Neck pain

Editor-In-Chief: Robert G. Schwartz, M.D. [3],Piedmont Physical Medicine and Rehabilitation, P.A.

Neck pain is a common problem, with two-thirds of the population having neck pain at some point in their lives.^[1] It is increasing in both intensity, frequency and severity of episodes. As people are increasingly sedentary, live fast-paced and hectic lives, they place more stress and strain on the upper back and neck regions of their spines.

The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain. The top three joints in the neck allow for most movement of your neck and head. The lower joints in the neck and those of the upper back create a supportive structure for your head to sit on. If this support system is affected adversly, then the muscles in the area will tighten, leading to neck pain.

Neck pain may also arise from many other physical and emotional health issues.

Neck pain, although felt in the neck, can be caused by numerous other spinal issues. For example, neck pain may arise due to muscular tightness in both the neck and upper back. Joint disruption and ligamentous strain in the neck and upper back can create pain, as can sympathtetically mediated pain. Neck pain is a frequent cause ofcervicogenic headache orMigraine.

About one-half of episodes resolve within one year. About 10% of cases become chronic.

The physician will examine the back and conduct neurologic tests to determine the cause of pain and appropriate treatment.

X-ray imaging includes conventional and enhanced methods that can help diagnose the cause and site of back pain. A conventional x-ray, often the first imaging technique used, looks for broken bones or an injured vertebra. A technician passes a concentrated beam of low-dose ionized radiation through the neck and takes pictures that, within minutes, clearly show the bony structure and any vertebral misalignment or fractures. Tissue masses such as injured muscles and ligaments or painful conditions such as a bulging disc are not visible on conventional x-rays. This fast, noninvasive, painless procedure is usually performed in a doctor’s office or at a clinic.

Computerized tomography (CT) is a quick and painless process used when disc rupture, spinal stenosis, or damage to vertebrae is suspected as a cause of neck pain. X-rays are passed through the body at various angles and are detected by a computerized scanner to produce two-dimensional slices (1 mm each) of internal structures of the neck. This diagnostic exam is generally conducted at an imaging center or hospital.

Magnetic resonance imaging (MRI) is used to evaluate the lumbar region for bone degeneration or injury or disease in tissues and nerves, muscles, ligaments, and blood vessels. MRI scanning equipment creates a magnetic field around the body strong enough to temporarily realign water molecules in the tissues. Radio waves are then passed through the body to detect the “relaxation” of the molecules back to a random alignment and trigger a resonance signal at different angles within the body. A computer processes this resonance into either a three-dimensional picture or a two-dimensional “slice” of the tissue being scanned, and differentiates between bone, soft tissues and fluid-filled spaces by their water content and structural properties. This noninvasive procedure is often used to identify a condition requiring prompt surgical treatment.

Diagnostic musculoskeletal ultrasound imaging, also called ultrasound scanning or sonography, uses high-frequency sound waves to obtain images inside the body. The sound wave echoes are recorded and displayed as a real-time visual image. Ultrasound imaging can show tears in ligaments, muscles, tendons, and other soft tissue masses in the back.

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• There is limited information about the historical perspective of neck pain.

• There is limited information about the historical perspective of neck pain.

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The exact pathogenesis of neck pain is not fully understood.It is thought that neck pain is the result of disturbed oxidative metabolism and increase levels of pain-generating substances in neck muscles,that cause impaired local muscle circulation.Is caused by either changing coordination of cervical muscles and impaired proprioception in the neckand shoulders.

• The exact pathogenesis of neck pain is not completely understood.

• It is understood that neck pain is the result of disturbed oxidative metabolism and increase levels of pain-generating substances in neck muscles,that cause impaired local muscle circulation.

• Is caused by either changing coordination of cervical muscles and impaired proprioception in the neckand shoulders.^[1][2]

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Editor-In-Chief: Robert G. Schwartz, M.D.[3],Piedmont Physical Medicine and Rehabilitation, P.A.

Neck pain, although felt in the neck, can be caused by numerous other spinal issues. Neck pain may arise due to muscular tightness in both the neck and upper back. Joint disruption in the neck creates pain, as does joint disruption in the upper back. Neck pain is a frequent cause ofcervicogenic headache orMigraine.

Reasons for neck pain can be complex. Major and severe causes of neck pain include:

• Spondylosis – degenerative arthritis and osteophytes
• Spinal stenosis – a narrowing of the spinal canal
• Spinal disc herniation – protruding or bulging discs, or if severe prolapse.
• Severe degeneration – usually as a result of past injuries or whiplash accidents.^[1][2][3][4]

The more common and lesser neck pain causes include:

• Stress – physical and emotional stresses
• Prolonged postures – many people fall asleep on sofas and chairs and wake with sore necks
• Minor injuries and falls – car accidents, sporting events and day to day minor injuries
• Referred pain – mostly from upper back problems
• Over-use – muscular strain or ligamentous sprain are two the most common causes^[5]

Non-spinal conditions:

• Cardiovascular disease
• infection
• malignancy
• rheumatologic disease

• Botulinum toxin
• Nabilone
• Tiagabine

Although the causes are numerous, most are easily rectified by either professional help or using self help advice and techniques.

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There is extensive differential diagnosis for neck pain.Varity of diseases manifest as neck pain.The most causes are biomechanical axial neck pain, whiplash associated disorder (WAD),radiculopathy, cervical myelopathy, infection, neoplasm, rheumatic causes, trauma, referred pain and fibromyalgia.

There is extensive differential diagnosis for neck pain.Varity of diseases manifest as neck pain.The most causes are biomechanical axial neck pain, whiplash associated disorder (WAD),radiculopathy, cervical myelopathy, infection, neoplasm, rheumatic causes, trauma, referred pain and fibromyalgia.^[1]

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Approximately two thirds of all individuals will experience neck pain in their life.The mean prevalence of neck pain is approximately 7.6%(range 5.9–38.7%).The lifetime prevalence of neck pain is approximately 48.5% (range 14.2–71.0%).Patients of all age groups may develop neck pain,but is more common in middle age.Female are more commonly affected by neck pain than male.

• The mean prevalence of neck pain is approximately 7.6%(range 5.9–38.7%).
• The lifetime prevalence of neck pain is approximately 48.5% (range 14.2–71.0%).^[1][2]

• Patients of all age groups may develop neck pain,but is more common in middle age.^[1][2]

• There is no racial predilection to neck pain.

• Female are more commonly affected by neck pain than male.^[1][2]

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The most potent risk factors in the development of uncomplicated neck pain is poor posture, anxiety and depression, neck strain, occupational injuries, or sporting injuries.Other risk factors include mechanical and degenerative factors, soft-tissue trauma, most typically seen in whiplash injuries. Disc prolapse and inflammatory, infective, or malignant conditions affect the cervical spine are less common risk factors.

• Bad everyday habits and postures: Chronic neck stiffness/pain is caused by everyday activities, including having poor posture while watching TV or reading, placing your computer monitor too high or too low, sleeping in an uncomfortable position, bending over a desk for hours, or twisting and turning the neck in a jarring manner while exercising.s^[1][2][3][4]
• Trauma and injury
• Degenerative changes in neck such as osteomyelitis, herniated disk
• Fibromyalgia
• Infection of the spine, such as abscess, meningitis
• Immune system diseases such as rheumatoid arthritis (RA), ankylosing spondylitis (AS),polymyalgia rheumatica
• Neurological diseases such as stroke, muscular dystrophy, multiple sclerosis
• Cancer that involves the spine

• Common risk factors in the development of neck pain may be occupational, environmental, genetic, and viral.
• Common risk factors in the development of neck pain include:
  • poor posture
  • anxiety
  • depression
  • neck strain
  • occupational injuries
  • sporting injuries
  • mechanical and degenerative factors
  • whiplash injuries^[1][2][3][4]

• Less common risk factors in the development of neck pain include:
  • Disc prolapse and inflammatory
  • infective
  • malignant conditions affect the cervical spine ^[1]

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Editor-In-Chief: Robert G. Schwartz, M.D.[3],Piedmont Physical Medicine and Rehabilitation, P.A.

After days and weeks neck pain usually become better, but can reoccur or become chronic.In 10% of population it become chronic and, proportion of disability is 5% of affected people.Disability is more common with Whiplash injuries.40% of patients with Wiplash injuries reported symptoms after 15 years.

• The symptoms of whiplash injuries may develop after 15 years follow up.
• If left untreated, 10% of patients with neck pain may become chronic or recurrent.^[1]
• In terms of overall disability, it ranks fourth in the world and, causes increase absence from work, insurance costs and decrease work efficiency.^[2][3]

• Common complications of whiplash injuries include:
  • Chronic neck pain
  • Headache

• Depending on the cause of the neck pain, the prognosis may vary. However, the prognosis is generally regarded as good.
• Disability is more common with Whiplash injuries.40% of patients with Whiplash injuries reported symptoms after 15 years.^[1]

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