Differential Diagnosis for Muscle Spasm in the Neck and Mid Back
- Single most likely diagnosis:
- Muscle strain: This is the most common cause of neck and mid back muscle spasm, often resulting from overuse, poor posture, or minor trauma. The patient's denial of injury does not rule out minor strains that may not be immediately recalled or recognized as significant.
- Other Likely diagnoses:
- Fibromyalgia: A condition characterized by widespread muscle pain, fatigue, and tender points. The neck and mid back are common areas of complaint.
- Cervical spondylosis: Age-related wear and tear on the cervical spine can lead to muscle spasm as the body tries to stabilize the area.
- Thoracic outlet syndrome: Compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib) can cause neck and mid back pain, among other symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Cervical spine fracture or instability: Even without a reported injury, it's crucial to consider the possibility of a fracture, especially if the patient has osteoporosis or was involved in a minor trauma that they might not consider significant.
- Spinal cord injury or compression: Any condition that compromises the spinal cord, such as a herniated disk, spinal stenosis, or tumor, can present with muscle spasm and must be promptly identified and treated.
- Aortic dissection: Although rare, an aortic dissection can cause severe back pain and must be considered, especially if the patient has risk factors such as hypertension or a history of aortic aneurysm.
- Rare diagnoses:
- Multiple sclerosis: An autoimmune disease that affects the brain and spinal cord, leading to a wide range of neurological symptoms, including muscle spasm.
- Polymyalgia rheumatica: An inflammatory disorder that causes muscle pain and stiffness, typically in the neck, shoulders, and hips.
- Infectious or inflammatory conditions (e.g., meningitis, discitis, or osteomyelitis): These conditions can cause severe pain and muscle spasm and require urgent medical attention.