Lesions of the neck are an uncommon primary cause of pain resulting in either lameness or poor performance but should be considered if local analgesic techniques of the limbs fail to abolish lameness or if there are clinical signs directly referable to the neck such as pain, abnormal neck posture, stiffness, or patchy sweating. Accurate diagnosis requires careful clinical examination, exclusion of other causes of lameness or poor performance, and accurate interpretation of diagnostic imaging findings.