Neck Pain

The neck (cervical spine) is composed of vertebrae which begin in the upper torso and end at the base of the skull. The bony vertebrae and the ligaments (like thick rubber bands) provide stability to the spine. The muscles in this area allow for support and neck motion. For many people, neck pain is a temporary condition that disappears with time. Others need medical diagnosis and treatment to relieve their symptoms. Many people suffer from neck pain due to injuries.

What causes neck pain?

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 cases, infection or tumors may cause neck pain.
Neck problems may be the source of pain in the upper back, shoulders or arms for some people
Osteoarthritis
Rheumatoid Arthritis
Cervical Disk Degeneration

Degenerative and inflammatory diseases

Osteoarthritis and rheumatoid arthritis are degenerative diseases that cause neck pain. Osteoarthritis usually occurs in older people as a result of wear of the joints between the bones in the neck. Rheumatoid arthritis can cause destruction of the joints of the neck. Both Osteo and Rheumatoid arthritis can cause stiffness and pain.

Cervical disk degeneration also can cause neck pain. It is more often seen in patients over the age of 40. The disk acts as a shock absorber between the bones in the neck. In cervical disk degeneration the normal gelatin-like center of the disk degenerates and the space between the vertebrae narrows. As the disk space narrows, more stress is applied to the joints of the spine causing more wear and degenerative disease. Herniated Cervical Disk is when the cervical disk protrudes and causes pressure on the spinal cord and nerve roots causing pain.

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 use of safety belts in motor vehicles has shown to prevent and minimize 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. Most of these injuries are to the soft tissues, i.e., muscles and ligaments. Severe injury with fracture or dislocation of the neck may damage the spinal cord and cause paralysis (quadriplegia).

Much less common causes of neck pain include tumors, infections, or congenital abnormalities of the vertebrae.

When should you seek medical care?

If severe neck pain occurs following an injury (motor vehicle accident, diving accident, fall), a trained medical professional, such as a paramedic, should immobilize the patient to avoid the risk of further injury and possible paralysis. Patient should be taken to the Emergency Room immediately for medical care and evaluation after a motor vehicle accident, especially in cases 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

Who can treat neck pain? Many patients seek orthopaedic care for neck pain, because orthopaedists are specifically trained in the workings of the musculoskeletal system, including the diagnosis, treatment, and prevention of problems involving the muscles, bones, joints, ligaments and tendons.

Diagnosing neck pain

It is essential to determine the source of the pain in order for the right method of treatment and rehabilitation to be recommended. Therefore a comprehensive examination is required to determine the cause of neck pain.

Your physician will gather the following information and order these diagnostic tests in order to diagnose your condition:

Physician will take a complete medical history from the patient and gather information about past injuries to patients neck and spine
Patient will need to describe symptoms of neck pain he is experiencing and what complaints he associates with the neck pain
Has patient had previous neck conditions
Has patient had previous treatments for his neck condition
Physician will perform a comprehensive physical examination to evaluate: neck motion, neck tenderness, and function of the nerves and muscles in patients arms and legs
X-rays are often ordered to take a close look at the bones in the neck

These simple diagnostic techniques often help orthopaedists to determine the cause of neck pain and to prescribe effective treatment.

Patients who require further evaluation may undergo one or more of the following examinations:

MRI (magnetic resonance imaging) - evaluates the spinal cord and nerve roots.
CT (computed tomography). This specialized X-ray study allows careful evaluation of the bone and spinal canal.
Myelogram (injection of a dye or contrast material into the spinal canal). This specific X-ray study also allows careful evaluation of the spinal canal and nerve roots.
EMG (electromyogram). This test evaluates nerve and muscle function.

Your orthopaedist may supplement your evaluation with blood tests, and, if necessary, will consult with other medical specialists.

Treatment

How neck pain is treated depends on what the diagnosis reveals.

In most cases, patients are treated successfully with a combination of these methods:

Rest – advise the patient to get proper rest
Anti-inflammatory medications are effective in reducing pain and inflammation, i.e. Ibuprofen, Naprosyn, Ketoprofen
Medicated creams: Ketoprofen 20% cream, Ibuprofen 10% cream, Lidocaine cream
Immobilization
Physical therapy – including pool therapy is very helpful in some patients to relieve pain
Exercise
Activity modifications
Neck collar –sometimes recommended by your orthopedist for a short period of time

For example, if pain is caused by inflammation as a result of stretching muscles and ligaments beyond their limits, your physician may prescribe rest and a neck collar for a specified period of time, as well as medication to reduce inflammation. If anti-inflammatory medications are prescribed to reduce pain, it should be used only as directed and should not be taken for extended periods of time. In addition, remember that if your orthopaedist prescribes rest, it is vital that you follow instructions carefully.

When neck pain persists or is chronic, your orthopedic surgeon may recommend a rehabilitation program that includes an exercise program and various types of physical therapy to help you relieve your pain and prevent it from coming back.

When is surgery recommended for neck pain?

Very few patients require surgery to relieve neck pain. For the vast majority of patients, a combination of rest, medication and physical therapy will relieve neck pain. Surgery may be recommended to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated disk or bony narrowing of the spinal canal. Surgery may also be required following an injury, to stabilize the neck and minimize the possibility of paralysis such as when a fracture results in instability of the neck.

Dr. Emmanuel is an orthopedic surgeon with extensive training in the diagnosis and nonsurgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves. If you have been experiencing neck pain, Contact Us to schedule an appointment with Dr. Emmanuel for a comprehensive evaluation of your symptoms.