Neck stiffness/pain

Neck stiffness/pain

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Pain and stiffness in the neck can be caused by a number of factors, but mainly by inflammation, infection or trauma. Inflammation of the neck and spinal cord can be indicated by an inability to touch the chin to the chest.

Differential Diagnosis

In alphabetical order.

• Dystonic reaction
• Infection
• Inflammatory
• Trauma
• Torticollis
• Tumors

Diagnosis

• Physical examination

History and Symptoms

• Focus on evidence of trauma and infection.

Other

• Lumbar puncture for CSF analysis

Laboratory Findings

• Labs include

• BUN/Creatinine
• CBC
• Electrolytes
• Calcium
• Glucose
• ESR
• Blood cultures if infection is suspected

MRI and CT

• Head CT without contrast can indicate bleeding
• Neck CT can indicate soft tissue disease
• MRI for epidural hematoma / abscess

Other Imaging Findings

• Cervical spine radiographs if trauma or neck infection are indicated.

Treatment

• Trauma

• soft collar immobilization
• halo brace immobilization

Acute Pharmacotherapies

• Torticollis/soft tissue injuries

• NSAIDs
• Muscle relaxants

• Bacterial meningitis requires ceftriaxone & vancomycin
• Viral meningitis treated supportively requires NSAIDs and IV fluids
• Abscess requires drainage and antibiotics
• Inflammatory arthropathies

• NSAIDs
• Steroids
• Antirheumatic agents

Indications for Surgery

• Subarachnoid hemmorhage requires surgery

References

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