Neck pain
Mr. Harish Kurup
Consultant in Orthopaedics
Pilgrim Hospital, 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, vigorous movement of the head damages 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
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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:
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neck pain and stiffness
tenderness along the cervical spine
reduced, or loss of, movement in the neck
headaches.
The less common symptoms are
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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.
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, are
recommended only if 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
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Analgesics & muscle relaxants
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Physiotherapy to strengthen muscles
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Recommend use of single firm pillow at night.
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Long tern use of a cervical collar is not recommended , as it can contribute to muscle
weakness and make symptoms worse.
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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.