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Neck pain is a common complaint. The prevalance is approximately
75% to 80% in the U. S. population. The neck is
composed of many pain-sensitive tissues in a small area, including
tendons, ligaments, muscle insertions, vertabrae, zygopophyseal
joints, nerve roots, nerves, and plexi. The cervical spine is mobile
and situated between an immobile thorax and a relatively weighty
head; therefore, it is subject to varying degrees of trauma with
body movement. Neck pain ranges from minor self-limited aches to
severe pain associated with signs and symptoms of nerve root impingement.
Patients with minor neck pain may not consult a physician. Those
who see a primary care physician often can be helped by conservative
management. A patient with severe chronic symptoms may be best served
in a comprehensive pain management clinic. Treatment options can
range from the conservative (transcutaneous electrical nerve stimulation [TENS] unit, physical
therapy and stretching) to the interventional (facet joint injection
and cervical nerve root block). In all cases, a knowledge of the
anatomy and the etiology of neck pain is required for definitive
treatment.
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Ideally, the cause of a patient’s neck pain is determined
by a careful history, physical examination, appropriate radiologic
and laboratory tests, and diagnostic nerve blocks.1 It
is vital to be aware of the more serious disorders that can cause
neck pain and that require urgent referral to a specialist. Table
27-1 lists many causes of neck pain.
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