Rationale
Neck pain is extremely common, and, in most cases, does not require investigation. However, there are patients presenting with pain, or signs of nerve compression, who require specific diagnosis and management to ensure good outcome. Neck pain may also be due to non-musculoskeletal causes.
Causal Conditions
(list not exhaustive)
- Mechanical problems
- Neck strain
- Spondylosis
- Acute, discogenic nerve root entrapment
- Spinal stenosis and/or cord compression
- Inflammatory arthritis (e.g., ankylosing spondylitis)
- Infections
- Fracture
- Neoplasm
- Pain from soft tissue structures (e.g., thyroid, pharynx)
Key Objectives
Given a patient with neck pain, the candidate will be able to determine whether the patient must undergo further tests and specific management. In particular, the candidate will determine if the patient requires urgent intervention.
Enabling Objectives
Given a patient with neck pain, the candidate will
- list and interpret critical clinical findings, including
- features on history and physical examination that suggest the need for urgent investigation or management (e.g., in case of neurologic abnormalities or fever);
- data from a patient-centered pain history, including the impact on function;
- occupational and recreational history;
- determination as to whether any further investigation is required or not;
- list and interpret critical investigations, including
- appropriate laboratory investigations and other tests (e.g., computed tomography or magnetic resonance imaging, if indicated)
- construct an effective management plan, including
- ensuring initial management of urgent problems, including appropriate referral for specialized care;
- counselling and educating the patient about appropriate exercise and return to work;
- recognizing the potential for long-term impact on function;
- prescribing medications in a safe and effective manner, if necessary (e.g., nonsteroidal anti-inflammatory drugs, opiates).
