Neck Pain Diagnosis

Finding the Cause of Your Neck Pain

Finding the cause of neck pain begins with a complete history and physical examination. After the history and physical exam, your doctor will have a good idea of the cause of your pain. To make sure of the exact cause of your neck pain, your doctor can use several diagnostic tests. These tests are used to find the cause of your pain, not to make your pain better. Regular X-rays taken in the doctor's office are usually a first step in looking into any neck problem and will help determine if more tests are needed.

Complete History
A "complete history" is usually made up of two parts. The first part is written; a form that you fill out while you wait to see the doctor. While you fill out the form, take time to think about everything you can remember that relates to your neck pain and write it down. The more you can tell your doctor, the faster he or she can diagnose the cause and help relieve your pain. The second part of your history will be answering questions. Your doctor will ask you to describe when your neck pain began and the type of pain you are having.

Examples of questions that might be asked include:

• When did the pain first begin?
• Have you increased your activity level?
• Have you had an injury, or surgery, to your neck at any time?
• Does the pain go down into your arms or legs?
• What causes your neck to hurt more or less?
• Have you had any problems with your bowels or bladder?
Physical Examination
Once most of the information is gathered, your doctor will give you a thorough physical exam. During the exam, your doctor will look at your neck to find out how well it is functioning. This includes:
• How well you can bend your neck and roll your head in all directions
• How well you can twist your neck
• If there is tenderness around the neck
• If there are muscle spasms around the neck and shoulders
Tests that examine the nerves that leave the spine are also important. These include:
Testing for numbness in the arms and hands
Testing the reflexes
Testing the strength of the muscles in the arms, hands, and legs
Testing for signs of nerve irritation
X-rays show the bones of the cervical spine. Most of the soft tissue structures of the spine, such as the nerves, discs, and muscles, do not show up on X-ray. X-rays can show problems that affect the bones, such as infection, fractures, or tumors of the bones. X-rays may also give some idea of how much degeneration has occurred in the spine. X-rays alone will not show a herniated disc. Also, narrowing of the disc space between each vertebra and bone spurs do show up on X-rays. The X-rays will be useful in showing how much degeneration and arthritis are affecting the neck.  
Neck Pain Diagnosis
Magnetic Resonance Imaging (MRI)
The MRI is the most commonly used test to evaluate the spine because it can show abnormal areas of the soft tissues around the spine. The MRI is better than an X-ray because in addition to the bones, it can also show pictures of the nerves and discs. The MRI is done to find tumors, herniated discs, or other soft-tissue disorders. The MRI is painless and lasts about 90 minutes. During the MRI, very detailed computer images of sections of the spine are taken. Unlike most other tests, which use X-rays, the MRI uses magnetic fields and radio waves to see the structures of the neck. Pictures can also be taken in a cross-section view. The MRI allows the doctor to clearly see the nerves and discs without using special dyes or needles. In many cases, the MRI scan is the only special test that needs to be done to find the cause of your neck pain.
Neck Pain Scan
MRI Scan Cervical Stenosis

Computer Assisted Tomography (CAT Scan)
The CAT scan is a very detailed X-ray, and is very similar to the MRI. During a CAT scan, cross-section X-rays, or X-ray "slices", are taken of the spine. The CAT scan shows the bones of the spine much better than the MRI; however, the MRI is better than the CAT scan for showing soft tissues. The CAT scan is most useful when your doctor suspects a condition that only affects the bones of the spine. The CAT scan is commonly combined with a myelogram to get a better picture of the spinal nerves. Together, these two tests can help determine if the pressure on the nerve is from spinal stenosis or a herniated disc.
Neck Pain Cat scan
CAT Scan Cervical Stenosis

The CAT scan is done much like the MRI; you are on a table that slides into the scanner, while you lie very still. The CAT scan lasts about 30 to 60 minutes. If dye is used, you will have restrictions on what you can eat or drink before the test. After pictures have been taken without dye, you will be removed from the scanner and dye will be injected. Then, you will be moved back into the scanner and more pictures will be taken.
Myelography (Myelogram)
Myelography is used to evaluate an area of the spine called the subarachnoid space. Myelography is used to find herniated discs, injury to the spinal nerve roots, or tumors. During this test, a special dye, which can be seen on the X-ray, is injected into the spinal sac. Because the dye weighs more than spinal fluid, the movement of the dye can be watched as the table is tilted up and down. By watching the movement of the dye, the doctor can see the outline of the subarahcnoid space. If the shape of the spinal sac looks abnormal, or indented, this may mean there is pressure on the nerves of the spine. A herniated disc may cause this pressure.
Neck Pain-Myelogram Cervical Stenosis
Myelogram Cervical Stenosis

You will have restrictions on your diet for several hours before the test. The test begins with the doctor inserting a needle between two discs in your back. This is done while you lie on the edge of the table with your chin on your chest and your knees drawn up toward your chest. Once the needle is in place, you will turn over and lie flat on your stomach. Then the nurse will strap you to the table for your protection. The doctor will inject dye through the needle in your back. You may notice a brief burning feeling as the dye is injected. After the dye is injected, you may feel warm or flushed. The table will be tilted. As the table tilts, the dye will flow through the spinal area. The doctor will watch the flow of the dye and take X-rays. After X-rays have been taken, the needle will be removed and you will rest in the hospital for several hours or maybe overnight.
Electromyogram (EMG)
An EMG tests the speed at which the nerve roots send electrical messages to the brain. The test is done by inserting tiny needle electrodes into the muscles of the lower leg. The EMG measures the electrical signals in the muscles. The EMG can show if a nerve is being pinched after it branches from the spine.
neck Pain- EMG test
Before the test, you may have some restrictions on what you eat or drink, including certain medications. You will need to sign a consent form. During the test, you will lie down or sit so that the muscles being tested are at rest. Then a needle electrode is inserted into the muscle; you may feel some discomfort. A metal plate that records the electrical signal is placed under you. Abnormal electrical activity can mean that the nerve is being pinched. The test lasts about an hour.

Bone Scan
A bone scan is used to help locate the affected area of the spine. In order to perform a bone scan, a radioactive chemical is injected into the bloodstream. The radioactive chemical attaches itself to areas of bone that are undergoing rapid changes for any reason. Areas of the skeleton that are undergoing rapid changes appear as dark areas on the film. Once the affected area is identified, other tests, such as the MRI scan are done to look more closely at the specific area.

Laboratory Tests
There are many possible causes of neck pain. Some of these causes are not related to degeneration of the spine. Blood tests to look for infection or arthritis may be necessary. Problems originating in areas other than the spine may also cause neck pain. If your doctor feels that you may have a throat problem or a thyroid problem, other tests may be ordered to make sure the problem is not coming from these areas.


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