GPAtlas🧭 When to suspect
Non-specific (mechanical) neck pain is pain and stiffness arising from the muscles, ligaments and joints of the cervical spine without a specific underlying disease, structural lesion or significant injury. It is extremely common, usually self-limiting, and is fundamentally a diagnosis of exclusion – made once cervical radiculopathy, myelopathy and serious systemic causes have been considered and excluded on history and examination.
The pain is typically felt in the neck and across the trapezius/shoulder-girdle, varies with posture and movement, and may radiate in a non-segmental pattern to the occiput, shoulder or arm. By definition there is no objective neurological deficit. The two clinical priorities in primary care are simple: screen for red flags so the rare serious cause is never missed, and then manage actively while avoiding over-investigation and medicalisation.
| Pattern | Typical features | Implication |
|---|---|---|
| Non-specific neck pain | Neck/trapezius pain and stiffness varying with posture and movement; non-segmental radiation to head, shoulder or arm; normal neurology. | Reassure and self-manage; simple analgesia; safety-net. |
| Cervical radiculopathy | Dermatomal arm pain (often > neck pain) with paraesthesia, sensory loss or myotomal weakness; commonly C6/C7. | Usually self-limiting; refer for MRI if persisting ≥ 4–6 weeks or objective/progressive signs. |
| Cervical myelopathy | Cord compression – clumsy hands, loss of dexterity, gait disturbance, hyperreflexia, positive Hoffmann's, ± sphincter disturbance. | Urgent – same-day spinal/neurosurgical referral and imaging. |
Source: NICE
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