Diagnosing Neck Pain

Diagnosing neck pain can involve an array of exams and tests to make an accurate diagnosis. 

Acute (short-term) neck pain isn’t always serious, especially if it’s caused by a minor muscle strain or sprain, but chronic (ongoing) pain can be representative of something more serious. If you have chronic neck pain, make an appointment with your doctor, especially if your pain is accompanied by other symptoms. Seek immediate medical care if your pain is accompanied by numbness or stiffness, or if your symptoms persist for several days after head or neck injury.

Below are some ways that common sources of neck pain are diagnosed.

Muscle Strain

To gather a history of your neck pain, your doctor may conduct a basic exam and ask questions, including:

  • When did your neck pain start?
  • Have you recently done any activities that could have caused your neck pain?
  • What does your pain feel like? Does it radiate down your arm?
  • Have you tried any home remedies?

The doctor may also observe your posture and physical condition, test your strength and movement, and note any movements that cause you pain. The doctor may ask you to undergo an x-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI) to further diagnose your neck pain.

(Source: 123RF)

Cervical Disc Herniation

A neurosurgeon may use your medical history, symptoms, physical exams, and scans to look at the structure of your vertebrae, the size and shape of your spinal canal/spinal cord, and any nerve root degeneration. A discogram, where a safe dye is injected into discs, may be performed. Electromyogram and nerve conduction studies may help to measure electrical impulses along nerve roots to show where potential nerve damage resides.

Not everyone with herniated or bulging discs reports pain, and yet, even those with minor bulging discs may have excruciating pain. Thus, researchers hypothesize that nerve pain may have more to do with the disc’s inflammatory qualities than mechanical pressure on the nerve itself.

Rheumatoid Arthritis

If your doctor, usually a primary care provider or rheumatologist, suspects you may have rheumatoid arthritis (RA) of the cervical spine, he or she may first perform a physical exam. For instance, they may check for limited or painful flexion, extension, and right and left lateral neck movements. They may also ask for a blood sample to look for indicators such as C-reactive protein (CRP), rheumatoid factor (RF), anti-citrullinated protein antibodies, antinuclear antibodies, or an elevated erythrocyte sedimentation rate (ESR).

CT or MRI images may be requested to examine bone involvement, bone erosion, or spinal stenosis. These types of scans can help determine whether your bones have shifted (called atlantoaxial subluxation or odontoid migration), or if your joints or bones have odd tissue growth projecting from them, as occurs in odontoid pannus. “Pannus” refers to tissue growth that coats a normal body structure. In RA, any kind of rheumatoid pannus tissue damages the joint it cloaks, releasing enzymes that degrade cartilage, discharge acids and proteins that damage bone, and produces excess fluid that contributes to joint pain and swelling. Pannus in the cervical spine can also destruct the neck’s transverse, apical, and alar ligaments.


If your doctor suspects meningitis, you may be asked to perform a quick test that involves lying down facing upward, with one knee flexed at a 90-degree angle. If the doctor is unable to straighten your leg due to tight, painful hamstrings, it could be considered a positive Kernig’s sign. Herpes simplex and varicella zoster are two viruses known to cause meningitis.

To test for the Brudzinski neck sign, you may be asked to lie on your back, while your doctor bends your head forward while holding your chest down. If meningitis is present, patients typically involuntarily jerk their knees up toward their chest as the resulting flexed hip position relieves pain.

While the lack of either sign does not rule out meningitis, the presence of both signs is a good indication of inflamed meninges. To confirm a diagnosis, your doctor may request a test called a lumbar puncture to collect cerebral spinal fluid samples, which are then sent to a lab to determine which bacteria or virus may be responsible for the inflammation of the meninges.


If you find a lump in your neck that your doctor suspects might be cancer, different blood tests and imaging exams may be requested. In addition, you may need to undergo a biopsy to confirm such a diagnosis.

In the case of a swollen neck lymph node due to cancer of an unknown origin, especially for patients who are human papilloma virus (HPV) positive, surgery may be done to gather tissue samples around the oropharynx, as small primary tumors less than 1 cm in diameter can hide in this area.

Cervical Myelopathy

Symptoms for cervical myelopathy may creep up slowly; it is not until 30%of the spinal cord is compressed that you may notice severe symptoms, according to the Columbia University Department of Neurological Surgery.

However, trouble buttoning a shirt, weak grip, changes in handwriting, or increased use of a cane or handrails may be early signs of nerve problems in the neck. Neck pain/stiffness or shooting, electrical pain down legs and arms can also occur. Bladder or bowel incontinence, loss of sensation or function of an arm or leg, or weak muscle tone in the legs are other common symptoms.

Your doctor may ask you to do a few reflex tests to assist with diagnosis, including:

  • Patellar reflex: a deep tendon reflex of the knee
  • Clonus: an ankle extension in which the foot is moved up and down repeatedly
  • Babinski reflex: a scratching of the foot’s sole to see if the big toe moves up instead of down
  • Hoffman reflex: a flicking of the middle finger, which causes the thumb and index finger to flex.

Other diagnostic tests can include MRIs, CT scans with myelograms, neck flexion, and X-rays or bone scans. A 2019 study by Nukala showed that diffusion tensor imaging helps to recognize spondylotic myelopathy changes in the early stages. Electrical studies, like the somatosensory evoked potential (SEP) test, stimulates the arms and legs, timing the arrival of the signal to the brain; a delay of which can indicate a compromise of the spinal cord.

Overall, diagnosing neck pain can be tricky, but with the proper medical exams and tests, your doctor can narrow down the cause of your pain to make an accurate diagnosis.

Updated on: 05/03/19
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