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We have all heard of the courtiers who mimicked the wry neck of Alexander the Great.


Neck pain is a very common symptom in both sexes at all ages and although most pain is experienced in the posterior aspect of the neck, anterior neck pain can occur from causes that overlap between front and back. The main cause of neck pain is a disorder of the cervical spine, which usually manifests as neck pain but can refer pain to the head, shoulders and chest. Such pain usually originates from the facet (apophyseal) joints but can arise from other musculoskeletal structures, such as the intervertebral discs and the muscles or ligaments (see FIG. 51.1). The other major symptom is limited movement or stiffness.


Transverse section illustrating the functional unit and nervous network of the cervical spine

General causes of neck pain are presented in TABLE 51.1.

Table 51.1Causes of neck pain (a pathological classification)

Key facts and checkpoints

  • According to an Australian study, about 18% of people wake with some degree of neck pain and 4% experience neck pain or stiffness for all of the day.1

  • The commonest cause of neck pain is idiopathic dysfunction of the facet joints, also called ‘non-specific’, without a history of injury, with a prevalence peak at 45 years.

  • Disorders of the intervertebral discs are common, especially in the lower cervical spine, and may cause unilateral pain, paraesthesia or anaesthesia in the arm.

  • In a UK study, radiological cervical disc degeneration was present in 40% of males and 28% of females between 55 and 64 years.2

  • Strains, sprains and fractures of the facet joints, especially after a ‘whiplash’ injury, are difficult to detect and are often overlooked as a cause of persistent neck pain.

  • Cervical spondylosis is a disorder of ageing: radiological signs occur in 50% of people over the age of 50 and in 75% over the age of 65 years.3

  • In cervical spondylosis, osteophytic projections may produce nerve root and spinal cord compression, resulting in radiculopathy and myelopathy respectively.

  • Radiculopathy can be caused by a soft ...

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