Finding the Cause of Your Neck Pain

Complete History

A "complete history" is usually made up of two parts. The first part is written; a form that you fill out while you wait to see the doctor. While you fill out the form, take time to think about everything you can remember that relates to your neck pain and write it down. The more you can tell your doctor, the faster he or she can diagnose the cause and help relieve your pain. The second part of your history will be answering questions. Your doctor will ask you to describe when your neck pain began and the type of pain you are having.

Examples of questions that might be asked include

• When did the pain first begin?
• Have you increased your activity level?
• Have you had an injury, or surgery, to your neck at any time?
• Does the pain go down into your arms or legs?
• What causes your neck to hurt more or less?
• Have you had any problems with your bowels or bladder?

Physical Examination

Once most of the information is gathered, your doctor will give you a thorough physical exam. During the exam, your doctor will look at your neck to find out how well it is functioning. This includes

• How well you can bend your neck and roll your head in all directions
• How well you can twist your neck
• If there is tenderness around the neck
• If there are muscle spasms around the neck and shoulders

Tests that examine the nerves that leave the spine are also important. These include:

• Testing for numbness in the arms and hands
• Testing the reflexes
• Testing the strength of the muscles in the arms, hands, and legs
• Testing for signs of nerve irritation

X-rays

X-rays show the bones of the cervical spine. Most of the soft tissue structures of the spine, such as the nerves, discs, and muscles, do not show up on X-ray. X-rays can show problems that affect the bones, such as infection, fractures, or tumors of the bones. X-rays may also give some idea of how much degeneration has occurred in the spine. X-rays alone will not show a herniated disc. Also, narrowing of the disc space between each vertebra and bone spurs do show up on X-rays. The X-rays will be useful in showing how much degeneration and arthritis are affecting the neck

Magnetic Resonance Imaging (MRI)

The MRI is the most commonly used test to evaluate the spine because it can show abnormal areas of the soft tissues around the spine. The MRI is better than an X-ray because in addition to the bones, it can also show pictures of the nerves and discs. The MRI is done to find tumors, herniated discs, or other soft-tissue disorders. The MRI is painless and lasts about 90 minutes. During the MRI, very detailed computer images of sections of the spine are taken. Unlike most other tests, which use X-rays, the MRI uses magnetic fields and radio waves to see the structures of the neck. Pictures can also be taken in a cross-section view. The MRI allows the doctor to clearly see the nerves and discs without using special dyes or needles. In many cases, the MRI scan is the only special test that needs to be done to find the cause of your neck pain.

Computer Assisted Tomography (CAT Scan)

The CAT scan is a very detailed X-ray, and is very similar to the MRI. During a CAT scan, cross-section X-rays, or X-ray "slices", are taken of the spine. The CAT scan shows the bones of the spine much better than the MRI; however, the MRI is better than the CAT scan for showing soft tissues. The CAT scan is most useful when your doctor suspects a condition that only affects the bones of the spine. The CAT scan is commonly combined with a milligram to get a better picture of the spinal nerves. Together, these two tests can help determine if the pressure on the nerve is from spinal stenosis or a herniated disc.

Finding the cause of neck pain begins with a complete history and physical examination. After the history and physical exam, your doctor will have a good idea of the cause of your pain. To make sure of the exact cause of your neck pain, your doctor can use several diagnostic tests. These tests are used to find the cause of your pain, not to make your pain better. Regular X-rays taken in the doctor's office are usually a first step in looking into any neck problem and will help determine if more tests are needed.