Neck Pain

PLEASE NOTE FOR MOST MSK PATHWAYS –

DO NOT ORDER MSK MRIs FROM PRIMARY CARE.
UNLESS THE PATIENT HAS A RED FLAG MOST MSK PATHWAYS REQUIRE A PERIOD OF CONSERVATIVE MANAGEMENT AND REFERRAL ONLY ON NON-RESOLUTION ONTO TO PHYSIO OR MSK TRIAGE SERVICES (SEE DETAIL FOR EACH PATHWAY ATTACHED).
PLEASE NOTE MSK TRIAGE SERVICES CAN ORDER MRIs AND OTHER DIAGNOSTICS

ONLY REFER DIRECT TO SECONDARY CARE IF RED FLAGS OR PRIOR APPROVAL HAS BEEN OBTAINED

NECK PAIN

Assess for red flags including pain, myelopathy (compression of the spinal cord, malignancy, inflammation or infection, trauma or skeletal injury, vascular conditions, weakness or loss of sensation involving more than one myotome or dermatome or significant intractable or increasing pain (use clinical judgement) - refer urgently to appropriate specialist if present.
Neck examination should include neurological examination.
If vertebro-basilar symptoms/suspicion of vertebro-basilar insufficiency - refer to neurology.
Consider common causes of neck pain- whiplash/ acute torticollis/ cervical radiculopathy/ non-specific neck pain.
Whiplash injury

Check for red flags - if fracture or subluxation of cervical vertebrae is suspected refer immediately to A&E. Urgent x-ray is recommended in some patients (see pathway).
Initial management is self-care/ pain relief.
Consider physiotherapy/ home exercise if persists after 2-4 weeks.
If persists after 6 months the patient should be managed in a holistic/ psychosocial manner.
Consider referral for persistent symptoms (6 months) to MSK triage for further assessment, investigations or MDT discussion/ pain management.
Non-specific neck pain

NB. X-ray is not routinely required.

Initial management should focus on self-management and return to normal lifestyle/ pain relief. Discourage use of cervical collars and advise on pillows.
If symptoms persist for 4-12 weeks consider referral to physiotherapy. Address any psychosocial factors. Consider occupational health if related to work.
If treatment persist beyond 12 weeks refer to MSK triage.
Acute torticollis

Advise patient this is likely to resolve quickly. Self-management with gentle exercise/ pain relief.
Cervical Radiculopathy

NB. Radiology is not routinely indicated before 4-6 weeks.

Assess for neurological features (see pathway).
Most patients with Cervical Radiculopathy from degenerative disorders will have self-limiting disease that will resolve spontaneously.
Pharmacological treatment should be in accordance with Neuropathic Pain pathway.
If neurological signs refer immediately to MSK triage for further investigations.
Without neurological signs- provide reassurance and information. If pain persists for 6 weeks or longer refer to MSK triage for further investigations.