| Neck Pain |
GP Assessment & Treatment
1) Establish diagnosis from history, examination and x-rays, sometimes MRI.
2) Confirm the presence or absence of any abnormal neurological signs.
3) In the absence of neurology, treat symptomatically with appropriate analgesics / NSAID, physiotherapy, cervical collar in very acute cases, etc.
Please be aware that pathology in the neck may give rise to pain radiating to the head, shoulders and sometimes the chest.
When to refer
1) Failed conservative treatment.
2) Presence of significant abnormal neurology or progressive neurological signs.
3) When there is doubt about the diagnosis.
When & to whom to refer
1) Persistent symptoms with no abnormal neurology, refer to the MSK service for a full evaluation as it is not as likley surgery is indicated.
2) Significant or progressive neurology --> Spinal Assessment Clinic
3) Significant instability --> Neurosurgery. If you are unsure refer to the Spinal Assessment Clinic
Advice to be given to patients
1) In established cervical spondylosis, the patient should be informed that they are likely to have continuing symptoms of variable intensity. They may require intermittent treatment with physiotherapy, appropriate NSAIDs, etc.
2) Sprains of the cervical spine / whiplash injuries. Patients should be encouraged to mobilise the neck as soon as pain subsides. They should be informed that it is likely that their symptoms will go on improving for up to 2 years. If they are still symptomatic after 2 years, then they are likely to have intermittent symptoms of varying intensity, again requiring intermittent conservative treatment.
3) Significant instability or persistent and progressive neurological signs may require surgery.
The most common causes of neck pain are:
1) Degenerative changes / cervical spondylosis
2) Musculo-ligamentous injuries, such as whiplash.
3) Cervical disc lesions usually associated with brachalgia ( referred pain in the arm usually from an irritated nerve in the neck).
4) Spinal pathology including facet joint arthrisis, instability such as in rheumatoid arthritis, tumours and infection though fortunately these are rare. |
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