Diagnosing Neck Pain

NYU Langone orthopedic specialists are experts at determining the cause of neck pain. The spine is composed of a stack of bones called vertebrae. The neck, or cervical spine, consists of the top seven vertebrae; the joints that connect them; and the ligaments and muscles that support the head and permit movement.

In between each of the vertebrae is a soft cartilage layer called a disc. The discs act as cushions, absorbing the force put on the spine during movement and allowing the spine to move flexibly.

Of the many possible causes for neck pain, the most common are muscle strain, trauma, a pinched nerve, or disc problems, such as degenerative disc disease, a herniated disc, or cervical spinal stenosis.

In the neck, nerve roots and the spinal cord pass through a “tunnel” in the vertebrae called the spinal canal. When bones and tissues, such as cartilage, muscles, or tendons, apply too much pressure to a nearby nerve, its function is disrupted, causing pain, tingling, or numbness. A herniated disc—a disc that has slipped out of place—in your cervical spine, for example, may put pressure on a nerve root, causing pain that radiates down your arm.

As a person ages, the spine degenerates, causing the spinal canal to become narrower. These changes most frequently affect the vertebrae and the joints, also called the facet joints, and the discs that lie between them.

Over time, discs can slowly lose their cushion-like qualities, causing bones to rub against one another, a condition known as osteoarthritis. The progressive wear and tear of osteoarthritis of the spine further reduces the protective lining between bones. When vertebrae rub together, small, hard growths called bone spurs, or osteophytes, may develop and push into the spinal canal, constricting nerve roots or the spinal cord. This friction may irritate nearby ligaments, causing them to swell and put pressure on the spinal cord or nerve roots. This can cause pain in the neck and arms.

If the disc or joints degenerate to such an extent that they can no longer provide stability to the vertebrae they support, a vertebra may slip out of place and move forward toward the spinal canal. This condition, called spondylolisthesis, causes neck pain if a vertebra slips too far forward and puts pressure on the spinal cord or nerve roots.

A compression fracture in the spine may also cause neck pain. This type of fracture may develop following trauma. Osteoporotic compression fractures are more common in the thoracic spine. A compression fracture in the spine typically occurs in the front part of a vertebra. In a burst compression fracture, a piece of the broken vertebra may push into the spinal canal, constricting nerve roots or the spinal cord.

To determine the cause of your neck pain, spine specialists at NYU Langone perform a complete examination of your spine and ask you to describe any pain. In addition, your doctor may recommend diagnostic tests to gather more detailed information about the condition of the nerves, vertebrae, and discs in the cervical spine.

Medical History

Your doctor takes a medical history and asks you about your pain. He or she might ask when you first noticed the pain, where in the neck you feel it, how long you have been experiencing it, and what time of day it is strongest.

The doctor also wants to know whether you feel any tingling or numbness in the arms, how much the pain interferes with your activities, what medications you take, and whether other medical conditions may be affecting your spinal health. For example, a previous neck or back injury may contribute to degenerative disc disease, leading to neck pain.

Physical Exam

A doctor examines your spine for signs of disc disease or a slipped disc, including pain or tenderness in the cervical spine, and evaluates the flexibility and range of motion of the spine. The doctor may ask you to move your head to assess what motions produce pain and whether the pain significantly affects movement.

Neurological Examination

A doctor performs a neurological examination to detect weakness in the arms and legs, as well as any loss of sensation. During the exam, the doctor also looks for evidence of spinal cord compression and walking or gait difficulty.

X-rays

X-rays use electromagnetic radiation to create pictures of the inside of the body. X-rays of the spine can reveal cartilage loss, bone spurs, fractures, or a vertebra that has slipped out of place.

CT Scans

A CT scan uses X-rays and a computer to create three-dimensional, cross-sectional images of your tissues and internal organs. It may reveal structural changes in the spine in more detail than a standard X-ray and can help your doctor determine if you need surgery to eliminate your pain.

MRI Scans

MRI scans use a magnetic field to create computerized, three-dimensional images of soft tissues inside the body. These include cartilage, nerves, and discs. Doctors examine MRI scans for evidence of disc damage that may not appear on an X-ray and determine if a tumor or nerves pinched between bones could be causing your pain.