UMEM Educational Pearls

Category: Misc

Title: Non-Musculoskeletal Causes of Neck Pain

Keywords: Neck pain (PubMed Search)

Posted: 7/16/2016 by Michael Bond, MD (Updated: 11/22/2017)
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Non-Musculoskeletal Causes of Neck Pain

Neck pain is a common complaint of people presenting to the ED. Most of the cases will be musculoskeleteal in origin and will respond to conservative therapy with NSAIDs or acetominophen. However, other non-musculoskeletal causes of pain could be lurky behind this benign complaint.

Don't forget to consider:

  1. Early mengingitis (84% of patients with meningitis will complain of neck stiffness)
  2. Myocardial infarction/angina. Women are known to have atypical symptoms and might just have dull pain in their neck. Be sure to ask about whether exertion increases the pain.
  3. Epidural Abscess- fever and neuro symptoms are often missing early on. Make sure to ask about risk factors for spinal epidural abscess.
  4. Vertebral Artery Discection - most common identifiable cause of stroke in your people.  <50% are associated with trauma and <8% of patients have connective tissue disorder. Patients are at increased risk if they have had
    1. Cervical trauma (remember seen in < 50% of cases)
    2. Recent infection
    3. Hypertension
    4. h/o migraines