Idiopathic neck pain

• 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

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