Neck pain

Rationale

Neck pain is a common condition that requires a focused history and physical examination to determine its etiology. When appropriate, investigations such as imaging can help further delineate the cause of the pain.

Causal Conditions

(list not exhaustive)

1. Musculoskeletal problems
   1. Strain
   2. Arthritis (spondyloarthritis and osteoarthritis)
   3. Nerve root compression or entrapment
   4. Spinal stenosis and/or spinal cord compression
   5. Vertebral fracture
2. Infections
3. Neoplasms
4. Nonmusculoskeletal problems
   1. Lymphadenopathy
   2. Thyroid disease
   3. Arteritis (carotidynia)

Key Objectives

Given a patient with neck pain, the candidate will 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

1. list and interpret critical clinical findings, including
   1. history and physical examination features that suggest the need for urgent investigation or management (e.g., neurologic abnormalities, fever),
   2. information from a patient-centred pain history, including the impact on function,
   3. results of a relevant occupational and recreational history, and
   4. determination as to whether any further investigation is required;
2. list critical investigations and interpret the results of the investigations, including appropriate laboratory tests and imaging when indicated (e.g., computed tomography, magnetic resonance imaging);
3. construct an effective management plan, including
   1. ensuring initial management of urgent problems, including appropriate referral for specialized care when required,
   2. counselling and educating the patient about appropriate exercise and return to activities (e.g., physiotherapy, activity modification),
   3. recognizing the potential long-term impacts on function, and
   4. prescribing medications in a safe and effective manner, when appropriate (e.g., nonsteroidal anti-inflammatory drugs, opioids, muscle relaxants, gabapentinoids).