An Approach to the Patient with Neck Pain

In the United States, neck pain is an extremely common reason for seeking medical attention.  While symptoms can occur abruptly, they are often more indolent in their course, usually without any temporal relationship to trauma or other inciting events. For these reasons, physicians need to be well-versed in the initial evaluation and management of these complaints. It is important to have a working knowledge of the cervical anatomy, the differential diagnosis for neck pain, and the potential mimics which may present. It is equally imperative to hone the skills necessary to effectively differentiate localized, mechanical neck pain syndromes from those of a more serious etiology. To that end, identifying “red flags” during the patient’s history and performing a focused musculoskeletal and neurological examination is critical to triaging the patient appropriately. As the U.S. health care system moves away from traditional fee-for-service reimbursement, greater emphasis will be placed on providing high-quality, cost-conscious care. Physicians must be deliberate when evaluating a patient with neck pain, rather than ordering a “one size fits all” battery of tests. Knowing when to order advanced imaging modalities or refer a patient to a specialist will be paramount in providing the best patient care while responsibly utilizing resources.