Neck
Cervical Fracture
You have seven bones in your neck. These are the cervical vertebrae, which support your head and connect it to the shoulders and body. A fracture, or break, in one of the cervical vertebrae is commonly called a broken neck.
Cervical fractures usually result from high-energy trauma, such as automobile crashes or falls. Athletes are also at risk. A cervical fracture can occur if:
- A football player "spears" an opponent with his head.
- An ice hockey player is struck from behind and rams into the boards.
- A gymnast misses the high bar during a release move and falls.
- A diver strikes the bottom of a shallow pool.
Any injury to the vertebrae can have serious consequences because the spinal cord, the central nervous connection between the brain and the body, runs through the center of the vertebrae. Damage to the spinal cord could result in paralysis or death. Injury to the spinal cord at the level of the cervical spine can lead to temporary or permanent quadriplegia, paralyzing the entire body from the neck down.
Emergency response
In a trauma situation, the neck should be immobilized until X-rays are taken and reviewed by a physician. Emergency medical personnel will assume that an unconscious individual has a neck injury and respond accordingly. The victim may experience shock and either temporary or permanent paralysis.
Conscious patients with an acute neck injury will usually have well-localized severe pain. They may also have pain spreading from the neck to the shoulders or arms, resulting from the vertebra compressing a nerve. There may be some bruising and swelling at the back of the neck. The physician will perform a complete neurological examination to assess nerve function and may request additional radiographic studies, such as an MRI or computed tomography (CT) scan, to determine the extent of the injuries.
Treatment
Treatment will depend on which of the seven cervical vertebrae was damaged and the kind of fracture sustained. A minor compression fracture can be treated with a cervical brace worn for six to eight weeks until the bone heals. A more complex or extensive fracture may require traction, surgery and internal fixation, two to three months in a rigid cast, or a combination of these treatments.
Improvements in athletic equipment and rule changes have reduced the number of cervical fractures over the past 20 years. You can help protect yourself and your family if you:
1. Always wear a seat belt when you are driving or a passenger in a car.
2. Never dive in a shallow pool area, and be sure that young people are properly supervised when swimming and diving.
3. Wear the proper protective equipment for your sport and follow all safety regulations, such as having a spotter and appropriate cushioning mats.
Cervical Radiculopathy
Usually, when something hurts, you don't have to look far to find the source of the pain. But an injury near the root of a nerve could result in pain at the end of the nerve, where sensation is felt. For example, an injury to the vertebrae or disks in your neck (your cervical vertebrae) could result in pain, numbness or weakness in your shoulder, arm, wrist or hand. That's because the nerves that extend out from between the cervical vertebrae provide sensation and trigger movement in these areas, this condition is called cervical radiculopathy (ra-dick-you-lop'-a-thee).
Causes of cervical radiculopathy
Several conditions can put pressure on nerve roots in the neck. The most common causes for cervical radiculopathy are:
Herniated cervical disk. In this situation, the outer layer (annulus) of the disk cracks and the gel-like center (nucleus) breaks through. This causes the disk to protrude, putting pressure on the nerve that exits the spinal column at that point.
Spinal stenosis. Sometimes, the space in the center of the vertebrae narrows and squeezes the spinal column and nerve roots.
Degenerative disk disease. As we age, the water content in our body cells diminishes and other chemical changes occur that can cause the disk to shrink. Without sufficient cushioning, the vertebrae may begin to press against each other, pinching the nerve, or to form bony spurs.
Diagnosis and treatment
Your physician will give you a careful examination and ask about your symptom history. You may be asked to extend and rotate your neck and/or arm to reproduce the pain symptoms. An X-ray will usually show any degenerative disk problems. Sometimes your physician may request an MRI (magnetic resonance image) or a CT scan (computed tomography) using a colored dye to outline the nerves. Initial treatment is usually conservative and aims to reduce the pain by easing the pressure on the nerves. The treatment consists of three parts: rest, medication and physical therapy.
- Rest. You may have to take it easy for a few days or wear a soft cervical collar to limit motion and relieve irritation on the nerves.
- Medication. Your doctor may prescribe a non-narcotic pain medicine and anti-inflammatory drugs to relieve any swelling.
- Physical therapy. After muscle spasms subside, your orthopaedic surgeon may prescribe a cervical traction device or other types of physical therapy such as heat or cold therapies, electrical stimulation, or isometric and stretching exercises.
If conservative treatment doesn't relieve your pain over the course of 6 to 12 weeks, surgery may be an option. The surgical procedure will depend on the underlying condition. Your orthopaedic surgeon will discuss the options with you. In most cases, surgery not only relieves the pain, but also improves functioning and movement of the affected areas.
Cervical Spondylosis
Pain in the neck is common and may be a natural consequence of aging in people over 50. Like the rest of the body, bones in the neck (cervical spine) progressively degenerate as we grow older. Over time, arthritis of the neck (cervical spondylosis) may result from bony spurs and problems with ligaments and disks. The spinal canal may narrow (stenosis) and compress the spinal cord and nerves to the arms. Injuries can also cause spinal cord compression. The pain that results may range from mild discomfort to severe, crippling dysfunction.
Symptoms
Cervical spondylosis can lead to chronic pain and stiffness in the neck that may also radiate to the upper extremities (radiculopathy).
- Neck pain and stiffness may be worse with upright activity.
- You may have numbness and weakness in the arms, hands and fingers, and trouble walking due to weakness in the legs.
- You may feel or hear grinding or popping in the neck when you move.
- Muscle spasms or headaches may originate in the neck.
The condition can make you feel irritable and fatigued, disturb your sleep and impair your ability to work. See your doctor soon for diagnosis and treatment.
Doctor's exam
Give the doctor your complete medical history. This can help him or her rule out other conditions that cause symptoms similar to cervical spondylosis. The doctor will examine you physically and may take X-rays or use other diagnostic imaging tests to see inside the body.
Medical history. Tell the doctor if you have any illnesses or chronic conditions. Describe the exact location of neck pain and when the problem began. What does the pain feel like? Have you ever injured your neck or been previously treated for neck pain?
Physical exam. The doctor may identify tender spots along the back of your neck and evaluate your ability to move the neck in various directions. He or she may test your reflexes and the function of nerves and muscles in the arms and legs. The doctor may want to watch you walk.
Imaging. X-rays and/or MRI (magnetic resonance imaging) studies may show bone spurs and other abnormalities and reveal the extent of damage to the cervical spine.
In certain cases, you may need additional tests before the doctor can make a diagnosis. Sometimes the doctor may want you to see a neurologist for evaluation.
Treatment
If you have cervical spondylosis, symptoms may last for several months or become chronic. Most of the time if symptoms are mild, the doctor may recommend a variety of non-surgical treatments. Rest, medication and physical therapy may take away most of your symptoms, but do not treat the underlying cause. The doctor may want to see you again to check if symptoms have gotten better, worse or stayed the same.
Rest. You may need to wear a soft cervical collar or neck brace to limit neck motion and relieve nerve irritation.
Medication. The doctor may prescribe non-steroidal anti-inflammatory medications (NSAIDs) or other non-narcotic pain relievers to relieve pain and reduce swelling.
Physical therapy. A cervical traction device, hot and cold therapy or active exercise program may help relieve symptoms. Exercises may include neck strengthening, neck and shoulder stretching and aerobic exercises. Gentle massage and improving your posture may also help.
Surgery. Surgery may be necessary if you have severe pain that does not improve with other treatments or progressive neurological symptoms. Surgery may remove bone spurs or disk material (decompression) and provide lasting relief.
Congenital Torticollis (Twisted Neck)
Description
Parents of a newborn are often fascinated by their child's every move. When a child doesn't move in a normal way, the parents are rightly concerned.
An infant who keeps his or her head tilted to one side may have a condition called congenital muscular torticollis. Congenital means that the condition is present at birth. Torticollis means twisted or bent neck. It is caused by a tight muscle on one side of the head that pulls the head (ear) down toward one shoulder as the chin tilts to the opposite side.
Within the first month after birth, a lump or pseudotumor may be felt on the tight muscle, but this gradually disappears. As many as one in five babies born with congenital muscular torticollis also has developmental dysplasia of the hip. Early diagnosis and treatment is required to avoid permanent deformities.
If you notice that your child consistently holds the head tilted to one side, consult your physician. Conditions other than congenital muscular torticollis may result in this head position, and the physician must eliminate them as possible causes. The physician will also want to check the child's hips to ensure that no dysplasia is present. He or she may request X-rays or an ultrasound of the hips.
Congenital muscular torticollis generally is painless and can be treated with a consistent program of exercises and stretching.
Risk Factors / Prevention
How it develops. No one knows exactly what causes this condition, which is more common in first-born children. One theory is that the muscle was stretched or torn during the delivery. Bleeding and swelling create pressure on the muscle. Eventually, scar tissue forms and replaces some of the muscle. Another theory suggests that the condition develops while the infant is still in the womb.
Symptoms
- Head tilts to one side, and chin points to the opposite shoulder. Usually, the head tilts right and the chin points left, meaning the muscle on the right side is affected.
- Lump or swelling in the muscle that gradually disappears.
- Limited range of motion in neck muscles.
- One side of face may flatten and the skull may appear oblong instead of round.
Treatment Options
The initial treatment consists of a series of exercises that must be done several times a day. The physician may refer you to a physical therapist, but most of the time, the parents will be doing the exercises with the child, turning and bending the child's head to stretch the muscle.
Placing toys and other objects in positions where the infant has to turn the head to see them encourages the infant to stretch the muscle. So does carrying the infant in a side-lying position, with the face away from you. Support the infant by putting one arm under the head on the side of the tight muscle, which will stretch the muscle. Place the other arm between the child's legs to hold the body.
Treatment Options: Surgical
Most of the time, this condition resolves by the time the child is a year old. If not, the physician may recommend surgical treatment to release and lengthen the tight muscle.
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 along with the ligaments (like thick rubber bands) provide stability to the spine. The muscles allow for support and motion. The neck has a significant amount of motion and supports the weight of the head. However, because it is less protected than the rest of the spine, the neck can be vulnerable to injury and disorders that produce pain and restrict motion. For many people, neck pain is a temporary condition that disappears with time. Others need medical diagnosis and treatment to relieve their symptoms.
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. In some people, neck problems may be the source of pain in the upper back, shoulders or arms.
Degenerative and inflammatory diseases - Degenerative diseases that cause neck pain include osteoarthritis and rheumatoid arthritis. 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 of these major types of arthritis can cause stiffness and pain.
Cervical disk degeneration also can cause neck pain. The disk acts as a shock absorber between the bones in the neck. In cervical disk degeneration (typically age 40 onwards), 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 cause 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 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 common 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 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
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. While 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.
Diagnosing neck pain
Determining the source of the pain is essential to recommend the right method of treatment and rehabilitation.Therefore a comprehensive examination is required to determine the cause of neck pain.
Your orthopaedist will take a complete history of the difficulties you are having with your neck. He or she may ask you about other illnesses, any injury that occurred to your neck and any complaints you have associated with neck pain. Previous treatment for your neck condition will also be noted.
Next, your orthopaedist will perform a physical examination. This examination may include evaluation of neck motion, neck tenderness, and the function of the nerves and muscles in your arms and legs.
X-ray studies often will be done to allow your orthopaedist to look closely at the bones in your 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). This non X-ray study allows an evaluation of 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. However, most patients are treated successfully with rest, medication, immobilization, physical therapy, exercise, activity modifications or a combination of these methods.
For example, if pain is caused by inflammation as a result of stretching muscles and ligaments beyond their limits, your orthopaedist may prescribe rest and a neck collar for a specified period of time, as well as medication to reduce inflammation. If medication is 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 orthopaedist 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.
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 necessary 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.
Your orthopaedist is a medical doctor with extensive training in the diagnosis and nonsurgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.
Neck Sprain
People who are involved in motor vehicle crashes or who take hard falls in a contact sport or around the house may get a real "pain in the neck." This pain can result from a ligament sprain or muscle strain.
The seven bones of the spinal column in your neck are called cervical vertebrae. They are connected to each other by ligaments, which are strong bands of tissue, like thick rubber bands.
A sprain is a stretch or tear in the ligament resulting from a sudden movement that causes the neck to extend to an extreme position. For example, in the rapid deceleration of a car crash, your head and neck can stretch far forward before stopping.
Symptoms
- Pain, especially in the back of the neck, that worsens with movement.
- Pain that often peaks a day or so after the injury, instead of immediately.
- Possible muscle spasms and pain in the upper regions of the shoulders.
- Headache in the rear of the head.
- Sore throat.
- Increased irritability, fatigue, difficulty sleeping and difficulty concentrating.
- Numbness in the arm or hand.
- Stiffness or decrease in range of motion (side to side, up and down, circular).
- Tingling or weakness in the arms.
Diagnosis
During the physical exam, your doctor will ask you how the injury occurred, measure range of motion and check for any point tenderness. Your orthopaedist may request X-ray studies to look closely at the bones in your neck. This evaluation helps eliminate or identify other sources of neck pain, such as spinal fractures, dislocations, arthritis and other serious conditions.
Treatment
All sprains or strains, no matter where they are located in the body, receive basically the same type of treatment. Usually, neck sprains, like other sprains, will gradually heal, given time and appropriate treatment. You may have to wear a soft cervical collar to help support the head and relieve pressure on the neck so the ligaments have time to heal.
Analgesics, such as aspirin or ibuprofen, can help reduce the pain and any swelling. Muscle relaxants can help ease spasms. You can apply an ice pack for 15 to 30 minutes at a time, several times a day for the first two or three days after the injury. This will help reduce inflammation and discomfort. Although heat, particularly moist heat, can help loosen cramped muscles, it should not be applied too quickly.
Other treatment options include:
- Massaging the tender area
- Ultrasound
- Cervical traction
- Aerobic and isometric exercise
Most symptoms will resolve in four to six weeks. A severe injury, such as might be sustained in a motor vehicle accident, may take longer to heal completely.
Whiplash
Imagine yourself driving when a car behind you rear-ends your vehicle. The impact pushes your car forward. It takes about 100 milliseconds for your body to catch up to the forward movement. Your shoulders travel forward until they are under your head, and your neck extends forward as your head tilts slightly down toward your steering wheel. You step on the brakes, bringing the car to an abrupt halt. The sudden stop throws your head and neck backward, and they bounce against the headrest. In a matter of seconds, you've experienced the classic mechanism of injury for whiplash.
About 20 percent of people involved in rear-end collisions later experience symptoms that center in the neck region. Although most of these people recover quickly, a small number develop chronic conditions that result in severe pain and sometimes disability.
Signs and symptoms
People who experience whiplash may develop one or more of the following symptoms, usually within the first two days after the accident:
- Neck pain and stiffness
- Headaches
- Pain in the shoulder or between the shoulder blades
- Low back pain
- Pain or numbness in the arm and/or hand
- Dizziness
- Ringing in the ears or blurred vision
- Difficulty concentrating or remembering
- Irritability, sleep disturbances, fatigue
Diagnosis and Treatment
How whiplash injuries occur is clearly understood, but the extent and type of injuries varies greatly. The diagnosis of whiplash is often one of exclusion. Most injuries are to soft tissues such as the disks, muscles and ligaments, and cannot be seen on standard X-rays. Your doctor may need to request specialized tests, such as computed tomography scans or magnetic resonance imaging (MRI).
In the past, whiplash injuries were often treated with immobilization in a cervical collar. However, the current trend is to encourage early movement, rather than immobilization. The soft collar may be used for a short term and on an intermittent basis.
Ice may be applied for the first 24 hours, followed by gentle active movement. Your doctor may provide you with a series of exercises that you can do at home. An early return to work is encouraged, even if your doctor must prescribe some temporary modifications in your work situation. No single treatment has been scientifically proven as effective, but pain relieving medications, exercises, physical therapy, traction, massage, heat, ice, injections and ultrasound have all been beneficial for some patients.
As soon as possible, you should begin aerobic activities, such as walking. Your doctor may prescribe some isometric exercises as your condition improves. Symptoms resolve within several months for about 75 percent of people who have whiplash. Chronic conditions should be investigated further and might require surgery.