Symptom Finder - Neck Pain
Neck Pain
When reviewing hospital charts, the author finds that the results of the neck examination are rarely listed, so he wonders if this part of the
physical examination is often skipped. In a patient presenting with neck pain, the first thing to do is palpate for point tenderness. That way, the
physician will not miss a subacute thyroiditis, occipital neuralgia, tender lymph nodes, or brachial plexus neuralgia.
Next, one must check the range of motion in all planes—anterior, posterior, adduction right and left, and rotation to the right and left. The
patient should be able to extend 45 degrees, flex 65 degrees (so that the chin touches the chest), adduct 45 degrees right and left, and rotate 60 degrees right and left. Any major deviation from these norms suggests cervical spondylosis, herniated disc, fracture, or other pathology. If there is a herniated disc or significant osteoarthritic spurs, cervical compression or Spurling test precipitates radicular pain down the upper extremity. Tender cervical lymph nodes suggest inflammation in the throat, salivary glands, teeth, or sinuses.
It is necessary to look for Horner syndrome in patients with cervical pain because this may indicate a thoracic outlet syndrome, brachial plexus
neuralgia, or mediastinal lesion. Cervical pain is associated with a mass in Ludwig angina, Zenker diverticulum, thyroiditis, and metastatic
neoplasms. The pain may occasionally be referred from coronary insufficiency, cholecystitis, or intrathoracic pathology.
When reviewing hospital charts, the author finds that the results of the neck examination are rarely listed, so he wonders if this part of the
physical examination is often skipped. In a patient presenting with neck pain, the first thing to do is palpate for point tenderness. That way, the
physician will not miss a subacute thyroiditis, occipital neuralgia, tender lymph nodes, or brachial plexus neuralgia.
Next, one must check the range of motion in all planes—anterior, posterior, adduction right and left, and rotation to the right and left. The
patient should be able to extend 45 degrees, flex 65 degrees (so that the chin touches the chest), adduct 45 degrees right and left, and rotate 60 degrees right and left. Any major deviation from these norms suggests cervical spondylosis, herniated disc, fracture, or other pathology. If there is a herniated disc or significant osteoarthritic spurs, cervical compression or Spurling test precipitates radicular pain down the upper extremity. Tender cervical lymph nodes suggest inflammation in the throat, salivary glands, teeth, or sinuses.
It is necessary to look for Horner syndrome in patients with cervical pain because this may indicate a thoracic outlet syndrome, brachial plexus
neuralgia, or mediastinal lesion. Cervical pain is associated with a mass in Ludwig angina, Zenker diverticulum, thyroiditis, and metastatic
neoplasms. The pain may occasionally be referred from coronary insufficiency, cholecystitis, or intrathoracic pathology.
