Makindo Medical Notes

📖 About

• Context and age are important when assessing neck pain.
• Neck pain is a common primary care complaint — lifetime prevalence 10–15% 📊.
• Most acute neck pain episodes resolve with conservative treatment ✅.
• Chronic/recurrent pain warrants further evaluation.

🧬 Aetiology

• Osteoarthritis — usually affects the lowest 3 cervical vertebrae.
• Cervical root pain may radiate into the arm.
• Other causes include degenerative disc disease, trauma, infection, or inflammatory arthritis.

🚨 Red Flags for Serious Disease

• Fever, malaise, chills, new headache, photophobia, non-blanching rash (infection or meningitis).
• High-velocity trauma in healthy patients OR any trauma in osteoporotic patients.
• Pain worse when reclined at night 🛏️.
• Syncope, history of malignancy, or immunosuppression.
• Neurological deficits ➝ sensory or motor loss, cranial nerve palsies, upper motor neurone signs.
• Faecal/urinary incontinence, new-onset ataxia, sexual dysfunction.
• Meningeal signs ➝ think meningitis or subarachnoid haemorrhage.

📝 Differentials

🩺 Clinical Assessment

• Look for red flags: fever, night sweats, night pain.
• History: mechanism of injury, progression, systemic symptoms.
• Examine: cord/root signs, cranial nerves, motor/sensory deficits, sphincter function.
• Check for signs of RA, ankylosing spondylitis.
• Risk factors: IV drug use ➝ abscess/osteomyelitis, malignancy, sepsis.
• Always consider cardiac causes (chest pain ➝ ECG for IHD).

🔬 Investigations

• Plain X-ray: AP + lateral views sufficient if no trauma/neurology. Flexion/extension if instability suspected.
• MRI: if neurological signs ➝ disc herniation, stenosis, tumour, infection.
• CT (± myelogram): alternative if MRI contraindicated. Gold standard for fractures in trauma 🚑.
• Nerve conduction studies: differentiate radiculopathy vs peripheral neuropathy.
• EMG: very sensitive for nerve root involvement.
• Evoked potentials: assess stenosis/upper motor neuron pathology.

🛠️ Management

• Protect airway, breathing, circulation. Immobilise neck if trauma until cleared.
• Pain relief ➝ stepwise analgesia with NSAIDs/paracetamol ± opioids.
• Surgical options: decompression, fusion, tumour removal where indicated.
• Rehabilitation: physio for strength, flexibility, posture correction.

📚 References

• Neck Pain – StatPearls (NCBI Bookshelf)
• NICE CKS: Neck Pain