Benign bone tumors and tumor-like benign bone tumors such as osteoma, osteoid osteoma, osteochondroma, chondroblastoma, etc.; tumor-like diseases such as isolated bone cysts, aneurysmal bone cysts, osteofibrous dysplasia, eosinophilic granuloma of bone, bone hemangiomas and so on. Diagnostic points (1) Pain characteristics: long-term existence can be painless, some due to other diseases or traumatic injuries found by chance after taking films. Enlarged mass can cause local pain and discomfort by stimulating the surrounding tissues. (2)Slow onset, localized mass may be palpable. (3) Benign tumors of the cervical spine may cause corresponding symptoms if they compress the spinal cord. (4) Benign tumors with destruction of bone structure and tumor-like lesions are prone to fracture due to trauma. (5) Blood test is normal. (6) Imaging examination: X-ray, CT, etc. for benign tumor or tumor-like lesion manifestation. (7) Tissue biopsy if necessary to confirm the diagnosis. 2.Primary malignant bone tumor Osteosarcoma, parosteal osteosarcoma, Ewing’s sarcoma, chondrosarcoma, chordoma, myeloma, etc. can occur in neck and shoulder bones. Diagnostic Points (1) Pain characteristics: with the development of the disease, the pain gradually worsens, from intermittent vague pain to persistent severe pain. (2)Swelling can often be palpated in the neck and shoulder region, which develops rapidly and has obvious pressure pain. (3) There may be systemic symptoms in the early stage, such as low-grade fever and progressive emaciation. (4) There are mostly anemia, leukocytosis, and rapid blood sedimentation. Blood alkaline phosphatase is increased in osteosarcoma, the positive rate of urinary catecholamines in Ewing’s sarcoma is as high as 90%, and urinary Benzoylated protein is increased in myeloma patients. (5) Imaging examination: X-ray, CT, MRI have special manifestations such as bone destruction of corresponding malignant bone tumors. (6) Isotope scanning has specific nuclide concentration changes. (7) Pathologic examination has the value of confirming the diagnosis. 3.Primary bone tumors with malignant tendency Osteoblastoma and giant cell tumor of bone are mostly benign, but some of them can be transformed into malignant. (1) Characteristics of pain: the pain is generally light, mostly localized hidden pain, and a few may have radicular or dry neuralgia. If transformed into malignant pain increases. (2) Generally no systemic symptoms, the growth of the mass is slow. If transformed into malignant, the growth of the mass is fast, and there may be systemic symptoms. (3) Blood biochemistry and sedimentation are normal in benign cases, but blood sedimentation may be accelerated and anemia may occur in malignant cases. (4) The changes of X-ray and CT are fast in malignant transformation and have the characteristics of malignant tumor. (5) Pathological examination has diagnostic value. 4. Bone metastatic tumor Diagnostic Points (1) Pain characteristics: early hidden pain, gradually aggravated and fast development, especially at night, and cannot be relieved by general painkillers. (2) Most of them have the history of breast cancer, lung cancer, thyroid cancer and other malignant tumors, or no history of malignant tumors. (3) Most of them have systemic reaction. (4) Accelerated blood sedimentation. (5) X-ray film, CT film or MRI suggests osteolytic bone destruction, and periosteal reaction is mostly insignificant. (6) Nuclide scan with abnormal changes. (7) Tissue biopsy, if necessary, has the value of confirming the diagnosis. 5.Cervical spinal intravertebral tumors can be divided into extramedullary intradural, epidural and intramedullary tumors according to the positional relationship between the tumor and the spine and dura mater. The common tumors are chordoma, nerve sheath tumor, neurofibroma, glioblastoma. Diagnostic points (1) Pain characteristics: radicular pain of the involved nerves, mostly paroxysmal, aggravated by coughing and defecation. The pain is aggravated at night and in lying position. (2) Symptoms of cervical spinal cord compression or invasion. Such as spinal cord hemisection syndrome or transverse spinal cord damage sign. (3) Increased CSF protein content and positive Queckenstedt¡¯s test. (4) MRI examination is of special value. 6.Superior sulcus syndrome caused by apical lung tumor Diagnostic points (1)Pain characteristics: lesions often invade the C8 and T1 nerve roots, the neck and ulnar side of the upper limb show persistent pain, progressive aggravation, mostly severe pain, burning pain, tearing pain. (2) Intrinsic muscle atrophy of the hand. Reduced or absent sensation on the ulnar side. (3) Cervical sympathetic nerve involvement can lead to Horner’s syndrome. (4) EMG with denervation potentials. (5) X-ray, CT or M RI examination reveals a tumor in the lung tip. (6) Tumor biopsy is mostly carcinoma of the lung tip or metastatic carcinoma. 7.Neck and shoulder peripheral nerve tumors Primary tumors of cervical plexus and brachial plexus include multiple neurofibromas, nerve sheath tumors, isolated neurofibromas, malignant nerve sheath tumors and so on. Secondary tumors and invasion by malignant tumors of peripheral tissues are also common. Diagnostic points (1) Pain characteristics: often persistent pain, progressive aggravation of traumatic pain and burning pain. (2) Progressive sensory abnormalities, severe sensory and motor loss. (3)Palpable mass in the neck and shoulder with obvious tenderness. (4) The mass is visible on X-ray and CT examination. (5) Pathology has diagnostic value. Neck and shoulder pain caused by systemic diseases 1, rheumatic fever A small number of patients first in the cervical spine and shoulder joints often bring some difficulties in early diagnosis. Diagnostic points (1) pain characteristics: acute onset of the majority of the affected joints red, swollen, hot and painful; a small number of insidious onset, joint pain. (2) The age of the first onset of disease is mostly 5~15 years old. (3) Fever, excessive sweating, general malaise, and rapid pulse are common at the onset of the disease. After the body temperature is normalized, the pulse still accelerates, showing the phenomenon of temperature-pulse separation. (4) Most have a history of upper respiratory tract infection before onset. (5) Acute arthritis symptoms mostly subside within 3 weeks, and the function can be restored to normal, but it can recur. (6) There is often carditis and skin damage, such as annular red shifts or subcutaneous nodules. (7) A few have manifestations of central and peripheral nervous system damage. (8) Accelerated blood sedimentation, leukocytosis, positive ASO and C-reactive protein (CRP) in the acute phase. (9) Pharyngeal swab culture may be positive for hemolytic streptococcus in the acute phase. (10) Electrocardiogram and cardiac X-ray may be altered. Rheumatoid arthritis is difficult to diagnose in the early stage in a small number of patients who start to suffer from one side of the neck, shoulder and elbow joints. Diagnostic points (1) Pain characteristics: shoulder and elbow joint swelling, neck and shoulder pain, aggravated by activities, a few have neuritis symptoms. (2) Most of the onset of disease is insidious, a few acute onset. It is often accompanied by fatigue, low-grade fever, hand numbness, and morning stiffness or rigidity of the affected joints. Joint deformity and dysfunction may remain. (3) The heart may be involved without clinical symptoms. (4) Juvenile rheumatoid arthritis should be considered in those who develop the disease before the age of 16 years with high fever, enlarged lymph nodes, hepatosplenomegaly, or complicated pericarditis. (5) Blood sedimentation is accelerated, C-reactive protein is increased, and more than 80% of rheumatoid factor (RF) is positive in the active phase. (6) Turbid synovial fluid or incomplete mucin precipitation. (7) There are typical X-ray features in the later stage: osteoporosis, narrowing of the joint space, and multiple small capsule-like destruction under the joint surface. 3.Ankylosing spondylitis A few patients start from cervical arthritis in the early stage and develop neck, shoulder, back and upper limb pain. Diagnostic points (1) pain characteristics: insidious onset, the beginning of interstitial pain, months or years after the emergence of persistent pain, rest, especially at night aggravated, relieved after activities. (2)The onset of the disease is mostly around 20 years old, and the incidence rate of men and women is 6~7:1. (3)The cervical vertebrae protrude posteriorly or laterally, and the head may be in a fixed forward-flexed position, with progressive spinal ankylosis, and there are different degrees of hunchback. Thoracic expansion is progressively limited. (4) Blood sedimentation is accelerated during the active phase, and 95% are HLA¨CB27 positive. (5) X-ray manifestations: early osteoporosis, with the development of the disease can appear “square vertebrae”, the formation of intervertebral bone bridges, bamboo-like ankylosis. Central pain 1, thalamic pain and pseudothalamic pain Thalamic pain can occur when damage occurs to the ventral posterior lateral nucleus of the thalamus; cerebral peduncle, pontine, medulla oblongata and the thalamus near the damage can occur pseudothalamic pain. Diagnostic points (1) pain characteristics: often for one side of the body spontaneous burning pain, tingling, there are a few for the head, face and upper limb pain, the onset of intolerable. Brain stem damage may appear ipsilateral neck and contralateral limb pain. (2) Some have a history of brain trauma or surgery. It is not uncommon to occur a few weeks to 2 years after a cerebrovascular accident. (3) It is accompanied by nociceptive alienation, hyperalgesia or hypersensitivity, and hypesthesia to touch. Positive neurologic signs in the affected area are present. (4) MRI may show damage to areas such as the thalamus or brainstem. Cervical spinal cord cavernous syndrome Diagnostic points (1) Pain characteristics: often unilateral scapular girdle and hand presenting periodic diffuse dull pain, sometimes severe burning pain. (2) Early atrophy of intrinsic muscle weakness in the hand with later upward progression. Upper extremity tendon reflexes disappear. (3) Impaired pain and temperature sensation and presence of other sensations characterize the disease. (4) MRI of the neck may suggest the existence of a cavity in the spinal cord. Sixth, cardiothoracic organ disease caused by neck and shoulder pain angina pectoris or myocardial infarction patients sometimes feel neck and shoulder pain, and to the upper limbs or hand radiation, especially the left upper limb medial, clinical attention should be paid to distinguish. 1, angina pectoris mostly in emergency situations, dull pain in the precordial area, and there is pressure heavy tightness; shortness of breath, sweating, nausea and ergonomics; rest and nitroglycerin can be taken to relieve the symptoms. Electrocardiogram often suggests ST segment lowering, if necessary, coronary angiography to help diagnosis. 2.Cardiac infarction is a common cause of cardiac death and disability. Its ferocious, according to angina pectoris method of treatment is ineffective, often need to use morphine to relieve pain; ECG has typical changes, such as the emergence of pathological Q wave, ST ¨ CT dynamic changes, etc.; myocardial enzyme spectrum is abnormal; radionuclide scanning is abnormal. Seventh, psychological pain This is a problem that deserves attention, it can be alone, but also with other non-psychological pain coexist. It is also called “pain syndromes without a specific organic etiology”. The American Psychiatric Association renamed it “idiopathic pain disorder” in DSM¨CIII¨CR. The diagnostic criteria are as follows: A. The primary disorder is preoccupation with pain for at least 6 months. B. Either (1) or (2): (1) There is no organic pathology or pathophysiologic mechanism (e.g., physical illness or injury) that could account for the pain after an appropriate examination. (2) If the organic disease in question is present, the pain complains of or causes impairment of social or occupational functioning to a much greater extent than could be caused by the organic disease. In the examination of patients with pain, the disease should be considered in the following cases when encountered in patients in whom no organic disease can be found by repeated necessary examinations, whose personality remains intact, who are socially well-adjusted, who are self-aware of their disease, and who take the initiative to seek treatment. (1) Pain is vague, indeterminate and variable in location. Most complain of cephalalgia, head and neck pain, anterior trunk pain, chest and upper extremity pain, and a few complain of external genital pain. (2) Some patients complain of generalized pain, usually more than two pain sites, mostly dull pain, often non-pulsatile, and when aggravated can be pulsatile. (3) Fixed persistent pain in a particular area, with a peculiar and very unpleasant feeling of constriction, and the patient has a peculiar thought process. (4) Difficulty in sleeping with the pain, but not waking up from sleep with the pain. (5) There is delusional pain or hallucinatory pain. (6) There is suspicious pain, accompanied by anxiety, nervousness and inexplicable fear. Although repeated and comprehensive examinations have been conducted in several hospitals, and medical personnel have told them that there is no organic disease, the patient firmly believes that he has a suspicious disease that has not been detected. (7) Often due to external suggestion or self-suggestion of the onset of a sudden loss of function of one side of the limb (no organic disease), the other part of the pain, mostly the left side of the pain, can be cured by suggestive methods, mostly hysteria. (8) Chronic pain is often accompanied by depression manifestations such as frustration and depression. (9) Onset in childhood, aggravated after puberty. Women with normal menstruation, excluding menopausal syndrome. (10) Those with similar family history.