Neck Pain

What is it?

The cervical spine (bones in the neck) allows for more motion than other parts of the spine, making the neck extremely flexible.  Because the neck is more flexible than other areas of the spine and allows for greater range-of-motion, it is less protected than the rest of the spine and more prone to injury.  For most people, neck pain is something that disappears with time, but for some it requires medical diagnosis and treatment.

Causes

Neck pain can be caused by a variety of abnormalities in soft tissues, muscles, ligaments, and nerves.  Neck pain can also stem from disorders of the bones and joints of the spine.  Prolonged wear and tear causes damage to the soft tissues, and this is the most common reason for neck pain.  In some cases, neck pain can come from problems in the back or shoulders.  On rare occasions, neck pain can be caused by infections or tumors.

Degenerative diseases that cause neck pain include osteoarthritis and rheumatoid arthritis. Osteoarthritis usually occurs in the elderly as a result of wear and tear of the joints between the bones in the neck.  Rheumatoid arthritis causes destruction to the neck joints.  Both are known to cause stiffness and pain in the neck.

Cervical disk degeneration can also cause neck pain, as the disk acts like a shock absorber between the bones in the neck.  People usually develop this condition after the age of 40.  The disk degenerates and the space between the vertebrae narrows.  The cervical disk could also protrude and cause pressure on the spinal cord or nerve roots when the disk weakens (herniated cervical disk).

Because the neck is so flexible and supports the weight of the head, it’s very susceptible to injury.  Injury occurs often in motor vehicle accidents, contact sports, diving accidents, and falls. In car accidents, some patients hyperextend their neck, which is when the neck moves backwards further then the normal limit.  People can do the opposite, which is known as hyperflexion, a forward motion beyond the normal limits.  Fractures or dislocations of the neck can damage the spinal cord and cause paralysis.

Seek Treatment When…

One should seek medical care for neck pain if it occurs after an automobile accident, or following any sort of trauma to the head or neck.  Immediate medical care should be sought if the injury causes pain down the arms and legs.  If pain is tolerable, but still causes radiating pain and numbness down the arms and legs, emergency care should be sought.  If your neck pain is not the result of injury, medical care should still be sought when pain is: continuous and persistent, severe, accompanied by pain down the arms and/or legs, or accompanied by headaches, numbness, and/or weakness.

Diagnosis

Orthopedic care is often sought for proper management of neck pain.  Orthopedic doctors are trained in the workings of the musculoskeletal system, including the muscles, bones, joints, ligaments, and tendons.  The first step to treating neck pain is to determine the source of the pain, which can be tougher than it may seem.  The doctor will first take a complete history of the problem concerning the neck, ask about other medical issues, and inquire about any previous treatment.  Next, the doctor will perform a physical examination, which includes evaluating range-of-motion, neck tenderness, and nerve and muscle functions.  In many cases, x-Rays are used to ensure there are no issues affecting the bones and discs.  If further diagnostic tests are required, your doctor may prescribe one or more of the following:

  • MRI (Magnetic Resonance Imaging): this procedure allows for evaluation of the spinal cord and nerve roots

  • Myelogram (injection of a dye or contrast material into the spinal canal): this x-ray allows for targeted evaluation of the nerve roots and spinal canal.

  • CT (computed tomography): this specialized x-Ray allows evaluation of the bone and spinal canal.

  • EMG (electromyogram): this test is used to evaluation nerve and muscle function.

Treatment

Treatment obviously depends on the diagnosis made by your doctor, but most of the time patients are successfully treated with rest, medication, immobilization, physical therapy, exercise, and activity modifications.

Rest is beneficial because many cases of neck pain stem from overuse of the muscles supporting the neck, which can cause pain.  Medication is often administered in the form of anti-inflammatories to reduce the swelling caused by overuse or irritation of the muscles.  Immobilization is used to limit motion in the neck to allow for the body to rest & recover before returning to normal activities.

Physical therapy can also help strengthen neck muscles and correct posture to alleviate pain from overuse.

Surgery is sometimes used to treat neck pain if pain persists after all other treatment options have been exhausted.  Surgery is often needed to reduce the pressure on the spinal cord or nerve roots in cases caused by a herniated disk or narrowing of the spinal canal.  Surgery is also needed sometimes following an injury, to stabilize the neck and minimize the possibility of paralysis (for example: when a fracture results in instability of the neck).

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