Duration and localization of pain

1. Acute onset of pain usually suggests muscle spasm or nerve root irritation; radiation to the occiput or interscapular area may suggest a nerve root lesion.

2. Chronic neck pain that occurs intermittently with or without radicular symptoms may be seen in cervical osteoarthritis.

3. If radiculitis is severe, pain radiation to the shoulder and arm indicates nerve root compression resulting from either a disk herniation or foraminal encroachment by the osteophytes associated with osteoarthritis.

4. Shoulder pain either may be a radicular symptom secondary to root compression or may represent primary pain with associated referred neck and trapezial pain.

C. Relief and aggravation of pain. Rest in the supine position usually relieves local neck pain produced by muscle spasm but may have little or no effect on processes primarily involving osseous or ligamentous structures.

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