Neck pain can last from days to years, depending on the cause. Seek immediate care if severe neck pain results from an injury, such as a motor vehicle accident, diving accident or fall.
Neck pain can make your neck muscles tense up, preventing you from moving your head. Patients can complain of neck pain for a variety of reasons. In this article, we will outline the most common causes of neck pain and how to treat it.
Identifying The Neck Pain
First, identify whether the patient has neck or shoulder pain. Shoulder pain and neck pain problems can overlap.
You need to know if the pain at the cervical spine or the shoulder itself is the origin of the pain that the patient’s symptoms improve by shoulder abduction and placing the hand over the head. Then the pain is of cervical spine origin.
Shoulder Abduction Test
Lifting the arm above the head usually relieves the symptoms of shoulder abduction because it decreases tension on the affected nerve. Pain is more when you move the shoulder.
Then the shoulder itself is the source of the pain. A pretty common cause of neck pain is disc herniation.
The patient will complain of numbness and paresthesia Radiculopathy (shooting pain radiating from the neck to the arm so that the patient will have unilateral arm pain).
Numbness tingling in a specific dermatome on the hand and weakness in a particular group of muscles. In cervical radiculopathy, the pain is sudden and goes to the arm. Radiculopathy occurs due to nerve root compression, either by a disc. Herniation or Arthritis that narrows the foramen.
Cervical disc herniation occurs most frequently at the level of c6 c7, and this will affect the c7 nerve root. It can also happen at c5 c6, and, in this case, it will affect the c-sex nerve root.
Cervical Spine Disc Herniation Test
You test the motor, the sensory and the reflexes. It is how you check the motor strength of the nerve roots from c5 to t1. It is how you test the sensation, as you see here in this diagram. It is how you test the reflexes, a spelling test for cervical spine radiculopathy.
What is the Spurling test? The spelling test comes out positive when neck extension and rotation towards the painful side reproduce symptoms in the ipsilateral arm.
The natural history of cervical Tumors is favourable with the resolution of the signs in most cases of cervical radiculopathy. With conservative treatment, patients will have 70 to 80 percent successful outcomes after two to three months.
How do you treat cervical disc herniation? You’re going to have a non-surgical treatment first. We will use anti-inflammatory medication, isometric exercises, physiotherapy muscle relaxants, then get an MRI if the symptoms do not improve after six weeks of conservative treatment.
The MRI result should correlate with the clinical symptoms.
Age Is Relevant to Neck Pain
Patients under 40 years old will have findings of a herniated disc or foraminal stenosis—the Asymptomatic patients are more than 40 years old.
You will find that 57% of these patients will have at least one degenerated disc on the MRI, so the MRI may show you a problem with the disc in patients that are not complaining of any neck pain; therefore, use the result of the MRI wisely and don’t scare the patient because what you find in the MRI could be a normal process.
Persistent disabling pain for six to twelve weeks despite non-operative treatment can indicate surgery. The surgery is usually anterior and involves decompression and fusion of the involved disc space.
Ask the patient if the patient has gait disturbance, unstable gait when walking at wide-based speed or hand clumsiness. It may indicate cervical myelopathy due to compression of the spinal cord, which is a severe condition.
The patient may have decreased manual dexterity and difficulty manipulating delicate objects such as buttoning and unbuttoning shirts.
The patient may have an occipital headache and a sense of discomfort in the neck. The patient may not have severe neck pain in general. In cervical myelopathy, the onset of pain is gradual, poorly characterized and localized.
Cervical myelopathy is a slowly progressive process with stepwise progression and deterioration over time. In cervical myelopathy, the MRI will show compression of the spinal cord.
You will find upper motor neuron signs like a positive Huffman sign in cervical myelopathy. It is how you will see a positive Huffman sign.
What Are Other Upper Motor Neuron Signs?
The patient will have hyperreflexia-positive babyness heat and clonus tests. Early recognition and early surgery are necessary for a good outcome. The severity of the symptoms and early treatment is most important to the result.
Surgery is done for any functional impairment of the gate or the hands. Usually, the treatment in this situation is surgery by decompression and fusion.
Ask the patient if they were involved in a car accident. The patient may have a whiplash injury, so that the patient will complain of pain in the neck after a car accident.
It may be referred to as head, shoulder and arm pain. Usually, there is no neurological deficit, the patient will have a soft tissue injury, and the x-ray will show loss of cervical lordosis due to muscle spasms treatment.
Aggressive Physiotherapy And Early Mobilization for Neck Pain
Ask the patient if the pain is connected to activity or is independent of action and if the pain is worse at night and not relieved by rest or immobilization.
This pain may be coming from a tumour or infection. Asking the patient about a history of weight loss or previous history of cancer or if the patient is getting fever and shells are scarce situations in a patient that have tingling or numbness in hand.
You can consider double crush, which means the patient will have two problems with the nerves; one problem comes from the neck, and another concern comes from compression of the nerves in the elbow, like gluteal tunnel syndrome or around the rest carpal tunnel syndrome.
ask the patient if he was diagnosed with carpal tunnel syndrome or cubital tunnel syndrome, and you may need to get the image and nervous studies to the upper extremity from the neck down. The patient may have cervical nerve root compression and distal nerve compression.
Another cause of neck pain is cervical spondylosis which is arthritis of the spine. It is a natural degenerative process of the cervical spine. The x-ray will show that arthritis treatment usually uses miracle management, and surgery is done if there is instability or neurological deficit.
The typical patient we will see is neck pain and no injury. The pain in the posterior part of the neck is tender to palpation, and no radiation to the arm sensory or motor deficit or neurological deficit. The XA will show mild arthritis, so that you will give the patient physiotherapy and anti-inflammatory medication.