Neck Pain

What is neck pain? What causes neck pain?
Pain in the neck can be more than just a hassle. Neck pain can come from disorders and diseases of any structure in the neck. There are seven vertebrae that are the bony building blocks of the spine in the neck (the cervical vertebrae) that surround the spinal cord and canal. Between these vertebrae are discs and nearby pass the nerves of the neck. Within the neck, structures include the neck muscles, arteries, veins, lymph glands, thyroid gland, parathyroid glands, esophagus, larynx, and trachea.

Pain located in the neck is a common medical condition. Neck pain can come from a number of disorders and diseases of any tissues in the neck, such as degenerative disc disease, neck strain, whiplash, a herniated disc, or a pinched nerve. Neck pain is also referred to as cervical pain.

Cause
Neck pain may result from abnormalities in the soft tissues-the muscles, ligaments, and nerves-as well as in bones and joints of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear and tear. In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders, or arms.

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The vertebral column.
Rheumatoid arthritis can destroy joints in the neck and cause severe stiffness and pain. Rheumatoid arthritis typically occurs in the upper neck area.

Cervical Disk Degeneration (Spondylosis)
The disk acts as a shock absorber between the bones in the neck. In cervical disk degeneration (which typically occurs in people age 40 years and older), the normal gelatin-like center of the disk degenerates and the space between the vertebrae narrows. As the disk space narrows, added stress is applied to the joints of the spine causing further wear and degenerative disease. The cervical disk may also protrude and put pressure on the spinal cord or nerve roots when the rim of the disk weakens. This is known as a herniated cervical disk.

Injury
Because the neck is so flexible and because it supports the head, it is extremely vulnerable to injury. Motor vehicle or diving accidents, contact sports, and falls may result in neck injury. The regular use of safety belts in motor vehicles can help to prevent or minimize neck injury. A "rear end" automobile collision may result in hyperextension, a backward motion of the neck beyond normal limits, or hyperflexion, a forward motion of the neck beyond normal limits. The most common neck injuries involve the soft tissues: the muscles and ligaments. Severe neck injuries with a fracture or dislocation of the neck may damage the spinal cord and cause paralysis.

Other Causes
Less common causes of neck pain include tumors, infections, or congenital abnormalities of the vertebrae.

How is neck pain diagnosed?
In diagnosing the cause of neck pain, it is important to review the history of the symptoms. In reviewing the history, the doctor will note the location, intensity, duration, and radiation of the pain. Any past injury to the neck is noted. Aggravating and/or relieving positions or motions are also recorded. The neck is examined at rest and in motion. Tenderness is detected during palpation of the neck. An examination of the nervous system is performed to determine whether or not nerve involvement is present.

Further testing of undiagnosed neck pain can include x-ray evaluation, CAT scan, bone scan, MRI scan, myelogram, and electrical tests such as electromyography (EMG) and nerve conduction velocity test (NCV).

When Should You Seek Medical Care?
If severe neck pain occurs following an injury (motor vehicle accident, diving accident, or fall), a trained professional, such as a paramedic, should immobilize the patient to avoid the risk of further injury and possible paralysis. Medical care should be sought immediately.

Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs.

Radiating pain or numbness in your arms or legs causing weakness in the arms or legs without significant neck pain should also be evaluated.

If there has not been an injury, you should seek medical care when neck pain is : -
continuous and persistent
severe
accompanied by pain that radiates down the arms or legs
accompanied by headaches, numbness, tingling, or weakness
Many patients seek orthopaedic care for neck pain because orthopaedists are specifically trained to diagnose, treat, and help prevent problems involving the muscles, bones, joints, ligaments, and tendons. Although some orthopaedists confine their practices to specific areas of the musculoskeletal system, most treat a wide variety of diseases, injuries, and other conditions, including neck pain.

How is neck pain treated?
The treatment of neck pain depends on its precise cause. Treatment options include rest, heat/ice applications, traction, soft collar, traction, physical therapy (ultrasound, massage, manipulation), local injections of cortisone or anesthetics, topical anesthetic creams, topical pain patches, muscle relaxants, analgesics, and surgical procedures.

Types of Neck Surgery
Here are three types of neck pain : -
Axial neck pain : - Axial pain is Musculoskeletal, and is pure neck or soft tissue pain. Whiplash or muscle strain is an example.
Radiculopathy : - Cervical radiculopathy refers to neck and arm pain due to nerve root compression. Symptoms include arm pain, numbness or weakness.
Myelopathy : - Myelopathy refers to pressure on the spinal cord, also referred to spinal cord compression. Symptoms include: neck pain with arm and/or leg weakness, numbness, or walking problems.


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