An overview of systematic reviews investigating the accuracy, reliability, and relationships of tests and measures for diagnosis of neck pain.
Background: Neck pain is a common condition and often difficult to differentiate and diagnose. Previous literature has investigated diagnostic accuracy of examination measures but is limited. Objective: To investigate examination measures for diagnosis of neck pain. Design: Umbrella review Literature Search: Four databases were searched electronically. Quality and risk of bias were assessed using the AMSTAR 2 and ROBIS. Diagnostic criteria were investigated for accuracy, reliability, and relationship to neck pain diagnoses. Study Selection Criteria: Systematic reviews of randomized clinical trials evaluating diagnostic criteria for neck pain. Data Synthesis: Twenty seven systematic reviews were included. Quantitative and qualitative results were summarized in narrative format. Results: Hand radiculopathy and numbness have good specificities (0.89-0.92) for facet and uncinate joint hypertrophy. 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 a positive ERT alone (+LR = 2.01; Sp = 0.59). Canadian C-spine Rules and Nexus low-risk 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. Conclusions: There are limited indicators providing strong diagnostic value for cervical spine diagnosis. Strength of recommendations are limited by heterogeneous outcomes, methodology, and classification systems. Future research should attempt to provide stronger recommendations of differential diagnostic criteria for pathoanatomical neck pain diagnoses.