Differential Diagnosis for Neck Pain

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Clinical Cornerstone:

• Diagnosing neck pain requires a patient-centered approach that integrates physical, psychological, and social aspects of pain. A comprehensive diagnostic strategy integrates clinical findings with patient narratives and risk factor evaluations for a complete understanding of the patient's condition.

• Neck pain is broadly categorized as non-specific, where pain or symptomology is not attributed to a distinct pathology, or specific, where it is linked to an underlying condition (e.g., cancer, fracture) or referred from other organs. Cervical disc herniation causing neck pain with radiculopathy is a common specific cause. Further diagnostic testing is often required to confirm a specific diagnosis of neck pain.

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Differential Diagnosis for Neck Pain

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1. Non-specific Neck Pain (NAD I-III)

• Cervical strain/sprain, WAD I-III, mechanical cervicalgia

• Degenerative changes/osteoarthritis (e.g., degenerative disc disease, facet arthropathy)

• Cervicogenic headache, whiplash-associated headache

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2. Specific Neck Pain

a) Neck Pain with Radiculopathy:

• Herniated nucleus pulposus (disc protrusion or herniation causing nerve root compression)

• Cervical spinal stenosis (narrowing of the spinal canal or foramen l  eading to nerve compression)

• Cervical spondylotic myelopathy (associated with upper extremity weakness, numbness or tingling, decreased fine motor abilities, spasticity, hyperreflexia, poor balance)

• Thoracic outlet syndrome (neurogenic or vascular) / Plexopathy

• Peripheral neuropathy (e.g. diabetic neuropathy)

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b) Fracture:

• Compression fracture from osteoporosis

• Trauma or minor trauma  with immediate onset of pain or associated with midline tenderness

• Trauma or minor trauma  from a dangerous mechanism (e.g. a fall from elevation, axial blow to the head, high speed collision or roll-over)

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c) Inflammatory Causes:

• Ankylosing spondylitis

• Rheumatoid arthritis

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d) Infectious Causes:

• Osteomyelitis (bone infection)

• Discitis (intervertebral disc infection)

• Epidural abscess

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e) Neoplastic Causes:

• Primary spinal tumors

• Metastatic spinal tumors

 

f) Referred Pain:

• Shoulder pathology (e.g., rotator cuff injuries)

• Referral from visceral diseases (e.g. a cardiac event, pulmonary or gallbladder conditions)

 

g) Other Causes:

• Fibromyalgia