Most common injuries of neck
What are certain features of the cervical spine? Common injuries affecting the cervical spine
The integration of the occiput with C1 and the atlantooccipital joint, provide one-third of flexion-extension and 50% of lateral bending. The atlantoaxial joint and articulation between C1 and C2 provide 50% of rotation. The joints of the C2-C4 vertebrae contribute to two-thirds of flexion-extension, 50% rotation, and 50% of lateral bending. Typically most degenerative changes occur at the C2-C7 segments of the cervical spine. The cervical spine has a normal lordotic curvature. This curve flattens or reverses with arthritic changes or muscle spasm. Accentuated curvature may be a secondary postural adjustment that can occur with thoracic kyphosis or poor posture. Average rotational capability is 90 degrees; lateral bending is 45 degrees, flexion at 60 degrees, and extension at 75 degrees.
Injuries to the cervical spine can cause localized neck pain (axial) versus pain that is referred into the upper extremities.
Cervical strain describes irritation to the muscles or ligaments of the neck. This pain can be attributed to overuse, poor posture, and positioning. The pain will typically last for several weeks but will improve if the source of the pain is avoided.
Myofascial neck pain is described as pain in areas of the neck and shoulders. This is more of a chronic pain marked by tight bands of both muscle and tissue, called trigger points . Palpation of trigger points can refer pain to a different location of the upper body. Myofascial pain can be modified with various stressors, including physical, emotional, or psychological.
Whiplash injury occurs from abrupt, forceful flexion-extension of the cervical spine. This can occur quite often on impact during a motor vehicle collision. The violent movement of the neck will often stress the surrounding joints, muscles, discs, nerves, and ligaments of the cervical spine. Pain will occur nonspecifically along the neck and shoulders. Although this injury is common, the nature of the pain is poorly understood. In one meta-analysis it was found that 50% of adults with whiplash will still have pain after 1 year. Microvascular bleeding and soft tissue inflammation explain the acute source of soft tissue pain. The cause of the chronic pain is not quite understood. It is theorized injury to the alar ligaments may explain the chronic nature of the pain.
Cervical radiculopathy refers to injury of the cervical nerve root. The common injury to a cervical nerve root can be caused by direct compression from a disc herniation, from degenerative changes narrowing the neuro-foramina, or from central stenosis. The C7 nerve root is the most common site of injury, making up 70% of all cervical radiculopathy injuries. The C6 nerve root makes up 20% of cervical nerve root injuries. Radicular pain is marked by paresthesias and/or numbness along a dermatomal distribution down the neck, arm, and hand. Some will experience weakness along a myotomal distribution or will have reflex changes, depending upon the nerve affected. Diagnosis is made based on history and physical examination. On examination, the Spurling’s maneuver (cervical extension and ipsilateral rotation) can reproduce cervical nerve root compression. This examination maneuver is highly specific but carries a low sensitivity. Neuroimaging or electromyography (EMG) testing can be confirmatory but not necessarily diagnostic. An MRI or CT myelogram can confirm nerve compression or central stenosis. An EMG can confirm the location and general timing of the cervical radiculopathy. A short period of high-dose glucocorticoids can provide good temporary relief. Nonsteroidal antiinflammatory drugs may also be an option for management of neck pain. Both tricyclic and reuptake inhibitor antidepressants as well as gabapentin have been prescribed for radicular pain. Cervical traction can be used to expand the intervertebral disc spaces and decompress the area of neck pain. Physical therapy can be performed in conjunction with the traction. Epidural steroid injections have been shown to provide good improvement of radicular pain for up to 6 months of relief. Surgery can be performed if pain persists for 6 to 8 weeks despite conservative care, or for signs of weakness and/or cervical myelopathy.