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 Actions
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 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
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.
Physical assessment
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’s no history of neck trauma, and palpate the cervical lymph nodes for enlargement.
Medical causes
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 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 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, a degenerative process, produces posterior neck pain that’s aggravated by and restricts movement. Pain may radiate down either arm and may accompany paresthesia, weakness, and stiffness.
Cervical stenosis
Cervical stenosis is a progressive disorder that commonly produces no symptoms. It may cause nonspecific neck and arm pain, paresthesia, muscle weakness or paralysis, and decreased ROM. The patient may report hand clumsiness and problems with gait and balance.
Herniated cervical disk
A herniated cervical disk characteristically causes variable neck pain that is aggravated by and restricts movement. 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
With 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 (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.
Paget’s disease
Paget’s disease commonly produces no symptoms 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
Rheumatoid arthritis 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 ROM; 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 ROM, muscle spasms, and deformity.
Subarachnoid hemorrhage
Subarachnoid hemorrhage is a life-threatening condition that may cause moderate to severe neck pain and rigidity, headache, and a decreased LOC. Kernig’s and Brudzinski’s signs are present. The patient may describe the headache as “the worst headache of my life.”
Torticollis
With torticollis, severe neck pain accompanies recurrent unilateral stiffness and muscle spasms. Stiffness of the neck muscles is followed by a momentary twitching or contraction that pulls the head to the affected side.
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.
Patient counseling
Explain necessary activity limitations to the patient, such as avoiding flexion, extension, or rotation of the neck. If the patient needs to wear a cervical collar, make sure he knows how to apply it properly. Reinforce exercises that have been taught during physical therapy.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Stiff neck
Read excerpts from these other book chapters related to Stiff neck:
Medical Books Excerpts
- NECK PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- "Differential Diagnosis in Primary Care" (2007)
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- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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- "Nursing: Interpreting Signs and Symptoms" (2007)
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- NECK PAIN
- "Differential Diagnosis in Primary Care" (2007)
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Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
More About Causes of Stiff neck
» Next page: Nuchal rigidity (Signs & Symptoms: A 2-in-1 Reference for Nurses)
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