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 .
Reliability and Diagnostic Accuracy of the Clinical Examination and Patient Self-Report Measures for Cervical Radiculopathy
Study Design . A blinded , prospect i ve diagnostic test study was conducted . Objectives . To assess the reliability and accuracy of individual clinical examination items  and  self-report instruments  for the diagnosis of cervical radiculopathy , and to identify and assess the accuracy of an optimum test-item cluster for the diagnosis of cervical radiculopathy . Summary of Background Data . Although cervical radiculopathy remains largely a clinical diagnosis , the reliability and diagnostic accuracy of clinical examination items , individually or in combination , for cervical radiculopathy is largely unknown . Methods . Patients with suspected cervical radiculopathy or carpal tunnel syndrome received st and ardized electrophysiologic examination of the symptomatic upper quarter followed by a st and ardized clinical examination by physical therapist examiners blinded to diagnosis . Diagnostic properties were assessed using a neural impairment reference criterion st and ard . Results . The study involved 82 patients . More than two thirds of 34 clinical examination items had reliability coefficients rated at least fair or better , and 13 items had likelihood ratio point estimates above 2 or below 0.50 . A single diagnostic test item cluster of four variables was identified and produced a positive likelihood ratio point estimate of 30.3 . The 95 % confidence intervals for all likelihood ratio point estimates in this study were wide . Conclusions . Many items of the clinical examination were found to be reliable and to have acceptable diagnostic properties , but the test item cluster identified was more useful for indicating cervical radiculopathy than any single test item . Upper limb tension Test A was the most useful test for ruling out cervical radiculopathy . Further investigation is required both to vali date the test item cluster and to improve point estimate precision
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 .