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Condition/Disorder Synonyms

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  • Simple neck pain

  • Neck sprain/strain

  • Mechanical neck pain

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ICD-9-CM Code

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  • 729.1 Myalgia and myositis unspecified

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ICD-10-CM Codes

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  • M60.9 Myositis, unspecified

  • M79.1 Myalgia

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Preferred Practice Pattern

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Key Features

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Description

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  • Neck pain from unknown cause

  • No underlying disease or specific disorder

  • Usually acute

  • Chronic, persistent, deep aching pains in muscle, non-articular 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

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Essentials of Diagnosis

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  • 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

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General Considerations

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  • 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

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Demographics

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  • In the U.S.: 14.4% of general population suffers from chronic musculoskeletal pain4

  • 21% to 93% of patients reporting regional pain have myofascial pain2

  • 25% to 54% of asymptomatic individuals have latent trigger points2

  • No racial differences in incidence of myofascial pain have been described

  • Myofascial pain affects men and women equally

  • Likelihood of developing active trigger points increases with age and activity level

  • Sedentary individuals more prone to developing active trigger points than individuals who exercise vigorously on a daily basis

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Clinical Findings

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Signs and Symptoms

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  • Muscle stiffness

  • Headaches

  • Vertigo

  • Paresthesias

  • Referred pain

  • Joint stiffness

  • Limited range of motion (ROM)

  • Acute pain

  • Pain with palpation of the trigger point

  • Difficulty sleeping

  • Weakness without atrophy may be seen when performing manual muscle testing

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Functional Implications

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  • Pain with standing, ambulation, ADLs

  • Limited range of motion

  • Weakness

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Possible Contributing Causes

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  • Improper posture

  • Emotional/psychological stress

  • Anxiety

  • Behavior

  • Traumatic events

  • Improper lifting, poor biomechanics

  • Lack of activity, immobility (cast)

  • Repetitive stress

  • Overuse

  • Poor muscular or ligamentous support

  • Obesity

  • Inflammatory conditions affecting ligaments, muscles, tendons

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Differential Diagnosis

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  • Herniated disc

  • Fibromyalgia

  • Rheumatoid arthritis

  • Complex regional pain syndrome

  • Radiculopathy

  • Ligamentous sprain

  • Muscle strain

  • Peripheral nerve impairment

  • Thoracic outlet syndrome

  • Shoulder pathology with radiating pain pattern

  • Spinal tumor

  • Carpal tunnel syndrome

  • Degenerative disk disease

  • Arnold Chiari malformation

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Means of Confirmation or Diagnosis

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Imaging

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  • Imaging not usually needed with non-specific neck pain unless warranted for differential diagnosis

    • MRI helps to ...

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