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Neck Pain Causes and Treatment

Neck Pain

Patients can complain of neck pain for a variety of reasons. We’re gonna try to outline the most common causes of neck pain and how you can treat it.
The first thing that you want to identify is if the patient has neck pain or shoulder pain. Shoulder pain and neck pain problems overlap.
You need to know if the origin of the pain at the cervical spine or if the shoulder itself is the origin of the pain.
Does the patient’s symptoms improve by shoulder abduction and placing the hand over the head, then the pain is cervical spine origin.
Shoulder Abduction Test lifting the arm above the head usually relieves the symptoms because it decreases tension on the affected nerve.
neck-pain1.jpg
Is the pain more when you move the shoulder?
Then the shoulder itself is the source of the pain.
2. An important cause of neck pain is a disc herniation
The patient will complain of numbness paresthesia radiculopathy which is shooting pain that radiates from the neck to the arm. The patient will have unilateral arm pain, numbness tingling in a specific dermatome in the hand.
As you see here in this diagram and weakness in a specific muscle group.
In cervical radiculopathy, the pain is sudden and goes to the arm.
Radiculopathy occurs due to compression of the nerve root either by a disc herniation or by arthritis that narrows
the foramen.

neck-pain2.jpg
Cervical disc herniation occurs most frequently at the level of c6 c7, and it will affect the c7 nerve root.
It also can occur at c5 c6, and in this case, it will affect the c6 nerve root.

Neck Pain
Neck Pain

How do you test for cervical spine disc herniation in neck pain?

In a patient that has tingling or numbness in the hand, you can consider double crush syndrome. with double crush syndrome the patient will have two problems to the nerves:
one problem comes from the neck!
Another problem comes from compression of the nerves in the elbow like gluteal tunnel syndrome or around the rest like carpal tunnel syndrome.
Ask the patient if there was any diagnosis of carpal tunnel syndrome or cubital tunnel syndrome, and you may need to get EMG and nervous studies to the upper extremity from the neck down.
With double crush syndrome, the patient may have cervical nerve root compression and distal nerve compression.

Cervical Spondylosis & neck pain

Another cause of neck pain is ‘cervical spondylosis’ which is arthritis of the spine. It is a natural degenerative process of the cervical spine.
The x-ray will show arthritis.
Treatment of Cervical Spondylosis
usually uses miracle management, and surgery is done if there is instability or neurological deficit.
In general, the typical patient that we will see is the patient with neck pain and no injury. The pain will be in the posterior part of the neck that is tender to palpation and no radiation to the arm, no sensory or motor deficit (no neurological deficit) and the x-ray will show mild arthritis. Give the patient physiotherapy and anti-inflammatory medication.

Spurling Test for Cervical Spine Radiculopathy
What is the Spurling test?
The Spurling test is considered positive when neck extension and rotation towards the painful side reproduces symptoms in the ipsilateral arm.
The natural history of cervical radiculopathy is favourable with the resolution of the symptoms in most cases.
In cervical radiculopathy, patients will have 70 – 80% successful outcomes after 2 – 3 months with conservative treatment.

How Do You Really Treat the Cervical Disc Herniation?

  • .Nonsurgical (do first)
  • Anti-inflammatory medication
  • Isometric exercises
  • Physical therapy
  • Muscle relaxant

Get an MRI if the symptoms do not improve after six weeks
of conservative treatment!
The MRI result should be correlated with the clinical symptoms. The false-positive rate of the MRI is high.
28% of asymptomatic patients less than 40 years old will have findings of a herniated disc or foraminal stenosis.
In asymptomatic patients older than 40 years old, you will find that 57% of these patients will have at least one degenerated disc on the MRI.
The MRI may show you a problem with the disc in patients that are not complaining of any neck pain.
Therefore, use the result of the MRI wisely and don’t scare the patient, because what you find in the MRI could be a normal process.
Persistent disabling pain for six to twelve weeks despite nonoperative treatment can be an indication for surgery. The surgery is usually anterior and involves decompression and fusion of the involved disc space.
Ask the patient if the patient has gait disturbance (unstable gait when walking, wide-based gait) or hand clumsiness, which may indicate cervical myelopathy due to compression of the spinal cord (serious condition).
The patient may have decreased manual dexterity and difficulty in manipulating fine objects such as buttoning and unbuttoning shirts.
The patient may have an occipital headache and a sense of discomfort in the neck. The patient may not have severe neck pain.
In general, in cervical myelopathy, the onset of pain is insidious, gradual, poorly characterized and localized.
Cervical myelopathy is a slowly progressive process with stepwise progression and deterioration over time.
In cervical myelopathy, the MRI will show compression of the spinal cord (Spinal Decompresion).
In cervical myelopathy, you will find upper motor neuron signs including a positive Hoffman’s sign.

What Is Back Pain? Back pain is a common problem.

What Are Other Upper Motor Neuron Signs?

You will find the patient will have hyperreflexia positive Babinski test and clonus test.
Early recognition and early surgery are important for a good outcome.
The severity of the symptoms and early treatment is most important to the outcome.
Surgery is done for any functional impairment of the gate or the hands.
Usually, the treatment in this situation is surgery by decompression and fusion.
Ask the patient if he or she was involved in a car accident, the patient may have a whiplash injury.
The patient will complain of pain in the neck after a car accident it may be referred pain in the head, shoulder and arm.
Usually, with a whiplash injury, there is no neurological deficit. The patient will have a soft tissue injury, and the x-ray will show loss of cervical lordosis due to muscle spasm.
.Treatment of whiplash injury
.Aggressive physical therapy
.Early mobilization

Neck Pain
Laser therapy is a well-studied method to eliminate chronic and acute pain.

Pain Due to Tumor or Infection

Another question is if the pain is connected to activity or is independent of activity?
Is the pain is worse at night and not relieved by rest or immobilization?
ُThis pain may be coming from a tumor or infection.
Ask the patient about history of weight loss, or previous history of cancer, or if the patient is getting fever and shells (very rare situations).

Double Crush Syndrome

In a patient that has tingling or numbness in the hand, you can consider double crush syndrome. with double crush syndrome the patient will have two problems to the nerves:
one problem comes from the neck!
Another problem comes from compression of the nerves in the elbow like gluteal tunnel syndrome or around the rest like carpal tunnel syndrome.
Ask the patient if there was any diagnosis of carpal tunnel syndrome or cubital tunnel syndrome, and you may need to get EMG and nervous studies to the upper extremity from the neck down.
With double crush syndrome, the patient may have cervical nerve root compression and distal nerve compression.

Laser therapy is a well-studied method to eliminate chronic and acute pain.
Leg Length Discrepancy
Physio knowledge

Leg Length Discrepancy

Leg length discrepancy is a common condition with diverse causes.

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