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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

Description

  • 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

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

Demographics

  • 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

Signs and Symptoms

  • 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

Functional Implications

  • Pain with standing, ambulation, ADLs
  • Limited range of motion
  • Weakness

Possible Contributing Causes

  • 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

Differential Diagnosis

  • 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

Imaging

  • Imaging not usually needed with non-specific neck pain unless warranted for differential diagnosis
    • MRI helps to visualize compressed or inflamed nerve root in diagnosis
    • X-ray/plain-film radiograph helpful if osteophyte located in intervertebral foramen
    • CT to show herniation compressing the spinal canal/nerves6
    • Electrodiagnostic/nerve conduction testing can help to determine specific impaired nerve function

Diagnostic Procedures

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