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Neck Strain (cont.)

Neck Strain Exams and Tests


Pain varies from person to person and is hard to measure. The doctor will rely on one's description of symptoms to better quantify the pain. Someone may be asked to rate pain on a scale from 0 to 10, with 0 representing no pain and 10 as the worst pain. Although difficult to generalize, the following types of symptoms usually predict the types of anatomic structures injured:

  • Cramping, dull, aching pain may indicate that muscles may be injured.
  • Sharp, shooting pain could be injury to a nerve root.
  • Sharp, lightning-like pain may indicate that a nerve is injured.
  • Burning, stinging pressure may indicate nerve injury.
  • Deep, nagging, dull pain could be injury to a bone.
  • Sharp, intolerable, severe pain could indicate a fracture.
  • Throbbing, diffuse pain may be injury to blood vessels.


As well as trying to determine the severity of someone's pain, a doctor will focus on several other key areas as he/she makes a diagnosis:

  • The patient's age
  • How the patient was injured
  • Previous injuries
  • One's usual level of activities
  • The presence (or absence) of head impact and loss of consciousness
  • The way the symptoms developed
  • Factors that make the patient feel better or worse
  • Radiation of the symptoms away from the neck and the presence of any symptoms that suggest nerve problems such as weakness, altered sensation, tingling, and (particularly ominous) any bowel or bladder dysfunction
  • Any treatments someone has already tried and their outcomes

Physical examination

Physical evaluation for neck strain may be divided into the phases of observation, touching the muscles and other structures in the neck (palpation), examination of the blood vessels in the neck, nerve testing and, finally, an assessment of the ability to move. In most cases of trauma involving a significant mechanism of action, a complete examination is usually not completed until a set of preliminary X-rays has confirmed the lack of fractures (broken bones) and dislocations of the cervical spine.

  • Observation
    • The doctor may wish to see the patient walk into and around the examination room.
    • Typically, the patient's posture, gait, facial expression, willingness to move for examination, and ease of movement will be assessed.
    • The doctor will be interested to see whether the patient's head is rotated to one side. This usually indicates muscle spasm of the neck (called torticollis).
    • The position of the patient's chin and head will be noted as well as his/her habitual posture and the symmetry of the neck contour formed by the trapezius muscle.
    • The posture of the patient's head and neck may also be checked while the patient sits and then stands. Any differences will be noted.
    • The patient's shoulders will be checked to see if they are level when relaxed. Asymmetry often indicates muscle spasm.
  • Doctor observation is often also sufficient to lead to a suspicion of a problem causing an inadequate blood supply (ischemia) in one of the upper limbs. A doctor will examine the blood vessels in the neck by feeling the pulses to assess for briskness of upstroke and fullness, and the presence of any abnormal sounds heard with a stethoscope placed over the blood vessel (auscultation). The doctor will also look for any evidence of any increased pressure in the neck veins (distended or bulging jugular veins). The doctor will check the patient's trachea, particularly if there are any symptoms of hoarseness.
  • The doctor will also palpate the patient's head, neck, shoulders, and possibly other areas. Palpation is useful in detecting differences in tissue tension, texture, and thickness, tenderness, and abnormal sensation. In addition, differences in temperature and dryness (or excessive moisture) become readily apparent. Tremor (shaking) and muscle twitches may also be checked in this manner.
  • The doctor will perform neuromuscular testing to determine whether the patient has any injuries to the nerves and joints in the neck. These tests typically involve moving the body both passively (with assistance) and actively, to assess for strength, range of motion, and any loss of sensation.

The combination of a detailed history, physical examination, and one or more imaging procedures should enable the doctor to exclude, or identify, any serious injury to the neck and thereby plan a course of treatment.

Medically Reviewed by a Doctor on 4/27/2015

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