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Neck pain - non-specific - Management
What are the 'red flags' for non-specific neck pain?
- 'Red flags' are clinical features that indicate an increased risk of specific conditions that can present with neck pain and require urgent attention.
- A serious underlying cause is more likely in people presenting with:
- New symptoms before the age of 20 years or after the age of 55 years.
- Weakness involving more than one myotome or loss of sensation involving more than one dermatome.
- Intractable or increasing pain.
- 'Red flags' that suggest compression of the spinal cord (myelopathy):
- Insidious progression.
- Neurological symptoms: gait disturbance, clumsy or weak hands, or loss of sexual, bladder, or bowel function.
- Neurological signs:
- Lhermitte's sign: flexion of the neck causes an electric shock-type sensation that radiates down the spine and into the limbs.
- Upper motor neuron signs in the lower limbs (Babinski's sign — up-going plantar reflex, hyperreflexia, clonus, spasticity).
- Lower motor neuron signs in the upper limbs (atrophy, hyporeflexia).
- Sensory changes are variable, with loss of vibration and joint position sense more evident in the hands than in the feet.
- 'Red flags' that suggest cancer, infection, or inflammation:
- Malaise, fever, unexplained weight loss.
- Pain that is increasing, is unremitting, or disturbs sleep.
- History of inflammatory arthritis, cancer, tuberculosis, immunosuppression, drug abuse, AIDS, or other infection.
- Lymphadenopathy.
- Exquisite localized tenderness over a vertebral body.
- 'Red flags' that suggest severe trauma or skeletal injury:
- A history of violent trauma (e.g. a road traffic accident) or a fall from a height. However, minor trauma may fracture the spine in people with osteoporosis.
- A history of neck surgery.
- Risk factors for osteoporosis: premature menopause, use of systemic steroids.
- 'Red flags' that suggest vascular insufficiency:
- Dizziness and blackouts (restriction of vertebral artery) on movement, especially extension of the neck when gazing upwards.
- Drop attacks.
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