Williams Brandon C, Lowe Scott W, McConnell Ryan C, Subialka Joshua A
Orthopaedic Manual Physical Therapy Fellowship Program, Upstream Rehabilitation Institute, Smyrna, GA, USA.
Department of Physical Therapy, Philadelphia College of Osteopathic Medicine, Georgia, Suwanee, GA, USA.
J Man Manip Ther. 2025 Aug;33(4):286-298. doi: 10.1080/10669817.2024.2436403. Epub 2024 Dec 13.
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.
颈部疼痛是一种常见病症，通常难以诊断。既往文献对检查措施的诊断准确性进行了研究，但力度和临床适用性有限。本系统评价概述旨在研究诊断颈部疼痛及其相关疾病的临床特征。
进行了一项系统评价概述，检索四个电子数据库以查找评估颈部疼痛诊断标准的系统评价。使用AMSTAR 2和ROBIS评估质量和偏倚风险。研究颈部疼痛的临床特征以评估其诊断效用。
纳入了27项系统评价。手部神经根病和麻木对于小关节和钩椎关节肥大具有良好的特异性（0.89 - 0.92）。对于与小关节相关的功能障碍，伸展旋转试验（ERT）和手法评估具有良好的敏感性和中等至良好的特异性。与单独的阳性ERT（+LR = 2.01；Sp = 0.59）相比，阳性ERT联合阳性手法评估结果（+LR = 4.71；Sp = 0.83）可提高诊断准确性。加拿大颈椎规则和Nexus标准在筛查颈椎骨折或不稳定方面具有出色的有效性。影像学在诊断韧带断裂或骨折方面似乎具有有效性，但在预测未来颈部疼痛方面缺乏清晰度。在挥鞭样相关疾病和机械性颈部疼痛中发现脂肪浸润增加。
本综述发现，为诊断颈部疼痛提供强有力诊断效用的指标有限。推荐强度受到异质性结果、方法和分类系统的限制。未来研究应探索针对导致颈部疼痛的特定结构的新的鉴别诊断标准。
