Neck pain can be described as ache, dull, sharp, stabbing, burning, throbbing or present with numbness and tingling.  Headaches commonly accompany neck pain.  But at what point do we need to start becoming concerned with these symptoms as all of these descriptive terms can be used to describe very common neck injuries? 

In our last article, I discussed the common causes of neck pain.  Here we will discuss some of the uncommon causes of neck pain.  I do emphasize uncommon, but they are conditions that occur.  My number one concern as a chiropractor, a doctor trained to treat neck injuries, is to make sure that the patient is safe to be treated.  If I don’t feel that it is safe to treat someone, I won’t recommend chiropractic care but will refer the patient to the appropriate professional.  

The following is a list of uncommon sources of neck pain but are referred to as Red Flags to healthcare providers as these are symptoms that make us STOP and get the patient to either the emergency room or on to further medical assessment and imaging.  A detailed history from the patient may help cross some of these off of our list of possibilities. 

1.  Infection: discitis, epidural abscess, osteomyelitis, meningitis or other infection that has gone septic.

If there is a fever, an infection is likely.  The infection may be local or if it has spread to multiple sites or in the blood, it can become septic.  This patient needs help to fight the infection and should be sent to the hospital.  This may result in neck pain and or headache depending on the structures infected.  

2.  Inflammatory conditions:  examples are rheumatoid arthritis, ankylosing spondylitis, polymyalgia rheumatica.  

Some inflammatory conditions can destroy ligaments leading to instability or excessive motion, causing further damage to other structures in the neck.  Ankylosing spondylitis is a condition where the ligaments in the spine turn to bone.  A sudden, sharp pain in the neck of someone with ankylosing spondylitis, in particular after trauma, could be from tiny fractures to these newly formed bony ligaments. 

3.  Malignancy:  Chordoma, metastasis, multiple myeloma, spinal cord tumor are some examples.  

A history of cancer and tenderness over the bony structures of the neck needs to be evaluated urgently.  Other signs and symptoms of malignancy would include fever, sudden weight-loss and hard to control night pain. 

4.  Myelopathy:  ALS, cord compression, transverse myelitis.

These conditions involve some form of compression to the spinal cord due to a congenital anomaly, degeneration, inflammation or arthritis.  When there is compression of the spinal cord in the neck, there will be effects seen at every level below, which include changes in gait.  Patients may also have tremors, bowel or bladder issues and/or deep achy neck pain.    

5.  Thoracic outlet syndrome: vascular compression type.  

Thoracic outlet syndrome (TOS) involves the compression of nerves or vasculature as they leave the neck and pass under the collar bone.  Severe cases of TOS affect the blood flow to the arm.  When blood flow is restricted to the arms there will be a sensation of numbness and tingling, but also a change in colour to the skin.  As in any other part of the body, lack of blood flow, means lack of oxygen and a buildup of carbon dioxide in the muscles and structures of the arm.  This can cause damage to the tissues but also may cause blood to clot in the arm.  

6.  Vascular emergencies in the neck:  arterial dissection or vertebrobasilar insufficiency.

There are several arteries in the neck that may become damaged or diseased.  Patients may recall feeling a ripping or tearing sensation in the neck.  In addition, any visual changes, drop attacks (sudden falls or lack of muscle strength), syncope (passing out or fainting), TIAs, headaches or dizziness symptoms that occur with a new onset of neck pain are symptoms that need to be considered an emergency.  

These are all serious issues .  If you or someone you know are experiencing any of the above symptoms, in particular, those presented in 6. above, please stop and call 911.  Maybe your symptoms are not an emergency, but everything else on this list would be considered urgent and needs to be addressed very soon.  In this case, please visit your closest urgent care center or place a call or visit your family doctor indicating your symptoms.  

In addition to the above, please consider that not all serious neck symptoms start out with severe, debilitating pain.  Often, they will progress over time.  In my clinic, if I have treated you six times and there has been little change in your symptoms, then I will reassess to see if there are any changes from the initial exam.  The majority of patients I see respond to care to some degree within 4-6 treatments.  Many healthcare providers agree that if there is no significant improvement within 4-6 weeks, then further evaluation via imaging or other testing needs to be considered.  If this is your case and you have been receiving care, doing your homework and there has not been much change in your overall condition, then please ask for further testing.