Acute Neck Pain continued

Physical Examination

Physical examination does not provide a patho-anatomic diagnosis of acute idiopathic or whiplash-associated neck pain as clinical tests have poor reliability and lack validity.

*LEVEL III: Gross et al. 1996; Fjellner et al. 1999; Smedmark et al. 2000; Nansel et al. 1989; De Boer et al. 1985; Mior et al. 1985; Youdas et al. 1991; Viikari-Juntura 1987

Despite limitations, physical examination is an opportunity to identify features of potentially serious conditions.

CONSENSUS: Review Group and Steering Committee

Tenderness and restricted cervical range of movement correlate well with the presence of neck pain, confirming a local cause for the pain.

*LEVEL III: Sandmark and Nisell 1995

Ancillary Investigations

Plain radiography is not indicated for the investigation of acute neck pain in the absence of a history of trauma, or in the absence of clinical features of a possible serious disorder.

*LEVEL III: Based on radiological surveys (Heller et al. 1983; Johnson and Lucas 1997; Hoffman et al. 2000)

In symptomatic patients with a history of trauma, radiography is indicated according the Canadian C-Spine Rule.

*LEVEL III: Based on a large epidemiological survey (Stiell et al. 2001)

CT is indicated only when: plain films are positive, suspicious or inadequate; plain films are normal but neurological signs or symptoms are present; screening films suggest injury at the occiput to C2 levels; there is severe head injury; there is severe injury with signs of lower cranial nerve injury, or pain and tenderness in the sub-occipital region.

CONSENSUS: Based on published consensus views (El Khoury et al. 1995; Kathol 1997)

Acute neck pain in conjunction with features alerting to the possibility of a serious underlying condition is an indication for MRI.

CONSENSUS: Consensus view (El Khoury et al. 1995)


Except for serious conditions, precise identification of the cause of neck pain is unnecessary.

CONSENSUS: Review Group and Steering Committee

Once serious causes have been recognised or excluded, terms to describe acute neck pain can be either 'acute idiopathic neck pain' or 'acute whiplash-associated neck pain'.

CONSENSUS: Review Group and Steering Committee

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