Causes of Stiff Neck

Common Causes

• Mechanical/Musculoskeletal Issues represent the majority of nontraumatic cervical or neck pain cases, according to the American College of Radiology 1, 3
• Cervical degenerative disc disease is a common cause of neck pain 4
• Cervical radiculopathy, or nerve root compression, is a common cause of neck pain 5
• Inflammatory conditions, such as cervical arthritis and inflammatory myopathies, are often associated with elevated inflammatory markers 3, 4

Serious Causes

• Infections, such as meningitis and cervical epidural abscess, can cause stiff neck and require urgent evaluation 1, 3, 6
• Neoplastic conditions, such as primary or metastatic tumors affecting the cervical spine, can cause stiff neck 3, 6
• Vascular causes, such as vertebral artery dissection and carotid artery pathologies, can cause stiff neck 1, 3, 4

Red Flag Symptoms

• Constitutional symptoms, such as fever and unexplained weight loss, can indicate a serious underlying condition 3, 6
• Laboratory abnormalities, such as elevated inflammatory markers, can indicate a serious underlying condition 3, 4, 6
• Neurological signs, such as spinal cord injury or deficit, can indicate a serious underlying condition 3, 4, 6

Diagnostic Approach

• Clinical assessment for red flags, such as presence of fever, neck stiffness, and altered mental status, is crucial in evaluating neck pain 3, 4, 6
• Imaging considerations, such as MRI without contrast, are recommended when red flags are present 3, 4, 6

Clinical Pearls

• Neck pain is one of the top 5 leading causes of global years lost to disability, according to the American College of Radiology 2, 7
• Nearly 50% of individuals with neck pain experience recurrent or persistent symptoms, according to the American College of Radiology 1, 3
• MRI findings should always be interpreted in combination with clinical findings due to high rates of abnormal findings in asymptomatic individuals 5