Neck pain DDx

Neck pain – Differential Diagnosis

Common causes

• Cervical sprain / whiplash
• Cervical spondylosis
• Cervical disc lesion
• Cervical lymphadenopathy
• Torticollis
• Psychogenic
• Fibromyalgia
• Occipital neuralgia

Must Not Miss

• Fracture(including osteoporotic)
• Cervical cord compression
• Malignancy
  • Bone
  • Multiple myeloma
  • Metastases
  • Pancoast tumour
• Infections
  • Meningitis
  • Osteomyelitis
  • Tuberculosis
  • Abscess
• Vascular
  • Angina
  • SAH
  • Aortic dissection
• Rheumatoid arthritis

Easily missed

• Polymyalgia rheumatica
• Ankylosing spondylitis
• Paget’s disease

Red flags

• Systemic symptoms
  • (fever, night sweats, weight loss)
• Significant trauma
• Cervical myelopathy
  • Altered gait
  • Bowel/Bladder dysfunction
  • ‘Clumsy’ /numb hands
• Severe pain/progressive symptoms
• Nocturnal pain
• Age <20 or >55 years
• Bony tenderness
• History of TB, HIV, Cancer
• Cervical lymphadenopathy

Investigations to consider

• FBC, CRP/ESR
• U&Es, LFTs, Bone profile
• Auto-antibody screen, Rheumatoid factor
• Myeloma Screen
• Cervical spine X-ray
• CXR
• CT/MRI scan
• Bone scan
• Lumbar puncture