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Neck
pain
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- The neck is the long, complex structure supporting the head. It is comprised of 7 cervical vertebrae (bones of the spine), disks (gelatinlike Shock absorbers), muscles,
ligaments (supportive, hard, bandlike structures), nerves,
blood vessels, glands, and lymphatic tissue.
- The 7 cervical vertebrae protect
the spinal cord -- a collection of nerves carrying
electrical messages from the brain to different parts of the
body.
- The vertebrae are round, flat
bones, each with a central cavity or hole for the cord to
pass through.
- Separating the vertebrae are disks
made of cushionlike material (cartilage). Nerves leave the
spinal cord and travel to other parts of the body through
holes provided in the vertebrae.
- Muscles and tendons protect and
support the cervical spine and neck.
- Conditions that adversely affect these structures can cause Neck Pain, stiffness,
and restricted mobility.
- When the joints between the bones
are narrowed by trauma, prolonged wear and tear, or immune
system attack (body's normal defenses), it causes the
vertebrae to grind against each other, creating pressure and
stress on localized nerves, muscles, and tendons. In turn,
this causes pain and other symptoms in the damaged area, as
well as to the shoulders, arms, hands, and fingers.
- Neck Pain can be
acute (days to a few weeks) or chronic (weeks to
years).
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- In most cases (except trauma)
involving muscular strain or rupture of the disk, the
symptoms develop over time.
- Slowly developing Neck Pain and
stiffness
- Pain often occurs after neck use --
as in reading, computer use, or viewing movies
- May have neck stiffness in the
mornings
- Muscle stiffness and tenderness
- There may be tender points along
the affected vertebrae.
- There may be pressure on the
nerves, producing pain, tingling, numbness, or an electrical
sensation in the fingers, hands, arms, or shoulders. This is
called radiculopathy.
- With more severe diseases, there
are Crepitations (sounds like popping popcorn) heard when
joints of the neck are moved.
- With prolonged nerve root
compression, muscles can become weak and atrophied (shrink).
- Headaches, especially those
starting at the base of the neck and radiating to scalp and
forehead, are common.
- Other organs or joints may be
involved.
- With trauma and severe neck damage, there may be Low Blood Pressure,
difficulty breathing, and
coma.
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- Biomechanical -- straining the neck
muscles, as with prolonged use or severe exercise, can cause
them to become stiff and painful.
- Degenerative changes (wear and tear) -- occur from constant repetitive movements (i.e., bending the neck at work) over long periods of time and can cause chronic Neck Pain.
- Osteoarthritis (OA)
is an example of a degenerative disease that can affect the
neck and other joints. It is a common condition after age
40, in which joint destruction is associated with formation
of bone spurs (extra bony material) that can further
aggravate the joints.
- Diseases such as Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS) -- in which the body's natural
defenses (immune system) mistakenly attack the bones and
joints -- can, over time, destroy the joints of the neck,
and cause pain and stiffness all over the body.
- Polymyalgia Rheumatica occurs in the elderly and causes
stiffness and pain over the neck, arms, shoulders, and
buttocks. It may be inherited or immune- system related, and
can cause depression.
- Attacks on the immune system, as in
RA, AS, Spondyloarthropathies (i.e., disease of the joints
of the spine like Reiter's and psoriatic arthritis) destroy
joints, bones, muscles, ligaments, as well as other body
parts (skin, eyes, etc.).
- Herniated Disk -- the disk can balloon out from
between the vertebrae (even rupture), causing pressure,
pain, and restricted mobility.
- With excessive wear and tear, disks
degenerate and narrow. The vertebrae, having nothing soft
between them, continue to grind, causing excessive damage.
- Trauma -- sudden neck movement
(whiplash), sudden impact (landing on head), or boxing
injuries can cause acute and chronic neck problems.
- Neurological -- diseases such as Stroke, Muscular Dystrophy, or Multiple Sclerosis
can cause weakness of the muscles of the neck, which over
time results in strain on the normal muscles and structures.
- Diffuse idiopathic skeletal hyperostosis (DISH) occurs when Calcium forms around
vertebrae and ligaments, causing stiffness and pain.
- Infections and cancers are rare sources of Neck Pain.
- Meningitis -- an
infection of the tissues covering the brain and spinal cord,
marked by high fever, headaches, and neck stiffness -- is a
dangerous condition requiring immediate
attention.
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- The doctor may ask how you've had the symptoms?
- Was the onset sudden or gradual?
- Do you have other symptoms, such as fever, headaches,
skin problems, pain in other joints, numbness, or
tingling?
- Did you fall or have an accident? What is your
occupation?
- Family history and a full medical history is
important.
- General exam of the body and neck
- The head and neck are felt, moved (not if trauma has
occurred).
- If the problem is muscular, the exam is limited and
treatment is started.
- X-Rays of the neck will show narrowed spaces between bones (OA, RA), fractures, Calcium formations,
and bone spurs.
- MRI or CAT scan allows a better view, and are
recommended if nerve or disk damage is
suspected.
- Blood tested if certain diseases (Prostate cancer, RA,
AS, etc.) are suspected
- Muscles and nerves -- nerve conduction studies and
Myelogram, respectively.
- These test are done if X-Ray, MRI, or CAT
scan are not helpful.
- Cancer spread from other parts of the body to the neck
bones -- detected by doing bone scan.
- Spinal tap (examination of spinal fluids) is done if Meningitis is
suspected.
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- Age --Osteoarthritis and
degenerative disk diseases commonly occur after age 40. AS
is common before age 40. Juvenile forms of RA occur before
age 14.
- Sex -- in AS, males are at greater
risk than females.
- Genetics -- AS may be inherited.
Both Juvenile RA and AS have been linked to gene HLA-B27.
- Sports, injuries, or obesity is often associated with Osteoarthritis.
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- If a trauma occurred (e.g., car accident or fall)
paramedics normally stabilize the neck before moving the
patient to the hospital.
- For chronic pain:
- Applying light heat (heating blanket, warm towel) can
relax the muscles and reduce pain.
- Massage with oils or creams (Zostrix, Icy hot, or Ben
Gay) can also help.
- Acupuncture and acupressure can help with pain and
muscle relaxation. Your general doctor may refer you to a
specialist (e.g., orthopedic, therapist).
- Physical therapist (PT) can show you stretching
exercises that help the stiffness and pain.
- PT or a chiropracter can use sound waves (ultra sound)
on the strained muscle.
- Non Steroidal Anti-inflammatory Drugs (NSAIDs) can
reduce irritation and swelling (inflammation) around the
damaged area and reduce pain and stiffness. Serious side
effects (stomach ulcers and bleeding) may occur over long
use without doctor's supervision.
- For severe muscular neck stiffness, muscle relaxants
such as Baclofen or Valium may be used.
- Corticosteroids such as Depomedrol or Prednisone are
strong anti-inflammatory medications that can be injected
or taken by mouth. They are used only for severe cases.
For example, injections cannot be given more than 1-3
times per year. Side effects include bleeding, thinning of
bones, and infections.
- Chronic pain can be depressing and anti-depressants
may help.
- For severe nerve damage, degenerative changes, disk
herniation, or fractures surgery may be
needed.
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Contact
your physician for further evaluation.
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