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 .
False‐Positive Rates of Cervical Zygapophysial Joint Blocks
Objective : To determine the false-positive rate of anesthetic blocks of the medial branches of the cervical dorsal rami in the diagnosis of cervical zygapophysial joint pain . Design : Comparison between single diagnostic blocks , and a criterion st and ard of double-blind , controlled , differential anesthetic blocks . Setting : Tertiary referral center . Patients : The first 55 consecutive patients with neck pain for > 3 months after and attributable to a motor vehicle accident , and who had completed a second diagnostic block after an initial positive response . A total of 60 joints was studied , with five patients providing two joints each . The mean age was 41 years : 61 % were female . Methods : Each patient had been investigated with radiologically controlled blocks of the medial branches of the cervical dorsal rami to anesthetize the target cervical zygapophysial joint . The initial block was performed using either 0.5 % bupivacaine or 2 % lignocaine , r and omly selected . The duration of pain relief was assessed in a double-blind fashion . The procedure was repeated with the complementary anesthetic . Only patients experiencing a longer period of pain relief from bupivacaine were considered to have true-positive responses . Results : The second block failed to relieve pain in two of the tested joints . In a further 14 joints , the control blocks relieved pain , but the patient failed to correctly discriminate the longer acting anesthetic . The remaining 44 joints met the criteria for true-positive responses . The false-positive rate of single blocks was 16 of 60 or 27 % ( 95 % confidence interval 15 % , 38 % ) . Conclusion : Uncontrolled diagnostic blocks are compromised by a significant false-positive rate that seriously detracts from the specificity of the test
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 .