Differential diagnosis of neck pain is complicated not only by the number of possible causes but also by the fact that many patients suffer from two or more conditions at the same time. In most cases, the physician will begin by trying to determine whether the neck pain is caused by a primary disorder in the neck and shoulder region itself, or whether the pain is the result of a systemic disease that is affecting the neck.
The taking of a careful patient history is particularly important in cases of neck pain because of the number of possible causes. A thorough history will include questions about the patient's occupation and sports or hobbies as well as medical history.
The physician will begin by touching, or palpating, the patient's neck and shoulder girdle. Because the underlying bones and muscles in the neck are close to the surface, an experienced examiner can feel swollen glands, tumorous swellings, muscle spasms, or abnormal protrusions between the vertebrae. The doctor will then turn the patient's head gently from side to side to determine the neck's range of motion and whether or not the pain is worsened by movement. Examination of the inside of the patient's mouth and throat allows the doctor to check the salivary glands, which are swollen and inflamed if the patient has mumps.
Rebecca J. Frey PhD, The Gale Group Inc., Gale, Detroit,