Red flags in patients with neck pain

Symptom or finding	Clinical significance
Recent major neck trauma	Raises concern for cervical spine fracture
Neurologic symptoms or signs that suggest spinal cord issue (eg, weakness, gait difficulty, bowel or bladder dysfunction)	Raises concern for cervical cord compression
Shock-like paresthesia (Lhermitte's phenomenon) with neck flexion	Suggestive of cervical cord compression or multiple sclerosis
Fever or chills	Suggestive of infection
History of injection drug use	Raises concern for cervical spine or disc infection
Immunosuppression	Raises concern for infection
Chronic glucocorticoid use	Raises concern for infection or cervical spine compression fracture
Unexplained weight loss	Suggestive of malignancy
History of cancer	Raises concern for metastatic disease to cervical spine
Headache, shoulder or hip girdle pain, or visual symptoms in older patient	Suggestive of rheumatic disease (eg, polymyalgia rheumatica, giant cell arteritis)
Anterior neck pain	Suggestive of a non-spinal cause (eg, angina pectoris)

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