Neck pain is a prevalent complaint and a frequent cause of disability. As if the pain wasn’t bad enough, it can also cause unnecessary worry.
If you're experiencing neck pain, you may be wondering (or anxious) about the tests your doctor may use to diagnose the cause of your pain. Well, we’ve got you covered. We’ll be taking a look at the physical examination, imaging, and laboratory tests frequently used by doctors to diagnose neck pain.
By understanding these tests, you'll be better prepared to work with your doctor to identify the cause of your pain. Are you ready? Then let’s dive in!
How Is Neck Pain Diagnosed?
Going to the doctor is stressful and can be a source of anxiety. The uncertainty of what the doctor will do or say is sometimes enough to trigger or worsen your neck pain.
But since you’re reading this, you can take a deep breath and relax as we’ll give you a quick run-through of what to expect during your visit to the doctor.
History
No, your doctor won’t surprise you with a pop quiz about historical figures and events, but they will ask you about your signs and symptoms. This will include questions about the following:
- The exact location of the neck pain
- When the neck pain started and its duration
- The characteristics and intensity of the neck pain
- Any illness, injuries, or activities that may have contributed to your neck pain.
Physical Examination
After giving your doctor detailed information about your neck pain, they will perform a full-body physical exam. The doctor will also take extra time to examine your neck, looking for signs of swelling, tenderness, weakness, or muscle spasms.
The doctor may also test your neck’s range of motion and ask you to perform special maneuvers or tests to see how your neck responds.
How Do Doctors Assess My Neck’s Range of Motion?
Your doctor can test your neck’s range of motion by asking you to perform some very simple movements. You may even be familiar with these movements already. Although they can measure the range of motion by eyeballing it, they may use special instruments to make it more accurate.
The following are the tests for your neck’s range of motion:
Cervical Flexion And Extension
- Your doctor will ask you to sit up straight on a chair with your back straight against the chair, arms at your side, and feet flat on the floor.
- For cervical flexion, your doctor will ask you to nod your head and bring your chin down towards your chest. Normal cervical flexion is usually 80°.
- For cervical extension, your doctor will ask you to look up at the ceiling as far as possible until your neck is fully extended. Normal cervical flexion is usually 50°.
- The total range of motion from full flexion and extension is 130°.
- Again, your doctor will ask you to sit up straight on a chair with your back straight against the chair, arms at your side, and feet flat on the floor. Make sure to look straight ahead.
- They will then ask you to tilt your head to the left. Imagine bringing your ear towards your shoulder without lifting your shoulder up.
- Then you will repeat the procedure on the right side.
- The normal range of motion for lateral flexion is 45° on each side.
- You guessed it. Your doctor will again ask you to sit up straight on a chair with your back straight against the chair, arms at your side, and feet flat on the floor.
- Then they will ask you to turn your head to the left as far as possible without tilting or tipping your head.
- Then repeat the procedure on the right side.
- The normal range of motion for cervical rotation is 80° on each side. Typically, your chin should end slightly in front of your shoulder.
What Are The Special Tests For Neck Pain?
Special or provocative tests are designed to replicate movements or positions that cause neck pain. These can help detect problems such as muscle strain or pinched nerves.
What Is The Spurling’s Test?
Spurling's test is a physical examination test used to determine if your neck pain is due to a pinched nerve (cervical radiculopathy). Although it’s specific to cervical radiculopathy, it does not always detect it.
How Is A Spurling’s Test Done?
Your doctor will perform the Spurling’s Test by extending or pulling back your head and bending it towards the side where you feel neck pain. The test is already considered positive if you experience pain, tingling, or muscle weakness.
If you don’t feel any pain during the initial step, your doctor will add pressure on top of your head (axial compression). If you feel any pain during this step, then the Spurling’s test is positive.
What Is The Distraction Test?
The distraction test can also detect pinched nerves (cervical radiculopathy). This is only done when you’re experiencing shooting pain or abnormal sensations down the arm.
How Is The Distraction Test Done?
You will be asked to lie down flat on an examining bench. Then the doctor will grasp your head with both of their hands and gently pull your head towards them. The test is positive if your symptoms are relieved.
What Is The Valsalva Test?
Like the Spurling’s test and distraction test, the Valsalva test can also detect cervical radiculopathy. It can also assess if your neck pain is caused by nerve damage. This maneuver can increase the pressure in your spine, which can worsen the symptoms of damaged or pinched nerves.
How Is The Valsalva Test Done?
The test is performed while you’re sitting, and you will be asked to take a deep breath and hold it while attempting to exhale for 2 to 3 seconds. When you exhale, gradually increase the force of exhalation. Just imagine you’re having a hard time in the toilet, or you can try blowing on the back of your hand.
The test is positive if you experience shooting pain down your arm or tingling sensations.
What Is The Cranial Cervical Flexion Test?
The cranial cervical flexion test (CCFT) assesses how well your nervous system can control your neck muscles. This includes how well it can activate your neck muscles and how much endurance your neck muscles have.
According to studies, people with neck pain may have impaired neck muscle activity. This means that the neck muscles may be less capable of handling heavy weights and tire out quickly.
How Is The Cranial Cervical Flexion Test Done?
During the CCFT, you will be asked to lie flat on an examining table with your head in a neutral position. The examiner may place towels under your head to achieve this position. Then the examiner will place a special device called the biofeedback unit (or a deflated blood pressure cuff) right below the base of your head.
Then the doctor will inflate the device to a pressure of 20 mmHg, and the test will proceed in two stages. First, you will be asked to perform a head nod until the pressure reading increases by 2 mmHg. You will hold this position for 2-3 seconds before returning to a relaxed position.
The doctor will look out for the following compensatory actions:
- Retraction or lifting of the head
- Activation of the front neck muscles early on during the activity
- Inability to relax in between attempts
If you can perform the first stage without using your other muscles to compensate, you will proceed to the second stage. In the same lying position, you will perform a head nod and hold it for 10 seconds. If you can perform this three times, you will continue to perform the head nod with increasing intensity.
Aside from the compensatory actions mentioned above, the doctor will look out for the following:
- Jerkiness during the hold
- Reduction in pressure
What Is The Neck Flexor Muscle Endurance Test?
The neck flexor muscle endurance test assesses how well your neck flexor muscles can endure prolonged activity. Your neck flexors are the muscles that allow you to bend your neck forward. They also allow you to rotate and tilt your head.
How Is The Neck Flexor Muscle Endurance Test Done?
You will be asked to lie down on an examining table with your knees bent. Then the doctor will ask you to retract or tuck your chin (imagine you’re sucking in your chin towards the back of your neck). Then you will lift your head and neck, with your chin still tucked in, until they are 1 inch above the table.
The doctor will keep track of how long you can hold this position. The doctor will stop the test if you can no longer maintain the chin tuck or lift your head and neck.
What Are The Diagnostic Tests Used To Diagnose Neck Pain?
Since a combination of multiple factors causes neck pain, it is usually hard to come up with a definite diagnosis from a detailed history and complete physical examination. Because of this, your doctor may suggest ancillary procedures. Ancillary procedures are diagnostic tests used to support a doctor’s diagnosis.
Blood Tests
Your doctor may request certain blood tests if they suspect that your neck pain is caused by an infection or an inflammatory condition like rheumatoid arthritis.
Usually, your doctor won’t order any more tests. However, if you had an accident or the pain persists, they will order imaging or nerve conduction tests to confirm their suspicion.
How Do Doctors Detect Nerve Damage In My Neck?
If some of the provocative tests were positive during your physical exam, your doctor might already suspect that you have nerve damage. However, they may need to confirm their suspicion with the following tests:
Imaging Tests
Depending on the suspected cause of your neck pain, the doctor may recommend imaging tests such as X-rays, CT scans, or MRIs. These tests will check for any damage in the bones of your neck, the discs of your spine, as well as the nerves and spinal cord.
These tests can also detect whether there are any tumors or other masses that are compressing your nerves.
Nerve Conduction Tests
Nerve conduction tests are a type of diagnostic test used to assess how well your nerves can send and receive signals. During a nerve conduction test, electrodes are placed on your skin over the nerve being tested. In this case, the electrode will be placed at the site of your neck pain.
The electrode will then send a small electrical impulse to your nerve, and it might cause you to jump in shock (pun obviously intended). This allows the machine to measure the speed and strength of your nerve’s response and help identify any nerve damage or compression.
Nerve conduction tests are often used with other tests, such as electromyography (EMG), to help diagnose neck pain.
Electromyography
Electromyography (EMG) is a diagnostic test that measures the electrical activity of your muscles. This will help identify problems with your neck muscles that may be causing pain or other symptoms.
During an EMG, a small needle is inserted into your neck muscles, and the resulting electrical activity is recorded on a computer. This helps your doctor identify problems such as muscle damage or muscle weakness.
Aside from nerve damage, your doctor will also order these tests if you exhibit any of the following:
- The pain has not improved after non-surgical treatment
- The pain appeared after an accident or injury.
Takeaway
Neck pain is a multifactorial condition that may be difficult to diagnose from a medical history alone. Because of this, your doctor may use various tests to get a definite diagnosis. These tests include provocative, laboratory, and imaging tests.
These tests are designed to help doctors identify the specific structures or conditions that may be causing your neck pain, such as a pinched nerve, muscle strain, or joint instability.
However, it's important to remember that these tests are not “one size fits all” tests. The tests used may vary depending on the individual patient and the suspected cause of their pain.
