Differential Diagnosis for Unilateral Neck Tightness

• Single most likely diagnosis
  • Muscle strain: This is the most common cause of unilateral neck tightness, often resulting from overuse, poor posture, or trauma to the neck muscles.
• Other Likely diagnoses
  • Cervical spondylosis: This condition, which involves wear and tear on the discs in the neck, can cause neck stiffness and pain, often unilateral.
  • Herniated cervical disc: A herniated disc in the neck can compress nerves, leading to pain and tightness on one side of the neck.
  • Torticollis: This condition involves a twisted neck, which can cause tightness and pain on one side of the neck.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Carotid artery dissection: A tear in the carotid artery can cause neck pain and tightness, often unilateral, and can lead to stroke if not promptly treated.
  • Cervical spine fracture: A fracture in the neck can cause severe pain and tightness, and can lead to spinal cord injury if not properly managed.
  • Meningitis: Inflammation of the membranes surrounding the brain and spinal cord can cause neck stiffness and pain, although it is typically bilateral.
• Rare diagnoses
  • Cervical dystonia: A rare neurological disorder that can cause involuntary muscle contractions, leading to abnormal postures and tightness in the neck.
  • Fibromyalgia: A chronic condition characterized by widespread muscle pain and stiffness, which can include unilateral neck tightness.
  • Polymyalgia rheumatica: An inflammatory condition that can cause muscle pain and stiffness, often in the neck and shoulders, although it is typically bilateral.