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 try to outline the most common causes of neck pain and how you can treat it.
Identifying The Neck Pain
The first thing you want to identify is if the patient has neck pain or shoulder pain. Shoulder pain and neck pain problems can overlap. You need to know if the origin of the pain at the cervical spine or if 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 paresthesia Radiculopathy (which is shooting pain that radiates from the neck to the arm so that the patient will have unilateral arm pain).
Radiculopathy
Numbness tingling in a specific dermatome on the hand and weakness in a specific muscle group. In cervical radiculopathy, the pain is sudden and goes to the arm. Radiculopathy occurs due to compression of the nerve root 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 reproduces symptoms in the ipsilateral arm. The natural history of cervical Tumor is favourable with the resolution of the symptoms, in most cases in 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 less than 40 years old will have findings of a herniated disc or foraminal stenosis—the Asymptomatic patients who are older 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 be an indication for surgery. The surgery is usually anterior and involves decompression and fusion of the involved disc space.
Cervical Myelopathy
Ask the patient if the patient has gait disturbance unstable gait when walking 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 insidious 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. In cervical myelopathy, you will find upper motor neuron signs like a positive Huffman sign. It is how you will see a positive Huffman sign.
What Are Other Upper Motor Neuron Signs?
You will find the patient will have hyperreflexia positive babyness heat test and clonus test. 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 the patient will complain of pain in the neck after a car accident. It may be referred to as a pain in the head, shoulder and arm. 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 history of weight loss or previous history of cancer or if the patient is getting fever and shells these are scarce situations in a patient that have tingling or numbness in the hand you can consider double crush which means the patient will have two problems to the nerves; one problem comes from the neck another concern comes from compression of the nerves in the elbow like gluteal tunnel syndrome or around the rest like carpal tunnel syndrome.
other causes
ask the patient if he had any diagnosis of 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 the arthritis treatment usually uses miracle management, and surgery is done if there is instability or neurological deficit.
The typical patient that we will see is a patient with 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 neurological deficit. The XA will show mild arthritis, so you’re going to give the patient physiotherapy and anti-inflammatory medication.
