Neck pain

Mr. Harish Kurup

Consultant in Orthopaedics

PilgrimHospital, Boston

Three most common neck problems in general practice are whiplash injury, cervical disc prolapse and cervical spondylosis.

Whiplash injury

1.Incidence/Prevalence

Whiplash is a term that is used to describe a neck injury caused by a sudden movement of the head forwards, backward, or sideways.The sudden, vigorousmovement of the headdamages the ligaments and tendons in the neck. During whiplash, the ligaments in the neck are sprained and can often take a long time to heal (sometimes several months).Whiplash typically causes pain, stiffness, and a loss of movement in the neck. Headaches, muscle spasms, and pain in the shoulders, or arms, are also possible symptoms.

2. Causes

Whiplash is common after motor vehicle accidents, when a collision (often from behind) jolts the head violently forwards and then backwards. Other causes are

  • sudden blow to the head - for example, during contact sports, such as boxing, or rugby
  • after being hit on the head by a heavy object
  • following a slip, or fall, where head is jolted backwards.

3. Symptoms

It may take between 6-12 hours for the symptoms of whiplash to become apparent, and the pain and stiffness is often worse on the day after the injury. The pain may continue to worsen during the days after the injury.

The common symptoms of whiplash include:

  • neck pain and stiffness
  • tenderness along the cervical spine
  • reduced, or loss of, movement in the neck
  • headaches.

The less common symptoms are

  • pain, numbness, or paraesthesia (pins and needles) in the arms and hands
  • muscle spasms
  • dizziness
  • tiredness
  • difficulty in swallowing
  • blurred vision
  • vertigo
  • tinnitus
  • Sometimes, whiplash can also cause memory loss, poor concentration, and irritability.

4.Physical signs

Tests and scans are not usually required in order to diagnose whiplash. The condition can usually be diagnosed from a description of history and symptoms.

5.Investigations

X-ray, computerised tomography (CT) scan, or magnetic resonance imaging (MRI) scan, arerecommended onlyif another problem, such as a spinal injury, is suspected.

6.Treatment

After a few days, the symptoms of whiplash should begin to improve. In about 60% of whiplash cases, the symptoms improve significantly, or completely disappear, within 1-4 weeks. Icepack, analgesics, exercise , physiotherapy all have a role. In severe whiplash cases, the pain can last for more than six months before finally disappearing. Prolonged pain may make it difficult to carry out normal, daily activities, or to enjoy leisure activities, and it may cause problems at work. Sometimes, this may cause anxiety and depression.

7.Prevention

Correctly adjusting the headrests in the vehicle may help to prevent whiplash by stopping the head from moving backwards. However, it is difficult to prevent head moving forwards, or sideways.

Cervical disc prolapse

1. Incidence

A slipped disc most commonly occurs in people who are between 30 and 50 years of age.

2. Symptoms

Cervical disc prolapse can cuase neck pain or radiculopathy ( pain radiating down the arms). This may be asociated with sensory or motor symptoms.

3. Treatment

Management in acute phase is by analgesics, exercise and physiotherapy. Most cases resolve within days to weeks.

4. Referral

Neck pain that do not resolve within few weeks or recurrent cases will need referal to Spine specialist for further evluation and investigations.

Cervical spondylosis

1. Introduction

Cervical spondylosis is a medical term used to refer to the general 'wear and tear' that occurs in the joints and bones in the neck as people get older. The condition is also known as degenerative osteoarthritis. It can lead to episodes of stiffness and neck pain.

2. Incidence / prevalence

It is estimated that by the age of 70, nearly 100% of men, and 96% of women, will have some degree of cervical spondylosis.

3. Causes

With age the cartilage inside the intervertebral discs becomes harder and more brittle, and provide less support to the vertebrae making spine less stable. Body tries to compensate for this by producing small lumps of extra bone known as osteophytes to better support neck and stiffen the spine.Spine becomes too rigid leading to the symptoms of stiffness and neck pain.They can then compress nearby nerves and blood vessels, causing symptoms of radiculopathy, difficulties with swallowing, and sudden fainting.

4. Symptoms

Around 90% of patients with cervical spondylosis will only experience episodes of stiffness and neck pain. Irritation of individual nerve roots cause radiculopathy with sensory and motor disturbances. Compression of vertebral artery causes dizziness or blackouts. Compression of spinal cord (myelopathy) causes weakness and unsteady walking, loss of bladder or bowel control.

5. Investigations

Patients who fail to respond to conservative treatment need referal to spine specialist for evluation and treatment. An X-ray is usually the first investigations and may be followed by MRI scan when appropriate.

6. Treatment

  • Analgesics & muscle relaxants
  • Physiotherapy to strengthen muscles
  • Recommend use of single firm pillow at night.
  • Long tern use of a cervical collar is not recommended , as it can contribute to muscle weakness and make symptoms worse.
  • Surgery is reserved for severe cases and myelopathy which may include laminectomy, discectomy, disc replacement or fusion.

7. Prevention

The best exercises for the health of the cervical spine are low-impact activities, such as swimming, walking, or yoga. Lowering the risk of neck injury by using the correct equipment and techniques when playing sports, may reduce the risk of developing cervical spondylosis. Good posture whilst standing, sitting, working at the computer, driving and sleeping will also help to prevent damage to the spine.