Neck pain
Neck pain may originate from any neck structure, ranging from the meninges and cervical vertebrae to its blood vessels, muscles, and lymphatic tissue. This symptom can also be referred from other areas of the body. Its location, onset, and pattern help determine its origin and underlying causes. Neck pain usually results from trauma and degenerative, congenital, inflammatory, metabolic, and neoplastic disorders.
Act Now: If the patient’s neck pain is due to trauma, first ensure proper cervical spine immobilization, preferably with a long backboard and a Philadelphia collar. (See Applying a Philadelphia collar.) Then take the patient’s vital signs, and perform a quick neurologic examination. If he shows signs of respiratory distress, give oxygen. Intubation or tracheostomy and mechanical ventilation may be necessary. Ask the patient (or a family member, if the patient can’t answer) how the injury occurred. Then examine the neck for abrasions, swelling, lacerations, erythema, and ecchymoses.
Assessment
History
If the patient hasn’t sustained trauma, inquire about the severity and onset of his neck pain. Where specifically in the neck does he feel pain? Does anything relieve or worsen the pain? Is there a particular event that precipitates the pain? Also, ask about the development of other symptoms such as headaches. Next, focus on the patient’s current and past illnesses and injuries, diet, drug history, and family health history.
Physical examination
Thoroughly inspect the patient’s neck, shoulders, and cervical spine for swelling, masses, erythema, and ecchymoses. Assess active range of motion (ROM) in his neck by having him perform flexion, extension, rotation, and lateral side bending. Note the degree of pain produced by these movements. Examine his posture, and test and compare bilateral muscle strength. Check the sensation in his arms, and assess his hand grasp and arm reflexes. Attempt to elicit Brudzinski’s and Kernig’s signs if there isn’t a history of neck trauma, and palpate the cervical lymph nodes for enlargement. (See Neck pain: Causes and associated findings.)
Pediatric pointers
The most common causes of neck pain in children are meningitis and trauma. Congenital torticollis can, rarely, cause neck pain.
Medical causes
Ankylosing spondylitis
Intermittent, moderate to severe neck pain and stiffness with severely restricted ROM is characteristic of ankylosing spondylitis. Intermittent low back pain and stiffness and arm pain are generally worse in the morning or after periods of inactivity and are usually relieved after exercise. Related findings also include low-grade fever, limited chest expansion, malaise, anorexia, fatigue and, occasionally, iritis.
Cervical extension injury
Anterior or posterior neck pain may develop within hours or days after a whiplash injury. Anterior pain usually diminishes within several days, but posterior pain persists and may even intensify. Associated findings include tenderness, swelling and nuchal rigidity, arm or back pain, occipital headache, muscle spasms, blurred vision, and unilateral miosis on the affected side.
Cervical fibrositis
Cervical fibrositis may produce anterior neck pain that radiates to one or both shoulders. Pain is intermittent and variable, commonly changing with weather patterns. Other findings are nonspecific but usually include point tenderness over involved muscles.
Cervical spine fracture
A fracture at C1 to C4 can cause sudden death; survivors may experience severe neck pain that restricts all movement, intense occipital headache, quadriplegia, deformity, and respiratory paralysis.
Cervical spine infection (acute)
Cervical spine infection can cause neck pain that restricts motion. Other findings include fever, possible deformity, muscle spasms, local tenderness, dysphagia, paresthesia, and muscle weakness.
Cervical spine tumor
Metastatic tumors typically produce persistent neck pain that increases with movement and isn’t relieved by rest; primary tumors cause mild to severe pain along a specific nerve root. Other findings depend on the lesions and may include paresthesia, arm and leg weakness that progresses to atrophy and paralysis, and bladder and bowel incontinence.
Cervical spondylosis
Cervical spondylosis is a degenerative process that produces posterior neck pain that restricts movement and is aggravated by it. Pain may radiate down either arm and may accompany paresthesia, weakness, and stiffness.
Cervical stenosis
Cervical stenosis is a progressive disorder, commonly asymptomatic, that may cause nonspecific neck and arm pain, paresthesia, muscle weakness or paralysis, and decreased ROM.
Esophageal trauma
An esophageal mucosal tear or a pulsion diverticulum may produce mild neck pain, chest pain, edema, hemoptysis, and dysphagia.
Herniated cervical disk
Herniated cervical disk characteristically causes variable neck pain that restricts movement and is aggravated by it. It also causes referred pain along a specific dermatome, paresthesia and other sensory disturbances, and arm weakness.
Hodgkin’s lymphoma
Hodgkin’s lymphoma may eventually result in generalized pain that may affect the neck. Lymphadenopathy, the classic sign, may accompany paresthesia, muscle weakness, fever, fatigue, weight loss, malaise, and hepatomegaly.
Laryngeal cancer
Neck pain that radiates to the ear develops late in laryngeal cancer. The patient may also develop dysphagia, dyspnea, hemoptysis, stridor, hoarseness, and cervical lymphadenopathy.
Lymphadenitis
With lymphadenitis, enlarged and inflamed cervical lymph nodes cause acute pain and tenderness. Fever, chills, and malaise may also occur.
Meningitis
Neck pain may accompany characteristic nuchal rigidity of meningitis. Related findings include fever, headache, photophobia, positive Brudzinski’s and Kernig’s signs, and a decreased level of consciousness (LOC).
Neck sprain
Minor sprains typically produce pain, slight swelling, stiffness, and restricted ROM. Ligament rupture causes pain, marked swelling, ecchymosis, muscle spasms, and nuchal rigidity with head tilt.
Osteoporosis
Neck pain is rare with osteoporosis, which usually affects the thoracic or lumbar vertebrae. Cervical vertebrae involvement produces tenderness and deformity.
Paget’s disease
Paget’s disease is a slowly developing disease that’s commonly asymptomatic in its early stages. As it progresses, cervical vertebrae deformity may produce severe, persistent neck pain, along with paresthesia and arm weakness or paralysis.
Rheumatoid arthritis (RA)
Although RA typically affects peripheral joints, it can also involve the cervical vertebrae. Acute inflammation may cause moderate to severe pain that radiates along a specific nerve root accompanied by increased warmth, swelling, and tenderness in involved joints. Stiffness may restrict the patient’s ROM. He may also experience paresthesia and muscle weakness, low-grade fever, anorexia, malaise, fatigue and, possibly, neck deformity. Some pain and stiffness remain after the acute phase.
Spinous process fracture
Fracture near the cervicothoracic junction produces acute pain radiating to the shoulders. Associated findings include swelling, exquisite tenderness, restricted ROM, muscle spasms, and deformity.
Subarachnoid hemorrhage
In subarachnoid hemorrhage, Kernig’s and Brudzinski’s signs are present. The patient may also develop a headache, possibly describing it as “the worst headache of my life.”
ALERT: Subarachnoid hemorrhage is a life-threatening condition. In addition to Kernig’s and Brudzinski’s signs and a headache, it may also cause moderate to severe neck pain and rigidity and a decreased LOC.
Thyroid trauma
Besides mild to moderate neck pain, thyroid trauma may cause local swelling and ecchymosis. If a hematoma forms, it can cause dyspnea.
Torticollis
With torticollis, severe neck pain accompanies recurrent unilateral stiffness and muscle spasms that produce a characteristic head tilt.
Tracheal trauma
Fracture of the tracheal cartilage, a life-threatening condition, produces moderate to severe neck pain and respiratory difficulty. Torn tracheal mucosa produces mild to moderate pain and may result in airway occlusion, hemoptysis, hoarseness, and dysphagia.
Nursing considerations
Promote the patient’s comfort by giving an anti-inflammatory and an analgesic, as needed. Prepare him for diagnostic tests, such as X-rays, computed tomography scan, blood tests, and cerebrospinal fluid analysis.
Patient teaching
Inform the patient about the need for activity restrictions. Teach him how to apply the cervical collar, if needed. Reinforce the importance of performing exercises, as indicated.
Pictures
Book Source Details
- Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Neck pain
Read excerpts from these other book chapters related to Neck pain:
Medical Books Excerpts
- HEADACHE
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- NECK PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Headache
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- HEADACHE
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- NECK PAIN
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Headache
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Neck pain
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Headache
- "A Pocket Manual of Differential Diagnosis" (1999)
- [ read ]
- Headache
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
- Headache
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Neck pain
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Headache
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Neck Pain
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Neck pain
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Headache
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Neck pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Headache
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- Headache
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- Neck pain
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- NECK PAIN
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2008 Williams & Wilkins.
More About Causes of Neck pain
» Next page: Headache (Signs & Symptoms: A 2-in-1 Reference for Nurses)
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