What it is
Neck pain is a symptom rather than a diagnosis. It comes from the discs, the small facet joints at the back of the spine, the muscles and ligaments that hold the neck upright, or some combination of all of them. In the large majority of people it settles within a few weeks without any procedure at all.
The reason it still deserves a careful look is that a small proportion of neck pain is the first sign of something that behaves differently — nerve compression, spinal cord compression, a fracture, infection or a tumor. Those are uncommon. They are also the ones where the cost of waiting is real.
Symptoms
- Aching or stiffness across the back of the neck and shoulders
- Pain that is worse at the end of the day or after sustained desk or phone use
- Headaches that begin at the base of the skull
- A limited, guarded range of movement
Symptoms that change the picture, and should be assessed promptly
Pain radiating below the elbow, numbness or weakness in an arm or hand, clumsiness with buttons or keys, unsteadiness when walking, or pain following a significant injury.
How it is diagnosed
The examination does most of the work. Dr. Long will test power, reflexes and sensation in both arms, look for signs that the spinal cord rather than a single nerve is involved, and assess how the neck moves. Plain X-rays show alignment and instability. An MRI is ordered when the examination points to nerve or cord involvement, not as a first step for uncomplicated pain.
Non-surgical treatment
Most people get better with time, activity modification, physical therapy aimed at the deep neck flexors and the shoulder girdle, and short courses of anti-inflammatory medication. Targeted injections can be useful both to relieve pain and to confirm which structure is generating it.
When surgery is considered
Surgery is for nerve or cord compression, instability, deformity, or a structural problem that has not responded to good non-operative care — not for neck pain alone. An operation reliably treats arm pain caused by a compressed nerve. It is far less predictable for central neck pain with no clear structural cause, and Dr. Long will say so plainly rather than operate in hope.