Acute neck and nerve-root pain describes several conditions that affect the cervical spine region, and can also cause head pain. In the long term, it is rarely as disabling as low-back pain, but the severity of acute nerve-root pain ca be just as bad as sciatica.

Neck Pain
Neck Pain

Causes

This pain can be caused by strain of the facet joints and ligaments, and disc herniation. Muscular pain is more of a chronic condition but can flare up. Your neck is also vulnerable to extend indirect trauma, as in whiplash syndrome. When acute neck pain arises spontaneously in young adults or adolescents it is called acute torticollis, or “wry neck”. Disc prolapse with nerve-root compression is the cause of the most severe pain.

Symptoms

You may feel sharp pain, centrally or to one side of the neck, with intense, dull aching that can spread further into the shoulder blade area and half-way down the thoracic spine. You may have stiffness due to your spine being trapped by a muscle spasm (known as “splinting”), and worse pain on certain movements such as bending forwards, backwards, sideways, or rotating. You may also find it hard to sit in a car or at a computer for long periods. The pain is often troublesome at night and lying down may make it worse. If a nerve is compressed or irritated, a sharp pain will radiate down your arm as far as your hand, accompanied by sensory disturbance such as pins and needles or numbness. If your motor nerve fibres have been damages, you may develop weakness in your upper arm/or forearm.

Risks and Complications

The risk of serious consequences of acute neck pain is extremely small. Most of the time the pain eases over a few weeks without specific treatment The main risk lies in too much rest, the fear of triggering pain through everyday movements, and the idea that more pain means further harm, as these can lead to loss of confidence and mobility. If you have developed pain after direct trauma such as a blow to the back of the neck, then you should obtain immediate medical advice.

Treatment for Cervical Disc Herniation

Herniated Disc

Seek Medical Attention

If you suspect your pain is caused by a cervical disc herniation, you should:

  • Relieve your pain by finding the least painful position.
  • Use ice pack for the first day of pain.
  • Take painkillers.
  • Try not to rest for more than 2-3 days.

If after 7-10 days and you are still feeling pain, you should:

  • Stay as active and mobile as you can, while being careful to avoid extreme movements of your neck.
  • Avoid prolonged reaching or working with your arms extended.
  • Ssee a doctor for stronger painkillers.

If after 2 – 4 weeks and you are still feeling pain, you should:

  • Consult a doctor for further examination and treatment.
  • See a specialist for an epidural steroid or nerve-root injection.

If after 6 – 8 weeks and you are still feeling pain, you should:

  • You may need to have an X-ray, MRI or blood test for further evaluation.

Treatment for Acute Torticollis

Seek Medical Attention

If you suspect your pain is caused by acute torticollis, you should:

  • Use ice packs and take some painkillers

If after 3 days and the pain increases, you should:

  • Avoid prolonged static positions

If after 7-10 days and the pain increases, you should:

  • Consult a doctor for further examination, advice, or treatment.

If after 6-8 weeks and the pain increases, you should:

  • You may need to have an X-ray, MRI or blood test for further evaluation.

Treatment for Whiplash

Whiplash Injury

If you suspect your pain is caused by whiplash, you should:

  • See a doctor to get your neck assessed to exclude more serious bone or nerve injury.

If after 7-10 days you are not able to resume normal activities, you should:

  • Consult a doctor for further examination, advice, or treatment.

If after 6-8 weeks you are not recovering as expected, you should:

  • See a specialist regarding the benefit from facet joint injections.
  • You may need to have an X-ray, MRI or blood test for further evaluation.

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Brief Outline of Ulnar Tunnel Syndrome

One of three major nerves responsible for motor function and sensation in the hand, the ulnar nerve runs along the inside of the forearm, reaching down to the heel of the hand. In the hand, the ulnar nerve radiates across the palm and into the little finger and ring finger. Pressure on the ulnar nerve can result in pain, loss of sensation and muscle weakness in the hand.

Anatomy and physiology

The humerus of the upper arm has three bony points, frequently associated with repetitive strain injuries. Two of these bony points are involved in ulnar tunnel syndrome, the olecranon and the medial epicondyle in the elbow. The space between these bony protrusions is known as the ulnar tunnel. The ulnar nerve, which acts on the muscle that pulls the thumb toward the palm of the hand, also controls small intrinsic muscles of the hand. It passes through the cubital or ulnar tunnel at the elbow, running down the forearm and into the hand. It is one of the three major nerves in the arm, the others being the radial and median nerves.

Ulnar Nerve Neuritis

 

Cause of Ulnar Tunnel Syndrome

Overuse of muscles and tendons of the forearm, especially in golf, and sports involving throwing. Abnormal growth in the wrist, such as cyst. Sudden trauma to the ulnar nerve within the ulnar tunnel.

Sign and symptoms

Weakness and increasing numbness on the little finger side of the hand. Difficulty grasping and holding objects. Tingling along the outer forearm, especially when the elbow is bent.

Treatment

  • Cease the activity which is causing pressure on the ulnar nerve, and avoid keeping the elbow in a bent position.
  • Injection.
  • Physiotherapy.
  • Surgery if all conservative treatment fails.

Rehabilitation and prevention

In the case of ulnar tunnel syndrome due to an abnormal growth such as a cyst, surgery may be required to remove it. Where repetitive stress or exercise have led to ulnar nerve inflammation, non-surgical physical therapy, including strengthening exercises will often yield improvement in 4-6 weeks.

Long-term Prognosis

In cases where ulnar tunnel syndrome receives prompt and appropriate attention, the prognosis for full recovery is good. Nerve damage and deficit can result however, should the condition be allowed to persist without care.

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Brief Outline Of Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a progressive affliction caused by direct trauma or repetitive overuse, which results in squeezing or compression of the median nerve at the wrist. The condition is three times more likely to affect women, largely due to occupational tasks such as keyboard work.

Anatomy and physiology

The carpal tunnel is a narrow, rigid structure composed of ligament and bone at the base of the hand. This nerve runs from the forearm to the hand and transmits sensation from the palm side of the thumb and fingers, as well as impulses to certain small muscles of the hand involved in movement. The tunnel surrounds the median nerve (which enters the hand between the carpal bones), and tendons. A narrowing of the tunnel may occur as a result of irritated or inflamed tendons, leading to pressure and compression of the median nerve, causing pain, weakness or numbness in the hand, which gradually radiates up the arm. The conditions is one of a variety of entrapment neuropathies – afflictions involving compression or trauma to peripheral nerves.

Carpal Tunnel Syndrome

Cause of Carpal Tunnel Syndrome

Sporting activities that involve repetitive flexion and extension of the wrist, e.g. cycling, throwing events, racket sports, and gymnastics. Congenital predisposition. Trauma or injury including fracture or sprain. Occupational tasks.

Signs and symptoms

Burning, numbness or itching in the palm of the hand and fingers. Sensation of finger and wrist swelling. Decreased grip strength. Pain that may wake the individual during the night.

Carpal Tunnel Syndrome

Complications if left unattended

Left untreated, carpal tunnel syndrome can lead to decreased or absent sensation in some fingers and permanent weakness of the thumb, as muscles of the thumb degenerate. Proper sensation of hot and cold temperatures may also be diminished in untreated CTS cases.

Treatment

  • Oral Medicines
  • Injection
  • Physiotherapy
  • Surgery if all conservative treatment fails

Rehabilitation and prevention

Halting the repetitive sport or activity and allowing for rest and rehabilitation time following diagnosis of carpal tunnel syndrome is essential. A bandage or splint may be used to stabilise the injured hand. Releasing the tension in the wrist and hand during sports and periodic exercises to retain mobility and retard stiffness in the hands may help prevent the onset of CTS.

Long-term prognosis

Recurrence of carpal tunnel syndrome following treatment is rare, (except in cases of underlying disease, diabetes, endocrine disorders, etc.). The majority of patients properly attending to the injury recover completely.

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Brachial Plexus

Brief Outline of Cervical Nerve Stretch Syndrome

Cervical nerve stretch syndrome, also sometimes referred to as a burner syndrome, results from the stretching (or compression) 0f the brachial plexus a complex of nerves in the lower neck and shoulder area. The injury is common in contact sports including hockey, football, wrestling, and rugby. Sports injuries to the brachial plexus are characterised by a burning sensation that radiates down an upper extremity. Symptoms may last anywhere from two minutes to two weeks.

Anatomy and physiology

Brachial Plexus

The brachial plexus are nerves originating in the brain. They exit the cervical vertebrae, extending to peripheral structures including muscles and organs, (to which they transmit motor and sensory nerve impulses). A series of cervical nerve roots within the brachial plexus send fibres to the shoulder and trapezius muscle, the deltoid muscle and distal radius, the elbow and the fingers.

Cause of the Cervical Nerve Stretch Syndrome

Blow to the head or shoulder, especially in a football tackle. Ear to shoulder bending with rotation (compression of cervical nerves). Hyperextension of the neck.

Signs and symptoms

Severe, burning pain, radiating from the neck to the arm and/or fingers. Parasthesia or numbness, tingling, pricking, burning, or creeping sensation of the skin. Muscle weakness.

Complications if left unattended

Burning and stinging symptoms will persist and often worsen. Further damage to the peripheral nerves can result should the injury be ignored. Symptoms may also indicate spinal cord injury, with potentially serious complications.

Treatment for Cervical Nerve Stretch Syndrome

  • Physiotherapy
  • Oral Medications
  • Ice

Rehabilitation and prevention

Rehabilitation for cervical nerve stretch syndrome usually entails physical therapy. Following a healing phase, such therapy seeks to improve cervical range of motion and to strengthen cervical muscles, with particular attention to the muscles supporting the injured brachial plexus nerve. Proper protective gear, appropriate technique and upper-extremity strength training can help prevent the injury.

Long-term prognosis

Prognosis for the injury is generally good, though some athletes develop chronic form of the condition and a high rate of recurrence has also been noted. In rare cases, nerve injury requires microsurgery to repair nerve damage.

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Anterior compartment syndrome is more often a chronic rather than an acute injury. Runners and other athletes involved in activities that require a lot of repetitive flexion and extension of the foot are most susceptible. Swelling or enlargement of the muscle in the front of the lower leg, causes this condition. Pain, especially when toeing up, and decreased sensation and weakness in the foot may be experienced with this condition. Virtually any injury involving bleeding or oedema formation may lead to compartment syndrome.

Anatomy and Physiology of Anterior Compartment Syndrome

Muscles are covered by fascia, a fairly inflexible fibrous sleeve that encases the muscle and bone. This creates a compartment for the muscle, with the bone forming one side, and the fascia is covering the other sides. In the lower leg, the two bones, the tibia and the fibula, create a more rigid compartment. The tbialis anterior muscle runs over the tibia and fibula and is covered by the fascia. This leaves little room for expansion or swelling of the muscle. When there is increased intramuscular swelling, as a result of trauma or overuse, it creates pressure inside the compartment, which can impede blood flow and function of tissues within the compartment of the muscle.

Cause of Anterior Compartment Syndrome

Acute: Trauma to, or tearing of, the tibialis anterior muscle causing bleeding and/or swelling.

Chronic: Overuse of the muscle causing inflammation and swelling of the muscle pressure in the compartment. Rapid growth of the muscle before the fascia can expand (as seen with anabolic steroid use).

Signs and Symptoms of Anterior Compartment Syndrome

Pain and tightness in the shin (especially the lateral side). Worsens with exercise. Decreased sensation on top of the foot over the second toe. Weakness and tingling may be noticed in the foot.

Complications if Left Anterior Compartment Syndrome Unattended

The pressure int he compartment may lead to permanent nerve and blood vessel damage if left unattended. The underlying cause of the condition will most likely continue to cause irritation and swelling if not treated.

Immediate Treatment for Anterior Compartment Syndrome

Rest, ice and elevation (no compression). Anti-inflammatory medication. Sports massage may be used to stretch the fascia.

Rehabilitation and Prevention for Anterior Compartment Syndrome

Stretching the muscles in the front of the shin will help to alleviate some of the pressure and elongate the muscle. Massage to stretch the fascia may also help to speed recovery. Gradual strengthening and a good flexibility program will help prevent this condition. Avoiding direct trauma to the shin area will prevent acute compartment syndrome.

Long-term Prognosis for Anterior Compartment Syndrome

If treated before damage to the nerves and blood vessels becomes serious, the recovery rate is very good. Acute or severe chronic anterior compartment syndrome may require surgical intervention to relieve the pressure in the compartment.

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