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.

Emergency Interventions

 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, page 546.) Then take 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.

History and physical examination

If the patient hasn’t sustained trauma, find out 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 any 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.

Thoroughly inspect the patient’s neck, shoulders, and cervical spine for swelling, masses, erythema, and ecchymoses. Assess active range of motion 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 is not a history of neck trauma, and palpate the cervical lymph nodes for enlargement. (See Neck pain: Causes and associated findings, pages 548 to 551.)

Medical causes

Ankylosing spondylitis

Intermittent, moderate to severe neck pain and stiffness with severely restricted range of motion is characteristic of this disorder. 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 following 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, visual blurring, and unilateral miosis on the affected side.

Cervical fibrositis

This disorder may produce anterior neck pain that radiates to one or both shoulders. Pain is intermittent and variable, often changing with weather patterns. Other findings are nonspecific but commonly include point tenderness over involved muscles.

Cervical spine fracture

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)

This 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

This degenerative process 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

This progressive disorder, commonly asymptomatic, may cause nonspecific neck and arm pain, paresthesia, muscle weakness or paralysis, and decreased range of motion.

Esophageal trauma

An esophageal mucosal tear or a pulsion diverticulum may produce mild neck pain, chest pain, edema, hemoptysis, and dysphagia.

Herniated cervical disk

This disorder 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

This disorder 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 this disorder. The patient may also develop dysphagia, dyspnea, hemoptysis, stridor, hoarseness, and cervical lymphadenopathy.

Lymphadenitis

With this disorder, 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. Related findings include fever, headache, photophobia, positive Brudzinski’s and Kernig’s signs, and decreased level of consciousness.

Neck sprain

Minor sprains typically produce pain, slight swelling, stiffness, and restricted range of motion. Ligament rupture causes pain, marked swelling, ecchymosis, muscle spasms, and nuchal rigidity with head tilt.

Osteoporosis

Neck pain is rare with this disorder, which usually affects the thoracic or lumbar vertebrae. Cervical vertebrae involvement produces tenderness and deformity.

Paget’s disease

This slowly developing disease is 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

This disorder usually affects peripheral joints, but it can also involve the cervical vertebrae. Acute inflammation may cause moderate to severe pain that radiates along a specific nerve root; increased warmth, swelling, and tenderness in involved joints; stiffness, restricting range of motion; paresthesia and muscle weakness; low-grade fever; anorexia; malaise; fatigue; and possible 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 range of motion, muscle spasms, and deformity.

Subarachnoid hemorrhage

This life-threatening condition may cause moderate to severe neck pain and rigidity, headache, and a decreased level of consciousness. Kernig’s and Brudzinski’s signs are present. The patient may describe the headache as “the worst headache of my life.”

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 this neck deformity, 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.

Special considerations

Promote patient 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.

Pediatric pointers

The most common causes of neck pain in children are meningitis and trauma. A rare cause of neck pain is congenital torticollis.

Pictures

Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

Other Book Chapters Related to Neck pain

Read excerpts from these other book chapters related to Neck pain:

Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.

More About Causes of Neck pain

• Back to symptom: Neck pain: Introduction (review 143 causes)
• Next Book Extract About Neck pain: Headache (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

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