No procedure on day one. The first visit exists to make the diagnosis.

YOUR FIRST VISIT

No procedure, no rush, and no decision made from a scan report. The first appointment exists to work out what is actually generating your pain.

Before you arrive

Bring imaging if you have it — on a disc or with portal access, not just the report. The report is somebody else’s reading of the images and it is written without your examination in front of them. We would rather look at the pictures alongside the findings.

Bring prior nerve studies, a medication list with actual doses, and a note of what has been tried and what each thing did. Partial responses matter and they are the detail people most often leave out.

What the appointment covers

• The history, in detail: where the pain is, where it travels, what provokes it, what relieves it, how it behaves at night, and how it started.
• A neurological examination: strength graded by muscle, reflexes, and sensation mapped rather than described.
• Cervical range and provocation, including rotation in flexion, which isolates the top two segments.
• The shoulder and the arm, every time, because the overlap with neck pain is substantial and frequently missed.
• Palpation of the facet columns, the upper cervical segments, and the muscles that refer into the head and arm.

What comes out of it

A working diagnosis naming a structure, not a category. A plan that says what is being tested and what is being treated. And where a test is needed, a clear statement of what that test will change — because a test that changes nothing is not worth having.

If the picture is clean, treatment starts that day. If it is genuinely ambiguous, the test that resolves the ambiguity gets arranged and nothing irreversible is set in motion in the meantime.

What will not happen

You will not be sent to a surgeon on the strength of a scan and a description. You will not have a procedure booked before there is a diagnosis it follows from. And you will not be told your imaging explains your pain when the examination says otherwise.

That last one matters more than it sounds. Age-related change on cervical imaging is close to universal after middle age and is present in large numbers of people with no symptoms at all. A finding earns the diagnosis when it matches the examination.

If a procedure is the right next step

It is scheduled separately, explained in full beforehand, and done with image guidance. You will know what is being injected, where, why, what the response is expected to look like, and what a non-response would mean. Most cervical procedures here are day cases and most people drive themselves home.

If you have already had surgery

Bring the operative note if you can get it, and any post-operative imaging. Knowing which levels were fused, by which approach, and whether hardware was used changes the differential substantially — adjacent segment loading, hardware problems and rotation loss are distinct problems with distinct answers.

Persistent pain after neck surgery is common enough to have its own literature and it is not a sign that nothing can be done. It is a sign that the question needs asking again from the beginning.

If your pain is long-standing

Years of pain changes how the nervous system processes it, and that central component is real, measurable, and treatable in its own right. It does not mean the peripheral generator has gone away — usually both are present and both need addressing.

What it does mean is that a single procedure aimed at a single joint is unlikely to resolve everything, and setting that expectation at the start is more useful than discovering it at week six.

Bringing somebody with you

Encouraged. A second person remembers different things, and where a procedure is being discussed it helps to have someone who heard the same explanation. If a procedure is done that day you may prefer not to drive, and that is worth planning for rather than discovering afterward.

What people ask about the first visit

Will you inject me on the first day?

Usually not. The first visit is diagnostic. A procedure done before the diagnosis is a guess with a needle in it. How candidacy is assessed.

Do I need to stop my medications?

Not for a consultation. If a procedure is planned, blood-thinning medication is discussed specifically and in advance. How treatment gets paid for.

What if my scan is normal?

Then the examination does the work, which is the usual situation for facet-mediated pain, myofascial pain and many nerve problems. A normal scan is not the end of the assessment. Why a normal MRI does not close the question.

How long until I know what is wrong?

Most people leave the first appointment with a working diagnosis. Where a nerve study or a diagnostic block is needed, it is usually days rather than months. How long neck pain should take to settle.

Related reading

• About this practice
• Am I a candidate?
• Why your MRI does not explain it
• EMG and nerve conduction studies
• When a neck problem is urgent
• Connect with us

How the visit is paid for — benefits, direct payment, or an open injury case — is set out on how treatment gets paid for.

Before the first visit, it helps to know what actually relieves neck pain and what only appears to.

Being awake for a diagnostic block is deliberate rather than economical. What each procedure actually feels like.

The examination in more detail

Strength is graded muscle by muscle rather than described as weak, because a C6 pattern and a C7 pattern differ by which muscles are involved and nothing else. Reflexes are compared side to side. Sensation is mapped to a distribution — the strip matters, the general area does not.

Provocation testing includes Spurling maneuver for the root, the shoulder abduction sign, and segmental palpation from the skull base down. Where the hands are involved, the specific entrapment tests at the wrist and the elbow are done at the same appointment rather than at a later one.

Why the shoulder gets examined at a neck appointment

Because C5 and C6 refer convincingly into the outer shoulder and upper arm, and because subacromial and AC joint problems refer into territory people describe as their neck. A systematic review exists specifically on overlapping, masquerading and causative cervical and shoulder pathology, which tells you how often this goes wrong.

It adds a few minutes. It changes the plan often enough that leaving it out would be indefensible.

What happens between the first visit and the second

If a nerve study or an image-guided diagnostic block is needed, it gets arranged. If treatment starts immediately, you leave with something to do rather than something to wait for. And if we have asked you to record a pain diary after a block, that record is the data the next decision rests on — we would rather have your hourly numbers than your overall impression a week later.

Impressions compress. A diary does not, and a diagnostic block interpreted from an impression is a block largely wasted.

Costs, and why they are not on this website

What a course of treatment costs depends on what turns out to be indicated, and that is not known before an evaluation. Publishing a figure in advance would mean publishing a figure for a plan nobody has made yet.

What we will do is tell you what is proposed and what it involves before anything is scheduled, so the decision is made with the information in front of you rather than afterward.