Chronic degenerative changes of cervical spine causing pain, stiffness, occasional radiculopathy/myelopathy.
History taking
- • Neck pain, stiffness, occipital headache; arm pain/paraesthesia (radiculopathy)
- • Gait disturbance, fine motor dysfunction, bladder symptoms (myelopathy)
- • Occupation, posture, trauma
Examination
- • Range of motion, paraspinal tenderness
- • Spurling test for radiculopathy; Hoffman, Babinski, hyperreflexia for myelopathy
- • Upper limb power, sensation, reflexes
Red flags
- • Myelopathy signs, severe trauma, unexplained weight loss, fever
Differential diagnosis
- • Cervical disc prolapse, rheumatoid, ankylosing spondylitis, malignancy, infection, fibromyalgia
Recommended investigations
- • Plain X-ray cervical spine
- • MRI if neurological deficit, refractory pain
Diagnosis
- • Clinical + imaging
Initial treatment / management
- • Postural correction, ergonomic advice, neck exercises
- • NSAIDs short course, physiotherapy
- • Soft cervical collar short-term only
Prescription examples
- • Tab Naproxen 500 mg PO BD x 7 d
- • Tab Tizanidine 2 mg PO TDS x 3 d
- • Physiotherapy referral
Follow-up advice
- • Review in 4 weeks
Patient counselling
- • Posture: avoid prolonged screen flexion, take breaks
- • Neck strengthening exercises
Referral criteria
- • Myelopathy, progressive radiculopathy
Clinical pearls
- • Hoffman's sign and hyperreflexia suggest myelopathy — urgent MRI
References
- • NASS Clinical Guidelines on Cervical Radiculopathy
Educational outpatient guide — verify against local guidelines before clinical use.
