NECK PAIN

Acute whiplashinjury needs assessment for spinal cord injury, NICE in 2016have recommended using
the CanadianC spine ruleto assess for low, no risk or high risk for cervical spine injury. ( Note can be
difficult to interpret in children where developmental stage must be considered)

 HIGH RISK ( If positive the patient should be transferred using spinal immobilization to A&E)
one of the following risk factors is positive
1. Age 65 years or older
2. Dangerous mechanism of injury(fall from a height of greater than 1 metre or 5 steps,axial load
to the head-for example diving, high speed motor vehiclee collision,rollover motor
accident,ejection from a motor vehicle, accident involving motorised recreational vehicles,
bicycle collision, horse riding accidents)
3. Paraesthesia in the upper or lower limbs
 LOW RISK if they have at least one of the following low risk factors
1. Involved in a minor rear-end motor vehicle collision
2. Comfortable in a sitting position
3. Ambulatory at any time since the injury
4. No midline cervical spine tenderness
5. Delayed onset of neck pain
 The person remains at LOW RISK if they are:
1. Unable to actively rotate their neck 45 degreesto the left and right
2. The range of the neck can only be assessed safely if the person is at low risk and they are no
high-risk factors
 NO RISK
1. Have one of the above low-risk factors and
2. Are able to actively rotate their neck 45 degrees to the left and right
Management (If low or no risk)
 Reassurance that is self limiting
 Early return to activities
 Analgesia
 Consider physiotherapy
 Manage psychosocial factors
 Late whiplash injury( symptoms persisting>6 months)
1. Encourage & faciliatereturn to usual activities
2. Diagnose & treat any co-existing anxiety & depression
3. Analgesia +/- trial of amitriptyline or gabapentin
Cervical radiculopathy
 Due to cervical disk herniation and degenerative changes
 C5-T1 commonly affected
 Diagnosis
1. History to exclude red flags & identify cause
2. Examination of signs including
Postural assymetry
Muscle wasting
Neurological signs and uper limb weakness
 Investigation
1. C-spine x-ray and other imaging modalities/investigations not routinely required
  Referral:Immediate specialist advice if
1. Severe progressive motor weakness or sensory loss
2. Compression of the spinal cord (myelopathy) suspected
3. History of cancer, infection, inflammation or significant trauma
 Management
1. <4-6 weeks neck pain & no objective neurological signs
Reassurance, encourage activity & normal lifestyle, firm pillow & simple analgesia
2. >4-6 weeks neck pain or objective signs present
Referral for MRI & consideration of invasive procedures
Simple analgesia & consider trial of amitriptyline or gabapentin

Acute torticollis/wry neck

 Immediate specialist advise if:
1. Severe progressive motor weakness or sensory loss
2. Compression of the spinal cord (myelopathy) suspected
3. History of cancer, infection, inflammation or
4. Significant trauma
 Reassurance that symptoms usually resolve within 24-48 hours
 Simple analgesia and gentle exercise
 Heat or cold packs
 Low firm pillow & maintain good posture
 Advise against use of soft cervical collar whilst driving as restricts rotation to view traffic
Non-specific neck pain
 Neck pain with no specific causes
1. Exclude above conditions
 Management
1. 4-12 weeks neck pain
Advice as above.Click here for neck exercises from Arthritis Research UK, refer to physiotherapy for
stretching & strengthening exercises and address psychosocial factors, refer to OH if related to work
and consider referral for acupuntcure
2. >12 weeks neck pain
As above but also consider
Trial of amitriptylineor gabapentin and/or referral to pain clinic