Skip to Main Content




  • Simple neck pain

  • Neck sprain/strain

  • Mechanical neck pain




  • 729.1 Myalgia and myositis unspecified




  • M60.9 Myositis, unspecified

  • M79.1 Myalgia




  • 4D: Impaired joint mobility, motor function, muscle performance, and range of motion associated with connective tissue dysfunction1



A 38-year-old female dental hygienist presents with complaints of neck pain with insidious onset 3 weeks ago. She reports she has pain while working on her dental patients and the pain gets worse throughout the day. She rates her pain at 8/10 at its worst. Her pain subsides with rest to a 3/10. She reports having approximately three to four headaches per week that typically arise in the middle of her workday. She also notes she is a very active cyclist and competes in many local races throughout the year.

Her primary care physician in order to evaluate and treat refers her for physical therapy. Physical therapy examination revealed decreased range of motion (ROM) in bilateral cervical rotation and cervical lateral flexion. Cervical and thoracic joint mobility was normal. On palpation, muscle tenderness was noted in the upper trapezius, sternocleidomastoid, scalene, and levator scapulae muscles bilaterally. She also has two active trigger points: one in her right upper trapezius and one in her right levator scapulae. Spurling test and upper limb nerve tension tests were negative for the reproduction of symptoms. There are no signs of muscle atrophy. Manual muscle testing revealed strength 4-/5 for bilateral shoulder elevation, 3/5 for scapular retraction, 3/5 for right cervical lateral flexion, 3+/5 for left cervical lateral flexion, and 3/5 for bilateral cervical rotation.




  • Neck pain from unknown cause

  • No underlying disease or specific disorder

  • Usually acute

  • Chronic, persistent, deep aching pains in the muscle, nonarticular in origin

  • Usually caused by sudden overload, overstretching, repetitive/sustained muscle activities

  • Pain associated with activities, generally relieved with rest

  • Can be in localized area affecting any muscle or fascia

FIGURE 123-1

A 63-year-old man presents with severe upper neck pain not responding to anti-inflammatory medication. (From Chen MYM, Pope TL, Ott DJ. Basic Radiology. 2nd ed. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
Essentials of Diagnosis

  • Diagnosis made by clinical examination (generally palpation) with no medical diagnostic tests available

  • Differentiated from fibromyalgia, as it can occur in a single area; fibromyalgia occurs in multiple locations, has specific tender points

General Considerations

  • Very common, affects most people in their lifetimes.

  • Latent trigger points are palpable, taut bands not tender to palpation, but may be converted into active trigger point.

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.