Medical History

A careful medical history including questions regarding systemic illness, unexplained weight loss, history of neoplasm, fever, infection, neurological changes including numbness and weakness in the extremities, and history of substance abuse is important to exclude serious causes of neck pain. Just as there are "red flags" with the assessment of low back pain, the same red flags should be emphasized in patients with neck pain. Infection, tumor, trauma (spinal cord, epidural hematoma, fractures) are serious causes that require urgent evaluation

Figure 26.3 Pain may be referred to various "zones" around the neck and shoulder depending on the cervical level affected. From Bogduk 2006, with permission.

to be ruled out. Myelopathy may present as difficulty grasping, diffuse numbness in the hands, difficulty with balance, and problems with sphincter control such as urinary urgency or frequency.

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