MEDizzy - You are caring for a 61-year-old man complaining of neck

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Acute Complaints

You are caring for a 61-year-old man complaining of neck pain for several weeks. He denies injury or illness. The pain is aggravated by movement, worse after activities, and there is a dull ache in the interscapular region. His examination reveals a limited range of motion, no tenderness to palpation, no radiation, and no neurologic signs. Which of the following is the most likely diagnosis?

ExplanationNeck pain is commonly seen in family medicine. In fact, the lifetime prevalence of at least one episode of neck pain in the adult population is estimated to be between 40% and 70%. Pain aggravated by movement, worse after activities, associated with a dull ache and with limited range of motion is consistent with spondylosis or osteoarthritis. If the pain were due to chronic mechanical problems, there would be tenderness to palpation on examination. If cervical nerve root irritation were the diagnosis, there would be radiation of symptoms, weakness, numbness, or paresthesias. With a whiplash injury, one would expect a history of an acceleration injury. And, with cervical dystonia (torticollis), the neck would be laterally flexed and rotated.