Initial Management of Neck Pain

Assessment Algorithm

The American College of Radiology recommends assessing for signs of serious underlying pathology that would warrant immediate investigation, including risk factors for fracture, signs of malignancy, constitutional symptoms, signs of infection, inflammatory arthritis, vascular etiology suspected, neurological deficits, and coagulopathy 1, 2, 3
The assessment should include evaluating for red flags such as trauma, osteoporosis, unexplained weight loss, history of cancer, fever, weight loss, immunosuppression, IV drug use, and elevated inflammatory markers 1, 2, 3

A physical examination should be performed to evaluate range of motion, assess for tenderness to palpation, and perform a neurological examination to rule out radiculopathy or myelopathy 1, 3
The examination should also include assessing for any neck masses or lymphadenopathy 3

The American College of Radiology recommends that imaging is not recommended for initial management unless red flags are present 1, 2, 4
The American College of Radiology also recommends that MRI has a high rate of abnormal findings in asymptomatic individuals and should be reserved for cases with focal neurologic symptoms or pain refractory to conventional treatment 4

The American College of Radiology recommends avoiding ordering unnecessary imaging studies in the absence of red flags 1, 4
The American College of Radiology also recommends avoiding overreliance on imaging findings that may not correlate with clinical symptoms 4