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  • 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.)

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 ...

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