# An overview of systematic reviews investigating clinical features for diagnosing neck pain and its associated disorders

## TL;DR

This paper reviews clinical features used to diagnose neck pain and related disorders, finding limited strong indicators and suggesting the need for better diagnostic criteria.

## Contribution

The study provides an overview of systematic reviews to evaluate diagnostic features for neck pain, highlighting gaps in current diagnostic tools.

## Key findings

- Hand radiculopathy and numbness have high specificity for facet and uncinate joint hypertrophy.
- Combining positive ERT with manual assessment improves diagnostic accuracy for facet-related dysfunction.
- Canadian C-spine Rules and Nexus criteria are highly valid for cervical fracture screening.

## Abstract

Neck pain is a common condition that is often difficult to diagnose. Previous literature has investigated diagnostic accuracy of examination measures, but the strength and clinical applicability are limited. This overview of systematic reviews aimed to investigate clinical features for diagnosing neck pain and its associated disorders.

An overview of systematic reviews was conducted searching four electronic databases for systematic reviews evaluating diagnostic criteria for neck pain. Quality and risk of bias were assessed using the AMSTAR 2 and ROBIS. Clinical features for neck pain were investigated for diagnostic utility.

Twenty-seven systematic reviews were included. Hand radiculopathy and numbness have good specificities (0.89–0.92) for facet and uncinate joint hypertrophy. For facet-related dysfunction, the extension rotation test (ERT) and manual assessment have good sensitivities and moderate-good specificities. Positive ERT combined with positive manual assessment findings (+LR = 4.71; Sp = 0.83) improves diagnostic accuracy compared to positive ERT alone (+LR = 2.01; Sp = 0.59). Canadian C-spine Rules and Nexus criteria have excellent validity in screening for cervical fracture or instability. Imaging appears to have validity in diagnosing ligamentous disruption or fractures but lacks clarity on predicting future neck pain. Increased fatty infiltrates have been found with whiplash-associated disorders and mechanical neck pain.

This review found limited indicators providing strong diagnostic utility for diagnosing neck pain. Strength of recommendations are limited by heterogeneous outcomes, methodology, and classification systems. Future research should investigate new differential diagnostic criteria for specific structures contributing to neck pain.