The Epidemiology of Neck Pain

, Medical College of Wisconsin, Milwaukee, Wis.

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In This Article

Causes of Neck Pain

Pain originating in and confined to the neck may arise from infections, tumors, and degenerative changes of the zygapophyseal joints and intervertebral discs. Cervical radicular pain is pain in the distribution of a cervical nerve root. This can be caused by any process that compresses or irritates the nerve, the most common being herniated intervertebral discs (Figure 1a,b) and osteophytes which narrow the neuroforamen (Figure 2a,b,c). Disc protrusion and osteophytes can also narrow the spinal canal, causing pressure on the cervical cord and resulting in a myelopathy (Figure 3).

Figure 1. A. Sagittal view of T2-weighted MRI image of patient with large C4-5 disc protrusion. B. Axial view of T2-weighted MRI image of patient with large C4-5 disc protrusion.
Figure 2. A. Plain oblique roentgenograms showing osteophytes originating from uncovertebral joint narrowing the neuroforamen. B. Plain oblique roentgenograms showing osteophytes originating from zygapophyseal joint narrowing the neuroforamen. C. Plain oblique roentgenograms showing osteophytes originating from both uncovertebral and zygapophyseal joints narrowing the neuroforamen.
Figure 3. T2-weighted MRI image of patient with severe spinal stenosis causing spinal cord compression.

Referred neck pain is generated by disease in an anatomic structure other than the neck. Examples of this are visceral diseases such as angina, apical lung tumors, and subdiaphragmatic irritation as in a subdiaphragmatic abscess. The most common conditions that may be confused with neck problems are intrinsic shoulder diseases such as impingement, rotator cuff tears, and adhesive capsulitis. Peripheral nerve entrapment occurring in thoracic outlet syndrome, ulnar cubital tunnel syndrome, and carpal tunnel syndrome can simulate cervical nerve root compression. Systemic diseases such as rheumatoid arthritis, spondyloarthropathies, fibromyalgia, and herpes zoster may also cause neck pain. However, in these conditions it is unusual for the only symptom to be in the neck.

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