Sprain and Strain
Cervical sprains and strains involve an overstretching or tearing in the supporting tissues of the neck. A sprain results from injury to the ligaments and a strain from injury to the muscles or muscle tendon. Sprained or strained tissue becomes tender to the touch, and results in stiffness, swelling and reduced range of motion in the neck. Other associated symptoms can include headache, dizziness, numbness, tingling, pain or weakness in the arms.
Cervical sprains and strains typically occur together and are usually a result of one of two common causes: long-term or excessive physical activity or sudden trauma. These types of injuries frequently occur in people whose occupation requires excessive or repetitive use of their arms or awkward head positions, such as working on an assembly line, in car repair, and even working in an office at a computer with poor ergonomics. Sudden trauma, such as an car accident, fall or sports injury, can also cause cervical sprains and strains.
Whiplash is a common cause of a sprain / strain injury. It is also the most common type of injury resulting from a motor vehicle accident. The force at impact causes sudden, excessive extension (backward motion) and then rapid flexion (forward motion) of the neck. A more severe ligament injury can even cause instability of the spine. This can be detected in routine x-rays. Whiplash motion can also cause trauma to the facet joints. Other, more serious injuries to the vertebrae or intervertebral discs are possible but less likely.
People usually report pain from whiplash shortly after an accident, but sometimes the pain doesn’t begin until several days later. After the injury, the muscles surrounding the neck and head stiffen up. Over time, this stiffness may spread from the neck to the upper back muscles. Associated symptoms can occur, including headaches, dizziness, and arm pain or tingling.
Most of the time, your body heals from whiplash, with minimal treatment, over the course of several weeks. Treatment includes heat application, oral anti-inflammatory medications or muscle relaxants and physical therapy.
Arthritis is inflammation and stiffness of a joint that may result in swelling and restricted motion. Arthritic disorders can complicate neck pain in many people.
Osteoarthritis is a degenerative joint disease that occurs in everyone as they age and tends to worsen over time. In fact, osteoarthritis occurs in everyone as they age and tends to worsen over time. In fact, osteoarthritis occurs in more than half the population over age 50. That said, only some of these people suffer chronic pain. Osteoarthritis in the neck can be precipitated by an earlier trauma or degenerative disc disease. Increased friction, inflammation, and bone formation occur because of a mechanical breakdown in the cartilage lining the joint.
Over time, as a response to everyday stressors, our bones thicken to stabilise the spine. When excessive thickening occurs, the extra bone (called bone spurs, or spondylosis) can causes pain by compressing or irritating the exiting the spinal nerve roots (spinal stenosis) or small nerves that supply the facet joints. Excessive bone formation can also extend into the spinal canal, compressing the spinal cord.
Several factors can increase the likelihood of developing severe osteoarthritis. Age is the primary and most predictable reason for osteoarthritis, often starting at around age 30. Work or sports related repetitive motion, or poor body mechanics, can set the stage for arthritis, particularly if you are overweight, because excess pounds place more stress on your joints. Genetic predisposition. poor circulation, or disease – such as diabetes – can also promote the onset and development of osteoarthritis.
Stiffness and pain are common features of osteoarthritis. These symptoms are typically at their worst first thing in the morning, lessening slightly as you become more active after rising. The pain can even awaken a person during the night. Many people with osteoarthritis experience a steady aching pain that is worsened by neck motion. Some people note that this pain becomes most acute during times of major weather changes. This is thought to be related to fluctuations in the barometric pressure and the heavier air that a low-pressure weather front brings.
Much less common types of arthritis include rheumatoid arthritis, psoriatic arthritis, gout, and ankylosing spondylitis.
The number one question that people with neck or upper back pain ask their doctors is if a slipped disc is the cause of their pain. Although it is probably the most common concern, it is not the most common cause of neck pain. Surprisingly, many people with a disc problem do not experience neck pain.
When disc disease is the cause of pain, it typically results in compression or chemical irritation of a spinal nerve root. The fibrous outer shell of the disc (annulus fibrosis) can become torn or cracked by an acute injury or by chronic wear. The back (posterior) of the disc is most susceptible to this type of damage, which can also lead to herniation of the inner nucleus pulposus. Small tears in the disc can heal over time, but recurrent or large tears can result in bulging disc (an intervertebral disc that extends beyond its normal boundary) or a herniated disc (when the inner nucleus pulposus extrudes through the outer annulus).
Large disc herniation in the cervical spine can cause narrowing of the central canal and, as a result, compression of the spinal cord. This compression can cause weakness and numbness not only in the arms but also in the legs. This is not an unusual scenario, yet most people – understandably- fail to attribute leg symptoms to neck problems. More commonly, disc herniation causes narrowing of the spinal foramina, resulting in irritation or compression of a spinal nerve root. The location of the irritation or compression determines where symptoms are experienced in the body. These symptoms can include pain, numbness, tingling, or even weakness and can be present in the neck, upper trunk, or arms. For example, compression of C8 nerve root (at the base of the neck) may result in numbness and tingling in the hand, while irritation of the C5 nerve root (at the middle of the neck) can cause symptoms in the shoulder region. Although some herniated discs require surgical repair, many patients respond to nonsurgical interventions, preventing or delaying a need for surgery. Nonsurgical options are described in the rest of this book.
Radiculopathy and Neuralgia
Radiculopathy is disease of a spinal nerve root. Typically, this disorder results from the compression or physical irritation of a spinal nerve root as it exits the neural foramen. The foraminal space can become narrowed by a disc herniation or by vertebral bone thickening (spurs), causing compression. Or the fluids ordinarily contained within a disc may leak out because of a tear, causing irritation and inflammation in a nearby nerve root. Less commonly, diseases such as shingles or diabetes similar affect the spinal nerve roots by inflaming them. Any one of the eight cervical nerve roots can be involved in a radiculopathy, but the sixth and seventh nerves are the most commonly affected. Cervical radiculopathy can cause not only neck pain but also pain, numbness, and weakness down one or both arms.
Spondylolisthesis and Spondylolysis
Spondylolisthesis is a slipping of one vertebra over another. The most common cause of such slippage is spondylolysis, or a crack in the posterior portion of the vertebra that connects the spinous process to the facet joint. This defect can occur on one or both sides of the vertebra, and it is typically a result of chronic repetitive motion or trauma such as that experienced by professional athletes or industrial workers. Although spondylolisthesis usually occurs in the lower back, it can occur in the neck, especially in people who wear heavy head gear while working, such as welders.
Your doctor will use diagnostic tests to aid in the evaluation of your chronic neck pain. Each test is designed to look for specific types of abnormalities in the anatomy or function of the cervical spine.
X-ray (radiography) is the most commonly performed diagnostic test for patients with neck pain. The bones of the neck are best visualised with this technique when looking for fractures or other changes to the bones.
Magnetic resonance imaging (MRI), unlike an x-ray, does not expose the body to any radiation. MRIs are more frequently ordered to evaluate possible disc pathology.