An Overview of Neck Pain

 

neck-painNeck pain is a common complaint seen by doctors. Cervical strain is one common cause of neck pain, as the neck muscles stress from poor posture, such as leaning over a workbench or computer. Arthritis is another cause of neck pain, as the vertebral joints (facet joints) suffer degeneration and wear-and-tear with age.

Approximately 85% of all neck pain is the result of stress and strains, and the prevalence rate of neck pain is 17%, with more than 1 million whiplash injuries occurring each year. In addition, chronic neck pain, regardless of the cause, occurs in 9% of adult men and 13.5% of adult women.

Causes of Neck pain

Neck pain can result from several conditions and causes, which include:

  • Muscle strain – Overuse of muscles from too many hours hunched over a steering wheel, workbench, or computer. Strain of muscles can also occur from gritting the teeth.
  • Worn joints – The facet joints undergo damage and aging, which causes arthritis of the cervical vertebrae (bones of the neck).
  • Nerve compression – Bone spurs or herniated discs between the vertebrae take up too much space and press on the spinal nerves.
  • Injuries – Rear-end motor vehicle collisions cause whiplash injuries, which occur when the head jerks backward and then forward. This type of injury causes stretching of the soft tissues in the neck.neck_pain
  • Certain diseases – Many diseases cause neck pain, such as meningitis, rheumatoid arthritis, fibromyalgia, and cancer.

Diagnosis of Neck Pain

To diagnose the cause of neck pain, the doctor will take a detailed medical history and conduct a comprehensive physical examination. Certain imaging and diagnostic tests may be ordered, as well, including:

  • X-rays – Cervical x-rays will show bone spurs, fractures, and bulging discs.
  • Computed tomography (CT) – This test gives views of the soft tissue structures of the neck, such as the muscles, tendons, and ligaments.
  • Magnetic resonance imaging (MRI) – This test uses radio waves and a magnetic field to create detailed images of the soft tissues and bones, including the vertebrae, spinal cord, and spinal nerves.
  • Electromyography (EMG) – Nerve conduction studies are done to asses for a pinched nerve. This test involves insertion of fine needles on the skin into the muscle to detect nerve function.
  • Lumbar puncture – Often called a spinal tap, this test involves insertion of a needle into the spine to withdraw a sample of cerebrospinal fluid. This is done to assess for meningitis.

Treatment of Neck Pain

The treatment of neck pain will depend on the cause. However, for musculoskeletal conditions, treatment options include:

  • Medications – The doctor may prescribe painkillers, muscle relaxants, or a tricyclic antidepressant.

 

  • Physical therapy – The physical therapist will teach neck exercises and stretches to help restore strength and neck function.Facet Joint Injection Use this

 

  • Immobilization – For whiplash and strain, the doctor will put you in a soft cervical collar, which supports the neck and relieves pressure.

 

  • Facet joint injection (FJI) – To alleviate inflammation and reduce pain, the doctor will inject a long-acting corticosteroid into the small facet joints of the cervical spine. The medicine is instilled near the nerve root, and sometimes, an anesthetic (lidocaine) is also injected.

 

  • Tigger point injection (TPI) – A trigger point injection involves injecting an anesthetic medication into the muscle areas that are painful, which are called trigger points.

 

Resources

Barnsley L, Lord S, Bogduk N. Whiplash injury. Pain. Sep 1994;58(3):283-307.

Chen TY. The clinical presentation of uppermost cervical disc protrusion. Spine. Feb 15 2000;25(4):439-42.

Freeman MD, Croft AC, Rossignol AM, et al. A review and methodologic critique of the literature refuting whiplash syndrome. Spine. Jan 1 1999;24(1):86-96.