Red flags

1. History of trauma

Table 5.2 Red flags in case of neck pain

diagnostic considerations
fracture leading to unstable spine
Cord compression
Myelopathy
Vertebral body fracture

2. Infectious history
Fever,malaise,
3. Tumor history
Sudden weight loss,Anorexia,night pain

meningitis
Epidural abcess
metastatic lesions
SOL leading to cord compression
Vertebral compression fracture

4. Progressive disturbance of gait,progressive motor

or sensory deficits,bladder bowel incontinence

unstable spine leading to cervical myelopathy

5. Acute progressive neurologic and cognitive deficits

accompanied by hemodynamic instability

dissecting vertebral artery aneurysms

dissecting extracranial ceratoid aneurysms

6. Associated chest pain, tachycardia and breathlessness on exertion

ischemic heart diseas. Cervical angina syndrome

7. Associated horners syndrome

pancoats tumor of lung

8. History of rheumatoid arthiritis

morning stiffnes >30 mins, peripheral joints
swelling and arthritis

atlantoaxial dislocation
fibromyalgia

Table 5.1 causes of neck pain

1. Cervical spine
4. Referred pain
a. facet join atrhropathy
a. shoulder joint
b. internal disc disruption (IDD)
b. heart
c. prolapsed intervertebral disc
c. lung
d. cervical radioculopathy
d. diaphragmatic irritation
e. vertebral fracture due to trauma
e. abdominal pathology
f. interspinous lligament sprain
2. Myofascial pain syndrome (MFS)
5. Others
a. trapezius MFS ( most common)
a. post-herpetic neuralgia
b. sternocliedomastoid MFS
b.diabetic polyneuropathy/mononeuropathy
c. occipitalis MFS
c. nerve entrapment syndrome, occipital
neuralgia
d. brachial plexus neuropathy
e. complex regional pain syndrome
3. Spondyloathropathies
a. degenerative atrhopy
c. rheumatoid arthritis (RA)
c. ankylosing spondylitis
Table 5.3 cervical pain referral pathways
Location
Source
Upper posterolateral cervical
region

C0-1, C1-2,C2-C3

occipital region

C2-3,C3

upper posterior cervical region

C2-3,C3-4,C3

middle posterior cervical region

C3-4,C4-5,C4

lower posterior cervical region

C4-5,C5-6,C4,C5

suprascapular region

C4-5,C5-6,C4

superior angle of scapula

C6-7,C6,C7

midscapula region

C7-T1,C7