Neck Problems

The neck may seem like a simple structure that merely holds up the head but it is really very complex. Problems here may cause pain in many parts of the body, and the diagnoses may require some expert sleuthing.

The most important thing to know is that the neck is the upper, narrow portion of the spine composed of vertebrae (bones) and ligaments that stretch like thick rubber bands. This area, called the cervical spine, provides stability and allows support and motion. Because it is less protected than the rest of the spine, the neck is especially vulnerable to injury. Sometimes rest alone may alleviate the pain, but a severe case may require medical diagnosis and treatment to relieve symptoms.

Causes of neck pain
Abnormalities in the soft tissues - muscles, ligaments and nerves - as well as in the bones and joints of the spine may cause neck pain due to injury or prolonged wear and tear. More rarely, infection or tumors may be to blame. In some cases, neck problems may cause 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 and tear of the joints between the neck bones. Rheumatoid arthritis is an inflammatory disease that can cause destruction of the joints of the neck. Both types can cause stiffness and pain.

Cervical disc degeneration can also cause neck pain, typically after age 40. In this case, the gelatin-like center of the disk, which is designed to act as a shock absorber between vertebrae, shrinks and the space between the vertebrae narrows. With this additional stress, the joints further deteriorate. The cervical disk may also protrude from its normal position, creating pressure on the spinal cord or nerve roots. This is called a herniated cervical disk.

Injury
Motor vehicle or diving accidents, contact sports and falls are frequent causes of neck injury. The regular use of safety belts in motor vehicles and helmets on bikes can help to prevent or minimize injury.

A "rear end" automobile collision may result in hyperextension, which is a backward motion of the neck beyond normal limits, or hyperflexion, a forward motion of the neck beyond normal limits, and injury to the soft tissues, muscles and ligaments. More serious injuries, as with fracture or dislocation of the neck, may damage the spinal cord and cause paralysis or quadriplegia.

Neck pain from tumors, infections or congenital abnormalities is much less common.

When to seek medical care
If severe neck pain occurs after an injury, a trained professional (a paramedic, for instance) should immobilize the patient on the spot to avoid the risk of further injury and possible paralysis. Medical treatment should follow as soon as possible. Immediate medical care is also crucial if an injury causes pain in the neck that radiates down the arms and legs. Radiating pain or numbness in arms or legs causing feelings of weakness without significant neck pain should also be evaluated promptly.

If there has been no injury, you should seek medical care when neck pain is

• continuous
• severe
• accompanied by pain that radiates down the arms or legs
• accompanied by headaches, numbness, tingling or weakness

Diagnosing neck pain
Orthopaedists, who are specially trained to diagnose and treat neck problems, will take a complete history of the difficulties being experienced by the patient, including previous injuries or complaints associated with neck pain. He or she will next perform a physical examination, evaluating neck motion, neck tenderness and the response of the nerves and muscles in your arms and legs. X-ray studies will also be taken to allow the doctor effective treatment after looking at the bones in your neck.

Further evaluation may also involve one or more of the following examination:

• MRI (magnetic resonance imaging)
• CT (computed tomography)
• Myelogram (an injection of dye or contrast material into the spinal column)
• EMG (electromyogram)

Blood tests may sometimes be required, as well as consultations with other medical specialists.

Treatments

Non-surgical
Most patients are treated successfully with rest, immobilization (with a neck collar), physical therapy, exercise, activity modifications or a combination of these methods. Medication to reduce pain should only be used as directed and not for extended periods of time. If rest is prescribed, it is vital that you follow instructions carefully.

If pain persists or is chronic, a rehabilitation program may be recommended that includes exercises and other types of physical therapy designed to relieve pain and prevent it from coming back.

Surgical
Surgery is seldom required. It may be necessary, however, to reduce pressure on the spinal cord or nerve root when pain is caused by a herniated disk or narrowed spinal cord. It may also be required following an injury in order to stabilize the neck and minimize the possibility of paralysis, especially if there has been a fracture in this area.