Signs and symptoms. Neck pain is a pain that is perceived by the patient as existing primarily within the axial portion of the spine. Pain may radiate to the base of the skull or to the midupper periscapular region. The pain may involve the posterior trapezius muscles or the posterior deltoids. The pain itself may be limited to a focal area or may involve a more global region. Night pain is common because the neck becomes a weight-bearing area. The longer the pain exists the more difficult it is for patients to localize it. Because the neck can be a prominent area of referred pain from thoracic organs such as the heart or aorta, the physician must be aware of the patient’s comorbid medical issues.

Physical examination. Examination of the patient with neck pain should include noting the position in which the neck is held. When there is severe neck spasm, the head may be flexed laterally to that side or even rotated. Muscle spasm can often be visualized and can be palpated posteriorly along the paraspinal musculature. Examination should include inspection of the symmetry of the paraspinal muscles as well as the trapezius and shoulder musculature. Any signs of atrophy must be noted. Strength and range of motion of the shoulder should be tested, as well as examination for focal tenderness within the shoulder (to help rule out the shoulder as a source of potential pain or to define coexistent shoulder disease).

Range of neck motion should include flexion, extension, rotation, and lateral bending. Normal flexion demonstrates the ability to touch the chin to the chest. Normal neck extension allows the occiput to approach the prominent C7 spinous process. Rotation is normally 70 degrees bilaterally and lateral bending is
50 to 60 degrees bilaterally. Palpation for carotid artery pulses as well as for the presence or absence of supraclavicular adenopathy should be performed.

Signs and symptoms. Cervical radiculopathy implies pain traveling on the basis of an anatomic distribution to the shoulder or down the arm. Patients describe sharp pain and tingling or burning sensations in the involved area. There may be sensory or motor loss corresponding to the involved nerve root, and reflex activity may be diminished.

Physical examination. The shoulder abduction relief sign is characterized by having the patient place the palm of his hand flat onto the top of his skull; this causes symptomatic relief of the radicular pain. Spurling’s test is performed by having the patient extend the neck and rotate and laterally bend the head toward the affected side; an axial compressive force is then applied to the top of the patient’s head. The test is positive when the maneuver reproduces the patient’s typical radicular arm pain.