Signs and Symptoms
Neck pain can show up in several ways:
- Aching or stiffness that limits turning or tilting your head
- Pain that spreads to the shoulders or between the shoulder blades
- Headaches that start at the base of the skull
- Pain, numbness or tingling running into the arm or hand, which suggests an irritated nerve root (cervical radiculopathy)
- Weak grip, clumsy hands or trouble with balance, which can signal pressure on the spinal cord and needs prompt evaluation
What Causes It?
Common causes include muscle strain from posture, screen use or sleeping position; arthritis of the facet joints and discs (cervical spondylosis); a herniated disc; cervical spinal stenosis; and whiplash or other injuries. Stress and long hours at a desk often make muscle tension worse.
How We Diagnose It at POPB
Dr. Baskin asks when the pain started, what makes it better or worse, and whether you have arm symptoms. He checks neck motion, posture, and the strength, reflexes and sensation in your arms. X-rays and MRI are available in our office when imaging will help, such as for arm symptoms, weakness or pain that is not improving.
When a specific facet joint seems to be the source, a fluoroscopy-guided diagnostic block can help confirm it.
Non-Surgical Treatment Options
Most neck pain improves with non-surgical care, which may include:
- Physical therapy in our office, with manual therapy, posture training and neck and upper back strengthening. Our therapists share your chart with Dr. Baskin.
- Adjusting your workstation, screen height and sleep setup
- Heat, gentle stretching and short courses of medication when appropriate
- Cervical transforaminal epidural steroid injections for arm pain from an irritated nerve, performed by Dr. Baskin under fluoroscopy in our in-office procedure room
- Facet joint injections and radiofrequency ablation for pain from arthritic neck joints
Surgical Options
Surgery is uncommon for neck pain. It may be considered for spinal cord compression, progressive arm weakness, or severe arm pain that does not respond to non-surgical care. Dr. Baskin does not perform spine surgery; when a surgical opinion is appropriate, he refers you to a spine surgeon and shares your records and imaging.
Recovery
Neck strains often improve within a few days to a few weeks. Pain from a pinched nerve may take six to twelve weeks or longer to settle. Relief after an injection usually starts within several days, and how long it lasts varies. Continuing your home exercises helps reduce flare-ups. Recovery varies by cause and by person.
Insurance and Cost
Office visits, imaging, physical therapy and cervical spine injections are generally covered by Medicare and most commercial PPO plans when medically necessary. Prior authorization is often needed for MRI and injections. HMO and managed-care plans require a referral in our office before your visit. If your neck pain followed a work injury, we accept workers' compensation and coordinate documentation with your employer and carrier.
When to Be Seen
Call our office if neck pain lasts more than a couple of weeks, keeps returning, or comes with arm pain, numbness or tingling.
Go to the emergency room or call 911 for neck pain after a major trauma such as a car crash or fall, loss of bladder or bowel control, sudden or worsening weakness in the arms or legs, trouble walking, or fever with a stiff, painful neck.
