Differential Diagnosis for Chronic Neck Pain
Given the clinical history and radiographic findings of the cervical spine, the following differential diagnoses are considered:
- Single most likely diagnosis
- Musculoskeletal strain or sprain: This is the most likely diagnosis given the chronic nature of the neck pain and the absence of any significant radiographic abnormalities. Musculoskeletal strain or sprain can occur due to various reasons such as poor posture, overuse, or trauma, and can cause chronic neck pain.
- Other Likely diagnoses
- Cervical spondylosis: Although the radiograph does not show significant degeneration of the facet joints or endplates/discs, early or mild cervical spondylosis could still be a possibility, especially in older adults. This condition can cause chronic neck pain due to wear and tear of the spinal joints and discs.
- Fibromyalgia: This is a chronic condition characterized by widespread muscle pain, fatigue, and tender points. Fibromyalgia can cause chronic neck pain, and the absence of radiographic abnormalities does not rule out this diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Spinal infection (e.g., osteomyelitis, discitis): Although the prevertebral soft tissues are within normal limits, spinal infection is a potentially life-threatening condition that requires prompt diagnosis and treatment. It can cause chronic neck pain, and the absence of significant radiographic abnormalities does not rule out this diagnosis.
- Spinal tumor: A spinal tumor can cause chronic neck pain, and the absence of radiographic abnormalities does not rule out this diagnosis. Although rare, spinal tumors can be life-threatening if left untreated.
- Rare diagnoses
- Rheumatoid arthritis: This is a chronic autoimmune disorder that can cause inflammation and pain in the joints, including the cervical spine. Although rare, rheumatoid arthritis can cause chronic neck pain, and the absence of significant radiographic abnormalities does not rule out this diagnosis.
- Ehlers-Danlos syndrome: This is a rare genetic disorder that affects the connective tissue and can cause joint hypermobility, skin hyperextensibility, and tissue fragility. Ehlers-Danlos syndrome can cause chronic neck pain due to joint instability or other related complications.