Screening protocol s have high predictive values to detect cervical spine fracture in alert , low-risk patients seeking emergency care after blunt neck trauma .
Computerized tomography ( CT ) scans had better validity ( in adults and elderly ) than radiographs in assessing high-risk and /or multi-injured blunt trauma neck patients .
In the absence of serious pathology , clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression .
One exception is the manual provocation test for cervical radiculopathy , which has high positive predictive value .
There was no evidence that specific MRI findings are associated with neck pain , cervicogenic headache , or whiplash exposure .
No evidence supports using cervical provocative discography , anesthetic facet , or medial branch blocks in evaluating neck pain .
Reliable and valid self-report question naires are useful in assessing pain , function , disability , and psychosocial status in individuals with neck pain .
CONCLUSION The scientific evidence supports screening protocol s in emergency care for low-risk patients ; and CT-scans for high-risk patients with blunt trauma to the neck .
In nonemergency neck pain without radiculopathy , the validity of most commonly used objective tests is lacking .
OBJECTIVE To critically appraise and synthesize the literature on assessment of  neck pain .
SUMMARY OF BACKGROUND DATA The published literature on assessment of neck pain is large and of variable quality .
There have been no prior systematic review s of this literature .
Cervical injury in head trauma.
Criteria for excluding cervical spine injury in patients who have sustained blunt head or neck trauma were prospect ively studied at four hospitals in the Chicago area . The authors attempted to define a subset of these adult patients who , based on clinical criteria , could reliably be excluded from cervical spine radiography , thus avoiding unnecessary radiation and saving considerable time and money in their evaluation . Patients fell into four groups : ( 1 ) patients who were awake , alert , and had no complaint of neck pain or tenderness on physical examination ; ( 2 ) patients who were awake , alert , but had complaint of neck pain or tenderness on physical examination laterally over the trapezius muscle only ; ( 3 ) patients who were awake , alert , but had complaint of central neck pain or tenderness on physical examination over the cervical spine or center of the neck ; and ( 4 ) patients who were not fully awake or alert , were clinical ly intoxicated , had other painful or distracting injuries , or had focal neurologic findings . Patients in group 4 had significantly more fractures ( 21/387 ) when compared with all other patients ( 7/478 ) . Patients with central neck pain or tenderness ( group 3 ) had significantly more fractures ( 7/237 ) than patients without pain or tenderness or with these findings limited to the trapezius area ( 0/236 ) . It is clear that patients who have altered mental status , abnormal examination findings , distracting injury , or pain or tenderness over the cervical spine must have cervical spine radiographs . ( ABSTRACT TRUNCATED AT 250 WORDS
Screening protocol s have high predictive values to detect cervical spine fracture in alert , low-risk patients seeking emergency care after blunt neck trauma .
Computerized tomography ( CT ) scans had better validity ( in adults and elderly ) than radiographs in assessing high-risk and /or multi-injured blunt trauma neck patients .
In the absence of serious pathology , clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression .
One exception is the manual provocation test for cervical radiculopathy , which has high positive predictive value .
There was no evidence that specific MRI findings are associated with neck pain , cervicogenic headache , or whiplash exposure .
No evidence supports using cervical provocative discography , anesthetic facet , or medial branch blocks in evaluating neck pain .
Reliable and valid self-report question naires are useful in assessing pain , function , disability , and psychosocial status in individuals with neck pain .
CONCLUSION The scientific evidence supports screening protocol s in emergency care for low-risk patients ; and CT-scans for high-risk patients with blunt trauma to the neck .
In nonemergency neck pain without radiculopathy , the validity of most commonly used objective tests is lacking .
OBJECTIVE To critically appraise and synthesize the literature on assessment of  neck pain .
SUMMARY OF BACKGROUND DATA The published literature on assessment of neck pain is large and of variable quality .
There have been no prior systematic review s of this literature .