Cervical Spine

MSK Physiotherapy services across the four Health and Social Care Partnerships and the department at the Western General Hospital accept referrals from primary care clinicians for people with cervical spine problems and cervical spine related arm symptoms. The flowchart below is provided to help support clinical decision making. Please also see additional information provided in the tabs Serious cervical spine conditions (Red Flags) – RefHelp, Non specific neck pain – RefHelp, Cervical spine related arm symptoms – RefHelp

Cervical Spine Assessment Flowchart (RefHelp)

Cervical spine flowchart Download

M.A & P.A. 5-8-26

All primary care clinicians i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners
Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP Where To Find Us – Musculoskeletal Physiotherapy)
Secondary care consultants and associated teams
MSK physiotherapists are able to escalate/refer to advanced practice physiotherapists underpinned by agreed pathways and processes MSK physiotherapy within NHS Lothian (services included in pilot only) – Cervical spine pathway | Right Decisions

All routine cases of cervical spine pain and cervical spine related arm symptoms who have not responded to initial primary care management within a 4-6 week period and do not have the presence of significant red flags nor have suspected inflammatory spinal pain – see sections serious cervical spine conditions and other considerations and inflammatory spinal pain
Cervical Spine related arm symptoms- Consider earlier referral in cases intractable symptoms and/ or developing motor deficit but without significant red flags
- Non-specific cervical spine pain in the absence of a dominant psychological component who have not received recent physiotherapy for their condition or who have received physiotherapy previously for their condition but;
  - have experienced a substantial change in their presentation
  - require assistance with achieving a functional goal
  - wish further assessment and considerations of management options
- have clinical features suggestive of an underlying specific cause for their cervical spine pain, in which further investigation would guide management (other than serious spinal pathology).
Additional information regarding imaging available for xray and MRI found at radiology ref help spine Plain X-Rays – RefHelp

Patients who have the presence of significant red flags/ suspicion of serious cervical spine condition or have suspected inflammatory spinal pain – see Serious cervical spine conditions (Red Flags) – RefHelp
Age <16
Chronic cervical spine pain with a significant psychological / psychiatric / drug addiction element/ pain causing significant distress & disability, no planned referral to another speciality for diagnosis or treatment of pain – see Chronic pain Chronic Pain – RefHelp.

For all cases of routine cervical spine pain / spine related arm symptoms– refer via SCI Gateway Referral “AHP-Physiotherapy” then choose local site.
Please include all relevant details on your referral to allow the appropriate initial triage of the patient. Initial triage will occur within MSK Physiotherapy and if appropriate will be passed to spinal advanced practice physiotherapy service.
Please signpost patients to Integrated Spinal Service Webpage for patient information.

For further information see associated sections