Acute Neck Pain
Neurological Signs
Result indicates an urgent medical review with a GP or Acute Medical Services
Is this a whiplash injury?
- Imaging invariably normal.
- Cervical facet joint pain is the single most common bases for chronic neck pain.
- It accounts for over 50% of patients with chronic neck pain after whiplash
- Facet joint pain is diagnosed with Medial branch blocks and treated with Radiofrequency Neurotomy (MSK Specialists).
Do they have any high risk factors that mandate radiography?
- Age > 65 years
-
Dangerous mechanism
- Fall from ≥1 metre, or 5 stairs
- An axial load to the head
-
A motor vehicle accident
- At high speed (> 100km/h)
- Rollover
- Ejection
- A collision involving a motorized recreational vehicle
- A bicycle collision
- Paresthesias in extremities
Do they have low-risk factors that allow safe range of motion assessment?
- Simple rear-end MVA
- Sitting position in the ED
- Ambulatory at any time
- Delayed neck pain onset
- No midline cervical tenderness
Are they able to rotate their neck actively? (45° left and right)
Radiography
No Radiography
Are there red flags?
- Trauma
- Fever
- Night Sweats
- Recent Surgery
- Catheterisation
- Venipuncture
- Illicit Drug Use
- Immunosuppression
- Awkward Posture
- Manipulation
- History of Cancer
- Weight Loss
- Exotic Exposure
- (Overseas) Travel
-
Neurological
- Symptoms/Signs
- Cerebrovascular
- Vomiting
- Cardiovascular
- Risk Factors
- Anticoagulants
- Urinary
- UTI
- Hematuria
- Retention
-
Reproductive
- Uterine
- Breast
-
Endocrine
- Corticosteroids
- Diabetes
- Hyperparathyroid
- GIT
- Dysphagia
-
Musculoskeletal
- Pain Elsewhere
-
Skin
- Infections
- Rashes
-
Respiratory
- Cough
Referral to GP, acute medical services, MSK specialist, orthopaedic surgeon.
This is neck pain of unknown origin
- Explanation
- Reassurance
- Activation
- Simple exercises
- Analgesia
Review - Is the issue improving or resolved?
No referral needed
Are there barriers to recovery?
- Social
- Occupation
Manage these barriers
Review treatment, add further treatments
Was this successful?
No referral needed
Consider referral
- MSK Specialist
- Orthopaedic Surgeon
- GP