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 .
What defines a distracting injury in cervical spine assessment?
BACKGROUND The National Emergency X-Radiography Utilization Study defined five criteria for obtaining cervical spine radiographic investigations in blunt trauma patients . Distracting injury was given as the indication for more than 30 % of all x-ray studies ordered . The hypothesis of this study was that upper and lower torso injuries would have different effects on clinical cervical spine assessment . METHODS This is a single-center , prospect i ve , observational study of admitted , alert , adult blunt-trauma patients . All patients underwent cervical spine plain-film radiography .  Data were collected on all injuries , physical examination findings , narcotic administration , and radiograph results . Patients with upper and lower torso injuries were compared in their ability complain of pain or midline tenderness relative to a cervical spine fracture . RESULTS In all , 406 patients participated . All patients received narcotic analgesics before examination . Forty patients ( 9.9 % ) had cervical spine fractures , of whom seven had a nontender neck examination . All seven patients with a nontender cervical spine and a neck fracture had at least one upper torso injury . None of the 99 patients with injuries isolated to the lower torso and a nontender neck had a cervical spine fracture ( p < 0.05 ) . The frequency of cervical spine fracture among patients with cervical spine tenderness was 19.8 % ( n = 33 ) . CONCLUSIONS The National Emergency X-Radiography Utilization Study definition of a distracting injury may be narrowed . Upper torso injuries may be sufficiently painful to distract from a reliable cervical spine examination . Patients may detect spine tenderness in the presence of isolated painful lower torso injuries . Patients with spine tenderness warrant imaging
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 .