Differential Diagnosis for Chronic Neck Pain
Given the clinical history and imaging 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 degenerative changes or other abnormalities on the imaging study. Musculoskeletal strain or sprain can occur due to various reasons such as poor posture, overuse, or minor injuries.
- Other Likely diagnoses
- Cervical spondylosis: Although the imaging study does not show significant degeneration of the facet joints or endplates/discs, early or mild forms of cervical spondylosis could still be present and cause chronic neck pain.
- Fibromyalgia: This condition is characterized by widespread musculoskeletal pain and could be a consideration in the differential diagnosis of chronic neck pain, especially if other symptoms such as fatigue, sleep disturbances, and tender points are present.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Spinal cord compression or injury: Although the imaging study does not show any evidence of spinal cord compression, it is crucial to consider this possibility, especially if there are any symptoms suggestive of myelopathy such as numbness, tingling, or weakness in the arms or legs.
- Infection (e.g., osteomyelitis, discitis): Infections of the cervical spine can present with chronic neck pain and may not always have significant findings on initial imaging studies. A high index of suspicion is necessary, especially if there are systemic symptoms such as fever or elevated inflammatory markers.
- Malignancy (e.g., metastatic disease): Although less likely, malignancy involving the cervical spine can cause chronic neck pain. It is essential to consider this possibility, especially in patients with a history of cancer or those who are at high risk for cancer.
- Rare diagnoses
- Rheumatoid arthritis or other inflammatory arthropathies: These conditions can affect the cervical spine and cause chronic neck pain, although they are less common than other diagnoses.
- Cervical dystonia: This is a rare condition characterized by abnormal posturing of the neck due to involuntary muscle contractions, which can cause chronic neck pain.