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Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,1
Pierre Côté DC, PhD,2
Dr. Hamilton Hall, MD, FRCSC,3

1 is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.
2Canada Research Chair in Disability Prevention and Rehabilitation; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT); Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation.
3 is a Professor in the Department of Surgery at the University of Toronto. He is the Medical Director, CBI Health Group and Executive Director of the Canadian Spine Society in Toronto, Ontario.

CLINICAL TOOLS

Abstract: Neck pain is a common presentation in primary care with an estimated one-year incidence ranging from 10.4-21.3% and a 25-50% recurrent rate.1 Guidelines have not included a specific approach to assessment although treatment recommendations have advised non-pharmacological and pharmacological management for optimal results. The CORE Neck Tool was designed as a comprehensive, user-friendly approach to clinical decision making for primary care providers assessing patients with neck pain. The key components of the tool include a high yield history, physical examination and a management matrix providing evidence-based recommendations for acute and chronic neck dominant and arm dominant pain patterns. Criteria is clearly described for investigations and referral management and patient key messages are embedded in the tool. This tool has been incorporated into the Ontario Quality Based Spine Pathway and is endorsed by the Ontario College of Family Physicians and the Nurse Practitioners Association of Ontario. A clinical case will be used to demonstrate the application of the tool to practice and instruct the reader on the key features.
Key Words: Spinal lesion, tumour, imaging characteristics, primary bone tumours.

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1. Most neck pain is benign mechanical pain and serious pathology is uncommon.
2. Always assess the patient's headache symptoms first before proceeding with the neck assessment.
3. Cervical imaging is only required in patients with persistent arm dominant pain, positive neurological findings or a history of significant trauma.12
4. Neck pain is considered chronic if persisting greater than three months.
5. Exercise, education and postural advice are the best evidence-based treatment.
If the patient presents with shoulder dominant pain, do a complete shoulder examination versus if the patient presents with neck dominant pain, only a shoulder screen assessing range is necessary.
Palpation of the cervical nodes is a quick and necessary component of the neck examination to ensure that a red flag is not present.
Cervical myelopathy signs may include difficulty with hand fine motor tasks, tingling and/or numbness in the upper extremities and changes in gait steadiness and coordination.
Do not make the concurrent diagnosis of bilateral carpal tunnel syndrome, until cervical cord pathology has been excluded.
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