Differential Diagnosis for Neck Pain
- Single most likely diagnosis
- Musculoskeletal strain or cervical spondylosis: The patient's symptoms of neck pain that worsen with turning her head and improve with massage suggest a musculoskeletal origin. The chronic nature of the pain and the fact that it has been present for 1-2 months also support this diagnosis.
- Other Likely diagnoses
- Cervical facet joint pain: This condition can cause neck pain that worsens with movement and can be relieved with massage or other forms of manual therapy.
- Myofascial pain syndrome: This condition is characterized by pain and stiffness in the muscles and can be triggered by poor posture, stress, or other factors.
- Herniated cervical disc: Although less likely, a herniated disc could cause neck pain that worsens with movement and may radiate to the arm.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Carotid artery dissection: The patient's complaint of feeling her pulse in her neck could be a red flag for a carotid artery dissection, which is a medical emergency.
- Cervical spine fracture or instability: Although the patient denies trauma, a fracture or instability of the cervical spine could cause neck pain and would require immediate medical attention.
- Meningitis or encephalitis: Although the patient denies fever and other systemic symptoms, these conditions can cause neck pain and stiffness and would require prompt medical evaluation.
- Rare diagnoses
- Cervical spine tumor: A tumor in the cervical spine could cause neck pain and would require further evaluation with imaging studies.
- Rheumatologic conditions (e.g. rheumatoid arthritis, ankylosing spondylitis): These conditions can cause neck pain and stiffness, but would typically be accompanied by other systemic symptoms.
- Vascular conditions (e.g. vertebral artery dissection, subclavian steal syndrome): These conditions can cause neck pain and would require further evaluation with imaging studies.