Most neck pain is transient of unknown cause. Potentially serious causes of neck problems usually result from injuries or degenerative or inflammatory diseases of the cervical joints. Given the proximity of the nerve and joint structures in the spine of the neck, joint disease has the potential to result in neurological pain, generally the most serious of cervical pathology.
Severe cervical pathology produces symptoms beyond the confines of the cervical region, sometimes without symptoms in the neck itself, and these symptoms are typically neurological in nature. Any disorder associated with cartilage or disc wear, rheumatoid arthritis, polymyalgia rheumatica, spondyloarthropathies, and fibromyalgia are associated with symptoms in the neck region.
To address this problem, the three most important pieces of information are duration, history, and musculoskeletal symptoms in other parts of the body. When the pain is of recent appearance, without previous injuries, is limited to the neck, and there are no other specific indications, a simple symptomatic therapy should be offered. When there is a history of trauma or injury, often as neck hyperextension, a conservative evaluation and diagnosis should be initiated.
Neck pain associated with general musculoskeletal pain leads to fibromyalgia, while neck pain with synovitis (inflammation of the synovium) of the peripheral joints suggests rheumatoid arthritis or other inflammatory arthropathy. In these cases the cervical spine will probably not be the best place to investigate. When the problem is more chronic and confined to the neck and shoulder region, especially in older subjects, degenerative diseases are more likely, and simple X-rays can aid in the diagnosis.
Diagnosis process of neck pain
The persistence of severe neck symptoms and neurological abnormalities of cervical origin require further investigation. Physical exams should be done covering range of motion and pain during flexion and extension, lateral flexion, and rotation movements. The physical exam may also indicate pain or spasms in the paravertebral muscles of the neck.
Limitations or pain associated with rotational movement generally reflects joint pathology in the C1-C2 cervical vertebrae, since most of the rotation results from movement in these joints.
Plain radiographs of the cervical vertebrae, including open C1-C2 and oblique views that allow visualization of the intervertebral neural foramin, can demonstrate degenerative disease and subluxations resulting from inflammatory arthritis or serious trauma. Computed tomography (CT) may be helpful when flat radiographs are inadequate and a fracture is considered. The role of magnetic resonance imaging (MRI) is limited and is most helpful in identifying the cause of a neurological syndrome (such as a compression of a nerve).
Interventional neck pain treatments
Treatments offered to relieve neck pain includes:
- Short-term immobilization. A soft collar that supports the neck can help relieve pain by taking pressure off the structures in the neck. However, if worn for more than three hours at a time or for more than one to two weeks, a collar could do more harm than good.
- Steroid injections. The doctor may inject corticosteroid medicine near the roots of the nerve, in the small joint facets of the bones of the cervical spine, or in the muscles of the neck to relieve pain. Anesthetics, such as lidocaine can also be injected to relieve neck pain.
- Traction. Traction uses weights, pulleys, or an inner tube to stretch the neck carefully. Under the supervision of a medical professional and a physical therapist, this therapy can provide relief for some neck pain, especially pain related to nerve root irritation.
- Transcutaneous electrical nerve stimulation. Electrodes placed on the skin near painful areas release small electrical impulses that can relieve pain.
- Physiotherapy. Conservative therapies may be beneficial in treating uncomplicated joint diseases, soft tissue injuries, and other painful neck syndromes. Many patients can benefit from the use of cervical collars for evening and night use and ergonomic pillows. Physical therapy, including local application of heat, massage, and ultrasound modalities, can help.
Do not wait to begin the conversation for your mobility issues or neck pain relief. Dr. Munish Lal will assist you in solving your frequent concerns and help you master how to enhance your health for optimal wellness. Right at the heart of Torrance, CA, pain care is just a call away.