Neck Pain


Neck pain is a generalized term describing pain at the neck region. It could be local tenderness or pain associated with movements.


Neck pain is a generalized term describing pain at the neck region. It could be local tenderness or pain associated with movements.

Symptoms and signs:

Patient sometimes presents with sudden onset of neck pain on waking up. The pain is so severe that it limits neck movements. Such pain is often referred to wry neck. Some patients may present with chronic neck pain associated with certain particular neck movements. Sometimes the pain may refer to upper limbs. Clinicians should be aware of the red flag symptoms, such as upper limb numbness or weakness, history of high impact injury, history of malignancy, history of rheumatoid arthritis, patient taking steroid, neck pain lasting more than 1 month and patient older than 50 year old.

Before examining the neck, shoulder joints shall be screened for abnormalities. Very often, clinician finds that neck pain is, in fact, part of the symptoms of shoulder joint problems as an unstable shoulder requires stabilization from and hence straining the adjacent neck muscles. Overactive of deltoid, levator scapulae, upper trapezius or scalene muscle may cause localized trigger point with radiating pain to the upper limb or neck. After excluding shoulder pathologies, neck movements will be examined and their range of motion should be documented so that comparison can be made before and after treatment. Neck muscles will then be examined for trigger points. Segmental examination of cervical joints is important to find out any segmental dysfunction. Spurling’s test is a sensitive screening test for cervical radiculopathy. Neurological examination may be necessary to rule out any neurological deficits.

Cause and biomechanics considerations:

Neck pain may be caused by much different pathologies. Neck pain can be originated from localized pathology from bony structures, ligament injury, apophyseal joint problems, nerve entrapments, cervical radiculopathy or as referred pain radiated from nearby structures. Apart from localized causes, it can be part of generalized syndromes, such as rheumatoid arthritis, fibromyalgia or polymyalgia rheumatica. Mechanically, neck pain can be caused by faulty biomechanics as a result of poor posture, inappropriate ergonomic settings, forward drawn head, excessive use of accessory respiratory muscles or from postural abnormality as a result of leg length discrepancies, kyphoscoliosis or weak core muscles.


Often the cause of neck pain can be identified after careful clinical examination. However, for patient with red flag symptoms or neurological signs, X-ray study or MRI imaging may be necessary. If inflammatory diseases are suspected, blood tests for rheumatoid or auto-immune diseases screening should be ordered.


Treatment depends on symptoms and signs of the patient. The aims are to control symptoms, improve motions, correcting biomechanical abnormalities and return to normal daily activities. Analgesics often are required to control pain. Soft neck collar sometimes may help to limit the neck movement and tie the patient off the acute pain period. If muscle trigger points are identified, they should be released with appropriate therapy. Prescribed exercises are indispensible to improve the stability and to retrain the weaken muscles. If the neck pain is chronic from ligament or tendon tears, musculoskeletal physicians may offer prolotherapy to trigger tissue repair. Occasionally, surgery is required to decompress the cervical nerve roots and stabilize the injured cervical spine.







在檢查頸部之前,首先篩查肩關節有無異常。臨床很多時發現所謂頸痛其實只是肩關節問題的部分表現:為了使不穩定的肩關節保持穩定,三角肌、肩胛提肌、斜方肌上部或斜角肌需額外工作,過勞時引起激痛點並產生放射痛到上肢或頸部。在排除肩部問題後,再檢查頸部活動情況並記錄活動範圍以便做治療前後的對比。然後尋找頸肌的激痛點及頸椎的節段性功能障礙。以Spurling's test篩查頸神經根痛是一項敏感度高的方法。如懷疑有其它神經系統的問題,必須進行相關檢查。