Head and neck: understanding symptoms and finding your way forward

In everyday life, symptoms in the neck, shoulder and arm cannot always be clearly separated. Pain can spread into neighbouring areas. Irritation of a nerve around the cervical spine may also cause pain, tingling or altered sensation in the arm. That is one possible connection, but it is not yet a diagnosis of your symptoms. If lifting or putting strain on your arm is the main source of pain, the ‘Shoulder pain’ page may be closer to your initial question. You do not, however, have to choose between two supposedly competing problems. Mention both areas during your consultation and describe which problem appeared first. Whether the cause is more likely to lie in the neck, shoulder or elsewhere is assessed by considering the findings together. On ‘Neck and arm pain and cervicobrachialgia’, we explain how symptoms along the arm are assessed and why pain, tingling and reduced strength provide different clues. You can also find out when treatment directed at the cervical spine may be considered.

Headaches at the back of the head, temples or around the jaw can have very different causes. The neck and chewing muscles may be involved. However, the location of the pain or a tense neck at the same time does not establish that connection. Nor does a term such as ‘HWS-Syndrom’ in an earlier report settle the question. HWS is the German abbreviation for the cervical spine; here, ‘syndrome’ initially describes a group of related symptoms. The page ‘Headaches at the back of the head, temples and jaw’ explores this question in more detail. It explains what we can assess from an orthopaedic perspective, which observations are helpful and when other specialties are needed. This also includes headaches that have been present for a long time. This does not mean that improvement will be straightforward or guaranteed for an individual patient. New, recurring or changing headaches and dizziness need medical assessment. Depending on the situation, your GP practice may be the appropriate first contact and can involve other specialties. An orthopaedic examination does not replace any necessary neurological or other assessment. Please also tell us about accompanying symptoms that do not seem directly related to orthopaedics.

Words such as ‘wear and tear’ or ‘disc changes’ can be worrying. Changes in the cervical spine also occur in people without symptoms. What matters, therefore, is whether a finding fits your description and the examination. A single term in a radiology report does not provide a complete treatment plan. Bring existing images and the written report. We consider this information in the context of your symptoms and discuss which question it answers. Further investigation can be arranged if needed. New images are not necessary simply because familiar symptoms recur. If symptoms persist despite appropriate treatment, worsen substantially or are accompanied by new findings, we assess whether additional images can answer a specific question and change the next steps. On ‘MRI and CT: arranging scans and interpreting findings’, you can find out more about using existing imaging and arranging further imaging when appropriate.

Perhaps you have started avoiding every turn of your head because you are afraid of causing damage. Or you are unsure whether you can continue your usual sport. These questions belong in the medical consultation. For neck pain with no indication of a dangerous structural cause or one requiring treatment, appropriate activity is an important part of managing symptoms. This does not, however, mean that the same movements are suitable for everyone. The ‘Movement and exercise’ page explains how your starting point, everyday goals and response to activity can be considered together. For example, you may want to do an activity for longer again or with more confidence. A good plan also takes account of your time, options and previous experience. You do not need to be sporty or already know an exercise programme.