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.
• Extremely common and usually self-limiting.
• 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:
• It varies with posture and movement.
• It 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.
• 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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