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Tripler Guide 2015
Tripler Guide 2015


Orthopedics - Cervical Pain/Stiffness

Orthopedics & Podiatry Main Menu

Cervical Pain/Stiffness


Cervical pain that is muscular, discogenic, or arthritic in nature.  Patient may be experiencing limited ROM of C-spine or have pain referred to the trapezius or upper extremity.  

Initial Diagnosis and Management

  • History and physical examination.
  • Radiograph of the spine if cervical pain started with trauma.
  • MRI/CT not indicated initially.
  • Initial Management:
    • NSAIDs.
    • Do not prescribe muscle relaxants as they are not effective.
    • Soft collar not recommended except for 1-5 days s/p high speed whiplash trauma (i.e., MVA).
    • Appropriate activity limitations on lifting, overhead work, heavy headgear, etc.
    • Ice packs every 20 minute q2h x 72 hours - then change to heat PRN.
    • Encourage gentle, pain-free ROM.

Ongoing Management and Objectives

  • Should observe a reduction in pain level within 5-7 days.
  • Chronic upper trapezius tension may persist for up to 2 months.
  • Expect increased AROM of C-spine and decreased muscle spasm within 2 weeks, complete resolution will take longer.


Indications for Specialty Care Referral

  • Specialty Care Referral (Physical Therapy):
    • No improvement after 7-10 days of initial primary care management.
    • If the patient has radicular symptoms.
  • Specialty Care Referral (Orthopedic Spine Referral):
    • If the patient has neurological findings (motor, sensory, or reflex deficits) and/or has positive MRI findings.

Criteria for Return to Primary Care

Chronic conditions with a stable neurologic exam in patients that have been evaluated by Orthopedics or Neurosurgery and are not surgical candidates. 

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