Exams and Tests for Neck Pain
How the Cause of Neck Pain Is Diagnosed
Neck pain can be a symptom of an underlying cervical spine condition. You should get an accurate diagnosis of what's causing your pain. Your doctor will go through several exams and tests to help diagnose your neck pain.
During your visit, your doctor or spine specialist will ask you questions and perform some basic exams. This is to try to identify the cause of your neck pain and develop a treatment plan for you—a way to manage your pain and other symptoms and to help you recover.
Medical History Review
First, the doctor will ask about your current symptoms and remedies you have already tried. He or she will ask some typical questions, such as:
- When did the neck pain start?
- What activities did you recently do?
- What have you done for your neck pain?
- Does the pain radiate or travel to other parts of your body (eg, down your arm)?
- Does anything reduce the pain or make it worse?
Physical and Neurological Exams
Your spine specialist will also perform physical and neurological exams.
In the physical exam, your doctor will observe your posture, range of motion, and physical condition, noting any movement that causes you pain. Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasm. He or she will also check your shoulder area.
During the neurological exam, your spine specialist will test your reflexes, muscle strength, other nerve changes, and pain spread (eg, does the pain move down your arm and into your hand?)
Imaging Tests: X-rays, CTs, and MRIs
To diagnose the cause of your neck pain, you may need to have some imaging tests done.
You may have an x-ray, which can show narrowed disc space (spinal stenosis), fractures, bone spurs (osteophytes), or osteoarthritis.
A computerized tomography (CT) scan or a magnetic resonance imaging (MRI) test can show a bulging disc or a herniated disc.
You also may be asked to undergo additional tests.
- Bone scan: To help your doctor detect spinal problems such as osteoarthritis (spondylosis), spinal fractures, or infections, you may have a bone scan. You will have a very small amount of radioactive material injected into a blood vessel. That will travel through your blood stream and be absorbed by your bones. More radioactive material will be absorbed by an area where there is abnormal activity—like an inflammation. A scanner can detect the amount of radiation in all your bones and show the "hot spots" (the areas with more radioactive material) to help your doctor figure out where the problem is.
- Discogram: This is a procedure that confirms or denies the disc(s) as the source of your pain. You will have a harmless dye injected into one of your discs. If there's a problem with your disc—like it's herniated—the dye will leak out of the disc. The doctor will be able to see that on an x-ray, and that will show him/her that there's something wrong with your disc.
- Electromyograph (EMG): If it's possible you have nerve damage, you may need this special test to measure how quickly your nerves respond. Usually, this test isn't ordered right away because it may take several weeks before you notice that you're having nerve problems (such as abnormal reflexes or weakness).
- Myelogram: To see if you have a spinal canal or spinal cord disorder—perhaps nerve compression causing pain and weakness—you may have a myelogram. In this test, you'll have a special dye injected into the area around your spinal cord and nerves. (Before that happens, the area will be numbed.) Then you'll have an x-ray or a CT scan. The image will provide a detailed anatomic picture of your spine, especially of the bones, and the doctor will look at that to see if anything's pressing on your nerves.
Diagnosing neck pain can be tricky. Because there are many possible causes of neck pain, there may be overlapping symptoms with other conditions. Be a good patient—and be patient. Your spine specialist is trying to determine if your neck pain is serious and is also working to choose the best treatment for your cervical spine condition.