Evidence-based work up and management of non-specific neck pain in the emergency department

Neck pain has become a commonly encountered complaint in the emergency department and primary care office. A large proportion of the population, ranging from a fifth (⅕) to a third (⅓) of the total, will experience non-specific neck pain in their lifetime. Because of the difficulty to quickly parse out the differential and the severity of several of these diagnoses, it is imperative for physicians in the emergency department to establish a systematic and effective approach for evaluating nonspecific neck pain. This article will present a standardized case of a patient presenting with nonspecific neck pain, critically analyze current evidence and guidelines from major ruling bodies in internal medicine, neurology, neurosurgery, and radiology, examine major statements released by the Choosing Wisely Campaign, and propose a new diagnostic decision tree for the management of nonspecific neck pain.