In brief Neck pain or related upper-limb pain can be very disabling for active patients young and old. The broad differential includes such conditions as strain, sprain, disk injury, radiculopathy, carpal tunnel syndrome, ulnar neuropathy, and degenerative shoulder disease. A diagnosis can often be made solely based on history and physical exam findings. It is essential to determine whether the pain is localized or radiating. Localized neck pain generally points to muscle strains, ligament sprains, and degenerative facet or disk processes. Pain that radiates into the upper limbs frequently stems from nerve involvement. Unless significant trauma has occurred, diagnostic images are not warranted unless they are likely to change treatment.