Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.
METHODS
Best evidence synthesis.


OBJECTIVE
To critically appraise and synthesize the literature on assessment of neck pain.


BACKGROUND
The published literature on assessment of neck pain is large and of variable quality. There have been no prior systematic reviews of this literature.


METHODS
The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders conducted a critical review of the literature (published 1980-2006) on assessment tools and screening protocols for traumatic and nontraumatic neck pain.


RESULTS
We found 359 articles on assessment of neck pain. After critical review, 95 (35%) were judged scientifically admissible. Screening protocols have high predictive values to detect cervical spine fracture in alert, low-risk patients seeking emergency care after blunt neck trauma. Computerized tomography (CT) scans had better validity (in adults and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high positive predictive value. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure. No evidence supports using cervical provocative discography, anesthetic facet, or medial branch blocks in evaluating neck pain. Reliable and valid self-report questionnaires are useful in assessing pain, function, disability, and psychosocial status in individuals with neck pain.


CONCLUSIONS
The scientific evidence supports screening protocols in emergency care for low-risk patients; and CT-scans for high-risk patients with blunt trauma to the neck. In nonemergency neck pain without radiculopathy, the validity of most commonly used objective tests is lacking. There is support for subjective self-report assessment in monitoring patients' course, response to treatment, and in clinical research.
Nordin
Margareta
M
Department of Orthopaedics, School of Medicine and Graduate School of Arts and Science, New York University, NY, USA. margareta.nordin@nyu.edu
Carragee
Eugene J
EJ
Hogg-Johnson
Sheilah
S
Weiner
Shira Schecter
SS
Hurwitz
Eric L
EL
Peloso
Paul M
PM
Guzman
Jaime
J
van der Velde
Gabrielle
G
Carroll
Linda J
LJ
Holm
Lena W
LW
Côté
Pierre
P
Cassidy
J David
JD
Haldeman
Scott
S
D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000592:standards / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data; D019838:Neck Injuries / Q000175:diagnosis* / Q000503:physiopathology; D019547:Neck Pain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D009460:Neurologic Examination / Q000592:standards / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012647:Self-Assessment; D011795:Surveys and Questionnaires / Q000592:standards