Initial evaluation and management in the adult patient presenting with new onset of neck pain

MRI: magnetic resonance imaging; CBC: complete blood count; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; ECG: electrocardiogram.
* Imaging is generally warranted. Refer to separate UpToDate content on acute cervical spine injury for details of the approach to evaluation.
¶ Forward flexion of the neck elicits an electric shock-like sensation in the neck, radiating down the spine or into the arms.
Δ MRI is usually performed without contrast unless infection or malignancy is suspected. If MRI is unavailable or contraindicated, cervical spine CT or CT myelography are alternatives.
◊ Provocative maneuvers include Spurling's maneuver, upper limb tension test, and manual neck distraction test. Refer to the UpToDate topic on evaluation of neck pain for details of performing and interpreting these tests.
§ Though the history and clinical findings can sometimes help distinguish between these, it is often difficult to identify a single specific etiology. The initial treatment for these conditions is similar and therefore differentiating between them is not critical, particularly if symptoms resolve with symptomatic management. Refer to the UpToDate topics on neck pain in adults for more detailed information.
¥ For patients with cervical radiculopathy who have clear radicular pain and symptoms of paresthesia, numbness, or nonprogressive neurologic deficits, conservative therapy is our usual initial treatment approach. This includes oral analgesics (eg, nonsteroidal antiinflammatory drugs), avoidance of provocative activities, and, if pain is severe, a short course of oral prednisone. Physical therapy is initiated once pain is tolerable. Referral to a specialist may be warranted for patients with severe and/or progressive symptoms. Refer to the UpToDate topics on cervical radiculopathy for additional details.