The Evaluation of Patients With Neck Pain

Donald R. Gore, MD


Medscape Orthopaedics & Sports Medicine eJourn. 2001;5(4) 

In This Article


Pain may originate from pathology within the neck (primary) or be referred from other parts of the body (secondary). As with pain in any location, the anatomic source may be myofascial, ligamentous, osseous, neurologic, cutaneous, or visceral. The cause can be compression of neural structures; inflammatory, neoplastic, infectious, or degenerative processes; or the disruption of tissue secondary to trauma.

Pain is a subjective sensation caused by a noxious stimulus to the nervous system. In the case of primary neck pain, the noxious stimulus affects the free nerve endings found in the supportive structures of the cervical skeleton. These include muscles and their attachments, the fibrous joint capsules of the zygapophyseal joints, and the fibrous capsule of the intervertebral joints, which is called the annulus fibrosus.

Direct involvement of neurologic structures may also cause pain. Cervical radiculopathy is pain in the distribution of a cervical nerve and is the result of anything that compresses or irritates the nerve. The most common causes are intervertebral disc protrusions or osteophytes in the neural foramen where the nerve exits the spinal canal (Figure 1). The spinal cord itself is insensitive, but the dural covering has free nerve endings that are likely to be capable of recording a painful stimulus, although compressive cervical myelopathies are usually relatively painless. The cervical sympathetic chain lies just anterior to the paraspinal flexor muscles on both sides of the neck and some investigators suggest it may cause headaches if pathology is present; this is still unproved.[2]

Figure 1A.

T1-weighted MRI image. Large lateral disc protrusion at C5-6 (arrow) producing radicular pain.

Figure 1B.

Osteophytes at C5-6 originating from the uncovertebral joints causing compromise of the neural foramen and radicular pain.


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