Which tests help differentiate discogenic pain from facet-mediated pain in the neck?

• A. Spurling's test
• B. Centralization phenomenon and provocative facet-loading tests
• C. Distraction test
• D. Shoulder abduction test

Answer: (B)

The key idea is using patterns of symptom response to targeted tests to tell disc problems from facet joint problems. The centralization phenomenon is when repeated movements or loading move symptoms toward the midline or proximal part of the spine, which is a hallmark suggesting disc-related pain. On the other hand, provocative facet-loading tests stress the facet joints directly and tend to reproduce facetogenic pain without producing the same centralizing pattern seen with disc problems. So, evaluating both aspects together—centralization patterns for discogenic involvement and facet-loading responses for facet joint involvement—provides the best differentiation between disc-related neck pain and facet-mediated neck pain.

Other tests may help identify cervical radiculopathy in general, but they don’t specifically separate discogenic from facet-mediated pain in the same integrated way.