Last reviewed: 22 Aug 2023
Last updated: 23 Sep 2021
Summary
Definition
History and exam
Key diagnostic factors
- spontaneous onset of neck pain
- cervical muscle pain and spasm
- headaches or occipital pain
- weakness or numbness
- presence of radiating arm pain
- reflex changes
- proximal arm weakness
- distal hand weakness
- gait ataxia
More key diagnostic factors
Other diagnostic factors
- cervical muscle spasm
- decreased cervical range of motion
- sensory changes
Other diagnostic factors
Risk factors
- age >40 years
- head or neck trauma
- previous cervical spine surgery
- previous cervical myofascial strain
- genetic predisposition
More risk factors
Diagnostic investigations
1st investigations to order
- cervical MRI
- cervical x-ray
More 1st investigations to order
Investigations to consider
- cervical CT scan
- cervical CT myelogram
- cervical/upper extremity electromyography or nerve conduction velocity
- cervical nerve root block
More investigations to consider
Treatment algorithm
ACUTE
axial neck pain
cervical spondylotic radiculopathy (CSR)
degenerative cervical myelopathy (DCM)
Contributors
Authors
Dennis A. Turner, MA, MD

Professor
Neurosurgery and Neurobiology
Duke University Medical Center
Durham
NC
Disclosures
DAT is an author of a reference cited in this topic.
Peer reviewers
Ricardo Pietrobon, MD, PhD, MBA
Associate Professor of Surgery
Associate Professor in Anesthesiology
Associate Vice-Chair, Systems Integration
Department of Surgery
Duke University Medical Center
Durham
NC
Disclosures
RP is an author of a number of references cited in this topic.
Allan I. Binder, MD
Consultant Rheumatologist
Lister Hospital
East and North Hertfordshire NHS Trust
Stevenage
UK
Disclosures
AIB is an author of a number of references cited in this topic.
Differentials
- Whiplash injury (cervical myofascial strain)
- Acute disk herniation
- Metastatic malignancy
More DifferentialsGuidelines
- ACR appropriateness criteria: cervical neck pain or cervical radiculopathy
- A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression
More GuidelinesPatient leaflets
Back pain (lower back)
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer