Questionnaire/history: Pain in the neck, shoulder and/or arm that approximates to that of a dermatome (lateral arm (C5), lateral forearm/thumb/index finger (C6), middle finger (C7), medial side lower forearm/ring and little finger (C8), medial side upper forearm (T1))? Pain radiates in a non-segmental distribution down the arm, up into the head, into the shoulder or across the scapulae? Side? Pain disturbing sleep? Sensory symptoms? - Shooting pains? - Hyperaesthesia? - Numbness? Motor symptoms? - Muscle weakness? Retro-orbital and temporal pain (suggesting referral from the upper cervical levels (C1-3)? Onset? - Gradual? Aggravated by particular movements, posture or activities? Previous injury or infection? Fever? Past medical history? Current medication? Previous treatments? Drug allergies? Occupational history? Examination: Appearance? - Postural asymmetry? - Muscle wasting? Neck movements? - Restricted or causing sharp pain radiating into the arm? Neck tenderness? Skin changes (eg papulovesicular rash, petechiae or purpura)? Dural irritation? - Spurling test? Neurological problems? - Objective muscle weakness? ----- Shoulder abduction (C5)? ----- Wrist extension (C6)? ----- Elbow extension (C7)? ----- Finger flexion (C8)? ----- Finger abduction/adduction (T1)? - Objective sensory changes? ----- Lateral arm (C5)? ----- Index finger (C6)? ----- Middle finger (C7)? ----- Ring and little finger (C8)? ----- Medial side upper forearm (T1)? - Reflex changes? ----- Biceps (C5)? ----- Supinator (C6)? ----- Triceps (C7)? (Note: Nerve root symptoms normally arise from a single nerve root – involvement of more than one nerve root suggests a more widespread neurological disorder) Spurling test (neck laterally flexed, extended and rotated with application of axial pressure on top of the head causes radicular pain)? Arm squeeze test (squeeze of the middle third of the upper arm with simultaneously thumb (from posterior) and fingers (from anterior) compression causes pain with a score (on a 0-10 visual analogue scale) ≥ 3 points compared with compression on the acromioclavicular and anterolateral subacromial area? Cervical distraction test? Upper limb neurodynamic test? Nuchal rigidity if meningitis is suspected? - Kernig’s sign (painful/resisted extension of leg bent at hip and knee)? - Brudzinski’s sign (reflective flexion of the knees when neck is bent forwards)? Management: Findings explained Advised: - Paracetamol +/- ibuprofen +/- codeine prn - Not to drive if the ROM is restricted - Firm pillow with lateral support and support of the hollow of the neck - To consider physiotherapy - Review if worsening symptoms, no improvement or ongoing symptoms in 6 weeks Reference(s): NICE CKS: Neck pain – non-specific