ABC of Rheumatology: PAIN IN NECK, SHOULDER, AND ARMBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6973.183 (Published 21 January 1995) Cite this as: BMJ 1995;310:183
- M Barry,
- J R Jenner
Pain in the neck is a common clinical presentation in primary care and rheumatological practice. It has been estimated that half of the population will have an episode of neck pain during their lifetime. Up to a third of patients attending general practices with neck pain will have had symptoms lasting more than six months or recurring in bouts.
Symptoms arising in the neck are often poorly localised, and there may be difficulty making a precise anatomical diagnosis, particularly as the clinical signs of neck disorders are neither sensitive nor specific. However, certain features of a patient's history and examination help to distinguish common mechanical disorders from more sinister systemic disease. A full history and physical examination are therefore essential for anything other than trivial neck pain.
Acute spasm of the neck muscles (spasmodic torticollis) is a common phenomenon. The exact cause of the spasm is uncertain but often appears to be due to bad posture. Examples include poor positioning of a computer screen, inappropriate seating, and sleeping without adequate neck support. Another common offender is carrying unbalanced loads, such as a heavy briefcase or shopping bag. A careful history is often required to identify such factors.
Degenerative changes in the cervical spine (cervical spondylosis) may be associated with neck pain but usually only when the degenerative changes are severe. Mild or moderate degenerative changes are often seen in asymptomatic individuals. In general the pain of mechanical disorders is intermittent and related to use. At least partial relief may be gained by supporting the head and neck.
Pain referred to the arm may indicate irritation or entrapment of a nerve root. Common causes are a prolapsed cervical disc or degenerative …