If the pain is temporarily relieved, the source of pain can be isolated to that specific structure.