History

HPI and context

Neck pain syndrome characterization

OPQRST

OPQRST framework

Associated symptoms

Associated symptoms cluster

Prior episodes and baseline

Baseline and recurrence

Special populations

Population modifiers

Alarm Features

Immediate escalation triggers

Immediate escalation criteria

High risk neurologic features

Neurologic red flags

Infection and malignancy features

Infection and malignancy red flags

Vascular and headache features

Vascular red flags

Vital sign danger thresholds

Concerning vital signs

Medications

Current therapies and recent changes

Medication exposure inventory

High risk medication classes

Medication risks relevant to neck pain workup

Contraindications and interaction traps

Common contraindications

Diet

Exposures that can amplify symptoms

Intake and exposure factors

Metabolic contributors

Review of Systems

Neurologic

Neurologic symptoms

Infectious and inflammatory

Inflammatory symptoms

ENT and airway

Upper aerodigestive symptoms

Cardiopulmonary

Cardiopulmonary symptoms

Musculoskeletal

Musculoskeletal symptoms

GI and GU

Autonomic and sphincter symptoms

Collateral History and Family History

Collateral and reliability

Collateral sources

Family history relevant to secondary causes

Family history screen

Household and exposure context

Exposure context

Risk Factors

Infection risk

Spinal infection risk factors

Vascular risk

Cervical artery dissection risk factors

Malignancy and fracture risk

Structural risk factors

Degenerative and occupational risk

Mechanical risk factors

Differential Diagnosis

Life threatening

Life threatening etiologies

Common

Common etiologies

Less common and zebras

Less common etiologies

Mimics and pitfalls

Past Medical History

Relevant chronic conditions

Chronic disease modifiers

Prior procedures and devices

Prior spine and invasive history

Baseline function

Baseline function and supports

Physical Exam

General and vitals

Overall appearance and stability

Neck and spine

Cervical spine exam

Neurologic

Neurologic exam

Meningeal and headache focused

Meningeal irritation screen

Vascular and cardiopulmonary

Vascular and heart exam

ENT and airway

ENT and airway assessment

Musculoskeletal adjacent joints

Shoulder and upper limb screen

Pitfalls

Pitfalls and subtle findings

Lab Studies

Infection and inflammation

Infection and inflammation labs

Metabolic and medication safety

Metabolic safety labs

Cardiac and vascular evaluation

Cardiac evaluation when referred pain concern

Pregnancy

Pregnancy testing when relevant

Imaging

Scoring Systems

Decision tools for imaging selection

MRI

MRI cervical spine

CT

CT based evaluation

Ultrasound

Ultrasound and POCUS roles

Special Tests

Bedside maneuvers for radicular patterns

Cervical radiculopathy exam maneuvers

Myelopathy screening maneuvers

Cervical myelopathy screening

Meningitis and deep infection evaluation

CNS infection evaluation elements

Do not do items

Avoid potentially harmful bedside tests

ECG

Indications in atraumatic neck pain

ECG indications

High risk ECG findings

High risk patterns

Rhythm and conduction

Rhythm evaluation

Serial ECG logic

Serial ECG timing

Assessment

Problem representation

Clinical syndrome framing

Working diagnosis examples with codes

Working diagnosis candidates

Severity and risk stratification

High risk categorization

Diagnostic uncertainty

Alternate diagnosis tracking

Plan

First 5 minutes workflow for critical patient

Immediate stabilization and triage

Analgesia and symptom control

Multimodal analgesia options

Targeted diagnostics and sequencing

Diagnostic sequencing

Antibiotics and sepsis pathway when indicated

Suspected spinal epidural abscess or vertebral osteomyelitis pathway

Monitoring and reassessment loop

Reassessment loop

Consultations

Consultation triggers

Disposition

ICU and high acuity criteria

ICU level care criteria

Inpatient admission criteria

Admission criteria

Observation pathway criteria

Observation appropriate when

Discharge criteria and follow up

Discharge criteria

Follow up timing

Discharge Instructions

Copy discharge instructions

Neck pain today appears most consistent with a non dangerous mechanical cause based on your exam and testing

Pain control options at home

Activity

Follow up

References

Guidelines and key evidence

Neck Pain Clinical Practice Guidelines Revision 2017 Journal of Orthopaedic and Sports Physical Therapy 2017

NICE Clinical Knowledge Summaries Neck pain cervical radiculopathy updated regularly

IDSA Clinical Practice Guidelines for Native Vertebral Osteomyelitis in Adults 2015

ACEP Clinical Policy Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache 2019

AHA Scientific Statement Treatment and Outcomes of Cervical Artery Dissection in Adults 2024

NEXUS Low Risk Criteria validation study New England Journal of Medicine 2000