Clinical Practice Guidelines Neck Pain: Revision 2017

Summery of neck examination

1.Excluding red flags and differential diagnosis: Clinicians should perform assessments and identify clinical findings in patients with neck pain to determine the potential for the presence of serious pathology (e.g., infection, cancer, cardiac involvement, arterial insufficiency, upper cervical ligamentous insufficiency, unexplained cranial nerve dysfunction or fracture), and refer for consultation as indicated. 2. IMAGING : Clinicians should utilize existing guidelines and appropriateness criteria in clinical decision making regarding referral or consultation for imaging studies for traumatic and non-traumatic neck pain in the acute and chronic stages. 3. OUTCOME MEASURES: Clinicians should use validated self-report questionnaires for patients with neck pain, to identify a patient’s baseline status and to monitor changes relative to pain, function, disability, and psychosocial functioning. 4. ACTIVITY LIMITATIONS AND PARTICIPATION MEASURES: Clinicians should utilize easily reproducible activity limitation and participation restriction measures associated with the patient’s neck pain to assess the changes in the patient’s level of function over the episode of care. 5. PHYSICAL IMPAIRMENT MEASURES: When evaluating a patient with neck pain over an episode of care, clinicians should include assessments of impairments of body function that can establish baselines, monitor changes over time, and be helpful in clinical decision making to rule in or rule out (1) neck pain with mobility deficits, including cervical active range of motion (ROM), the cervical flexion-rotation test, and cervical and thoracic segmental mobility tests; (2) neck pain with headache, including cervical active ROM, the cervical flexion-rotation test, and upper cervical segmental mobility testing; (3) neck pain with radiating pain, including neurodynamic testing, Spurling’s test, the distraction test, and the Valsalva test; and (4) neck pain with movement coordination impairments, including cranial cervical flexion and neck flexor muscle endurance tests. Clinicians should include algometric assessment of pressure pain threshold for classifying pain.

6. DIAGNOSIS/CLASSIFICATION : Clinicians should use motion limitations in the cervical and upper thoracic regions, presence of cervicogenic headache, history of trauma, and referred or radiating pain into an upper extremity as useful clinical findings for classifying a patient with neck pain into the following categories: • Neck pain with mobility deficits • Neck pain with movement coordination impairments (including whiplash-associated disorder [WAD]) • Neck pain with headaches (cervicogenic headache) • Neck pain with radiating pain (radicular)

Read details of the guidelines: https://www. jospt.org/doi/full/10.2519/jospt.2017.0302