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Description of the Symptom

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This chapter describes pathology that may lead to neck pain. Local causes of neck pain are defined as pathology occurring within the vertebral column from the occipital condyle to the seventh cervical vertebra, along with associated joint and soft tissue structures. Remote causes are defined as occurring outside this region. The chapter is divided between anterior and posterior/posterolateral neck pain.

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Special Concerns

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  • Ataxia or other gait disturbances

  • Clonus, positive Hoffman's and Babinski tests, or hyperreflexia

  • Drop attacks

  • Facial paresthesias or muscle paresis

  • Horner's sign (ptosis, enophthalmos, anhidrosis, miosis, and facial flushing)

  • Pain and stiffness associated with fever or recent illness

  • Positive alar ligament test, Sharp-Purser test

  • Radicular symptoms into bilateral upper extremities accompanied by lower extremity symptoms (eg, bilateral or quadrilateral paresthesias)

  • Signs and symptoms of vertebral artery insufficiency including dizziness, dysphagia, dysarthria, dystonia, and disorientation

  • Signs of upper cervical instability (eg, unwillingness to actively move head and neck, reports of dizziness, nausea, or paresthesias with neck flexion)

  • Syncope

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CHAPTER PREVIEW: Conditions That May Lead to Neck Pain

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