Most neck problems are minor and heal with time and over the counter pain medicines. Some, neck pain is worrisome enough that medical care is needed. Occasionally the problems are so severe or chronic that surgery will be needed. This page will explain the cause of neck pain. It will tell you how to identify neck problems that need emergency care and it will help you deal with the rest.
Neck pain is a symptom that is very common and may be caused by several different problems. It can be caused by an injury to the spinal cord, a pinched nerve, a bad disc, a damaged bone, arthritic joints, torn ligaments or sprained muscles. Sprains and arthritis are the most common problems. Spinal cord compression and pinched nerves are the most serious.
Muscular: tightness or spasm (the rhomboids, trapezius, scalenes, and the erector spinae muscles) cause midline pain (along the center of the neck) or pain in the shoulder blades. A torn disc or a stretched ligament will cause almost the same pain. All of these problems are known as "soft tissue injuries." They cannot be seen on plain x-rays since they do not involve the "hard tissues" -- the bones. Sometimes these problems can be seen on MRI scans. Often the scans are "normal," even when there is a serious muscle or soft tissue injury. The most common serious soft tissue injury is called whiplash.
The bones and discs are injured less frequently than the soft tissues. Each vertebra has two facet joints. There is one on the right and another on the left. Facet joint injuries or arthritis can be seen on x-ray but not MRI. The discs can be torn, stretched or even ruptured. The discs are seen well on MRI but not x-ray. Unless a nerve is damaged, the pain is felt in the middle of the neck or between the shoulder blades.
When the bones or ligaments are very badly damaged, they can pinch the spinal cord or the nerves. This is seen on MRI but not x-ray. If the nerves are pinched, arm pain is common. If the spinal cord is injured, pain and weakness can include the legs as well.
Degenerative problems (like arthritis) and inflammatory diseases (like ankylosing spondylitis) can cause neck pain. Ordinary arthritis, or osteoarthritis, is the result of wear and tear from years of use. It is normal. Occasionally fibromyalgia can cause neck pain.
Because the neck is so flexible and because it supports the head, it is extremely vulnerable to injury. Motor vehicle or diving accidents, contact sports, and falls may result in neck injury. A "rear end" automobile collision may result in hyperextension (too much bending back) and hyperflexion (too much bending forward). This hyperextension/hyperflexion injury is the cause of whiplash. More severe injuries can break the bones in the neck and cause a spinal cord injury with paralysis.
Tumors, infections, and congenital abnormalities of the neck are all possible but are all relatively uncommon.
When should you seek medical care for neck pain?
If you have a major injury such as a car accident or fall, and have any neck pain or soreness, you need immediate attention. Trained professionals, such as paramedics, should be called and will immobilize you to lower the risk of further injury or paralysis. The paramedics will take you to a hospital for an examination and x-rays.
If you have severe pain, numbness, or weakness, you also need professional attention.
If you ignore a bad neck injury, you may risk paralysis.
Diagnosing neck pain
Determining the source of the pain is essential to recommend the right treatment. A comprehensive examination, and possibly specialized testing, is required to determine the cause of neck pain. MRI (magnetic resonance imaging) scans are frequently needed. These non X-ray studies show the spinal cord and nerve roots. CT (computed tomography) is a type of x-ray study which used to be more common but still shows more bony detail than MRI. Myelograms are tests where a dye is injected into the spinal canal. This used to be common and is now rare. It is occasionally needed in patients with metal hardware in place. The CT and MRI machines cannot see around the hardware. EMG (electromyogram) tests look at nerve and muscle function. They are used to make sure that the problems are coming from the neck, rather than from a pinched nerve in the arms.
Treatment for neck pain
Your treatment will depend on your diagnosis. Most patients recover with rest, medication, physical therapy, exercise, activity modifications, or some combination of these. If pain is caused by inflammation or the stretching of muscles and ligaments, rest, a neck collar, and pain medications are used.
Very few patients require surgery to relieve neck pain. Surgery is needed when the spinal cord or a nerve root is pinched by a herniated disc or an arthritic bone. Surgery is often needed if there is a fracture.
About 20 percent of people involved in rear-end collisions have significant neck pain. Most recover quickly but a small number develop chronic pain and disability from whiplash, including:
The mechanism of whiplash injuries occur is not clear and the severity of problems varies greatly. In the past, whiplash injuries were treated with immobilization. Currently, we encourage movement, and soft collars are used only for short periods.
Cervical spinal stenosis is a narrowing of the spinal canal, which places pressure on the spinal cord. When there is compression of the spinal cord, there can be weakness and stiffness (paralysis and spasticity) of the arms and legs. Stenosis may be congenital (from birth) or something you develop as a result of “wear and tear” over the years. MRI (magnetic resonance imaging) scans will show stenosis well in most cases.
There are a number of ways a doctor can treat stenosis. Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) may help. Cortisone injections (epidural steroids) can reduce swelling and are good for acute pain. The relief can be temporary or permanent. Physical therapy is sometimes helpful. When non-surgical treatments do not work, surgery can be done to un-pinch the cord. the results are good and ninety percent of people improve. Complications are rare but can be serious.
Another type of surgery to treat stenosis is laminoplasty. The laminoplasty is slightly more complex, takes a little longer and has higher risks. It is usually only done in young people with stenosis.