Neck and back

• Neck pain ddx:

  • Torticollis (muscle spasm)
  • Arthritis - non-inflammatory e.g. osteoarthritis, inflammatory e.g. RA and SpAs
  • Cervical disc pathology e.g. prolapse or discitis
  • Malignancy e.g. myeloma
  • PMR (shoulders, neck and hips)
  • Referred pain from:
  • Local structures - thyroiditis, cervical lymphadenopathy
  • Distant structures - ischaemic heart disease
• Back pain ddx:

  • Non specific LBP - sprains and strains
  • Arthritis - non-inflammatory and inflammatory
  • Bony changes - spinal stenosis and spondylolisthesis, either due to OA degeneration (spondylosis) or trauma e.g. vertebral crush fracture secondary to OA
  • Infection e.g. osteomyelitis, epidural abscess
  • Scoliosis
  • Disc pathology - prolapse and discitis
  • Sacroiliitis e.g. ankylosing spondylitis
  • PMR
  • Malignancy - myeloma, metastatic spread
  • Referred pain from abdominal cause
• Symptoms of damage to spinal cord = myelopathy
• Symptoms of damage to nerve roots = radiculopathy
• Duration of lower back pain:

  • Acute = less than 3 months
  • Chronic = more than 3 months
• A late sign of spinal cord compression causing myelopathy is bladder and bowel dysfunction, whereas this will occur quicker in cauda equina syndrome