An overview of systematic reviews investigating clinical features for diagnosing neck pain and its associated disorders.
Brandon C Williams, Scott W Lowe, Ryan C McConnell and 1 others
PMID 39670815WHAT IT FOUND
Imaging findings often appear in healthy people and those with neck pain, so scans rarely pinpoint the specific mechanical cause.
However, combining the extension-rotation test with manual assessment of joint stiffness and muscle tenderness provides moderate to high diagnostic validity for facetogenic pain.
Key findings
01Current data does not support a causal relationship between structural changes on imaging, clinical test results, and symptoms, as abnormalities are frequently found in both healthy controls and patients.
02For diagnosing facetogenic pain, the extension-rotation test combined with positive manual assessment findings (joint stiffness and palpable segmental muscle tenderness) shows high specificity (0.83) and a positive likelihood ratio of 4.71.
03The Canadian Cervical Spine Rules and NEXUS criteria have high sensitivity and negative predictive value for ruling out the need for imaging in traumatic cervical instability, though specificity is low-moderate.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The data across included reviews were highly heterogeneous, preventing a meta-analysis and limiting the ability to draw a single, strong conclusion for all diagnostic tests. Many included reviews focused on 'non-specific neck pain' without attempting to link clinical features to a specific mechanical cause. The review did not assess the quality of individual primary trials within the included systematic reviews, only the quality of the reviews themselves. There is a risk of overrepresentation because primary studies may have been included in multiple systematic reviews within this overview. The review did not find any systematic reviews investigating the influence of psychosocial variables on NAD, which is a known factor in chronic pain presentations.
Declared interests
No specific funding sources or author conflicts of interest are declared in the provided text.
The easy way to misread this
Do not interpret the high sensitivity of the Canadian Cervical Spine Rules or NEXUS criteria as proof of instability. These rules are designed to rule out serious pathology in trauma; a positive screen indicates the need for imaging, not a diagnosis of instability. Similarly, do not use MRI findings like disc protrusion or Modic changes to definitively diagnose the source of chronic neck pain, as these are frequently present in people without pain.