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Wednesday, March 19, 2014

Cervical Spine Pain




Neck pain

  • The neck is the long, complex structure supporting the head. It is comprised of 7 cervical vertebrae (bones of the spine), disks (gelatinlikeShock absorbers), muscles, ligaments (supportive, hard, bandlike structures), nerves, blood vessels, glands, and lymphatic tissue.
  • The 7 cervical vertebrae protect the spinal cord -- a collection of nerves carrying electrical messages from the brain to different parts of the body.
  • The vertebrae are round, flat bones, each with a central cavity or hole for the cord to pass through.
  • Separating the vertebrae are disks made of cushionlike material (cartilage). Nerves leave the spinal cord and travel to other parts of the body through holes provided in the vertebrae.
  • Muscles and tendons protect and support the cervical spine and neck.
  • Conditions that adversely affect these structures can cause Neck Pain, stiffness, and restricted mobility.
  • When the joints between the bones are narrowed by trauma, prolonged wear and tear, or immune system attack (body's normal defenses), it causes the vertebrae to grind against each other, creating pressure and stress on localized nerves, muscles, and tendons. In turn, this causes pain and other symptoms in the damaged area, as well as to the shoulders, arms, hands, and fingers.
  • Neck Pain can be acute (days to a few weeks) or chronic (weeks to years).

  • In most cases (except trauma) involving muscular strain or rupture of the disk, the symptoms develop over time.
  • Slowly developing Neck Pain and stiffness
  • Pain often occurs after neck use -- as in reading, computer use, or viewing movies
  • May have neck stiffness in the mornings
  • Muscle stiffness and tenderness
  • There may be tender points along the affected vertebrae.
  • There may be pressure on the nerves, producing pain, tingling, numbness, or an electrical sensation in the fingers, hands, arms, or shoulders. This is called radiculopathy.
  • With more severe diseases, there are Crepitations (sounds like popping popcorn) heard when joints of the neck are moved.
  • With prolonged nerve root compression, muscles can become weak and atrophied (shrink).
  • Headaches, especially those starting at the base of the neck and radiating to scalp and forehead, are common.
  • Other organs or joints may be involved.
  • With trauma and severe neck damage, there may be Low Blood Pressure, difficulty breathing, and coma.

  • Biomechanical -- straining the neck muscles, as with prolonged use or severe exercise, can cause them to become stiff and painful.
  • Degenerative changes (wear and tear) -- occur from constant repetitive movements (i.e., bending the neck at work) over long periods of time and can cause chronic Neck Pain.
  • Osteoarthritis (OA) is an example of a degenerative disease that can affect the neck and other joints. It is a common condition after age 40, in which joint destruction is associated with formation of bone spurs (extra bony material) that can further aggravate the joints.
  • Diseases such as Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS) -- in which the body's natural defenses (immune system) mistakenly attack the bones and joints -- can, over time, destroy the joints of the neck, and cause pain and stiffness all over the body.
  • Polymyalgia Rheumatica occurs in the elderly and causes stiffness and pain over the neck, arms, shoulders, and buttocks. It may be inherited or immune- system related, and can cause depression.
  • Attacks on the immune system, as in RA, AS, Spondyloarthropathies (i.e., disease of the joints of the spine like Reiter's and psoriatic arthritis) destroy joints, bones, muscles, ligaments, as well as other body parts (skin, eyes, etc.).
  • Herniated Disk -- the disk can balloon out from between the vertebrae (even rupture), causing pressure, pain, and restricted mobility.
  • With excessive wear and tear, disks degenerate and narrow. The vertebrae, having nothing soft between them, continue to grind, causing excessive damage.
  • Trauma -- sudden neck movement (whiplash), sudden impact (landing on head), or boxing injuries can cause acute and chronic neck problems.
  • Neurological -- diseases such as Stroke,Muscular Dystrophy, or Multiple Sclerosiscan cause weakness of the muscles of the neck, which over time results in strain on the normal muscles and structures.
  • Diffuse idiopathic skeletal hyperostosis (DISH) occurs when Calcium forms around vertebrae and ligaments, causing stiffness and pain.
  • Infections and cancers are rare sources of Neck Pain.
  • Meningitis -- an infection of the tissues covering the brain and spinal cord, marked by high fever, headaches, and neck stiffness -- is a dangerous condition requiring immediate attention.

  • History:
  1. The doctor may ask how you've had the symptoms?
  2. Was the onset sudden or gradual?
  3. Do you have other symptoms, such as fever, headaches, skin problems, pain in other joints, numbness, or tingling?
  4. Did you fall or have an accident? What is your occupation?
  5. Family history and a full medical history is important.
  • Physical exam:
  1. General exam of the body and neck
  2. The head and neck are felt, moved (not if trauma has occurred).
  3. If the problem is muscular, the exam is limited and treatment is started.
  • Tests include:
  1. X-Rays of the neck will show narrowed spaces between bones (OA, RA), fractures,Calcium formations, and bone spurs.
  2. MRI or CAT scan allows a better view, and are recommended if nerve or disk damage is suspected.
  • Other tests include:
  1. Blood tested if certain diseases (Prostate cancer, RA, AS, etc.) are suspected
  2. Muscles and nerves -- nerve conduction studies and Myelogram, respectively.
  3. These test are done if X-Ray, MRI, or CAT scan are not helpful.
  4. Cancer spread from other parts of the body to the neck bones -- detected by doing bone scan.
  5. Spinal tap (examination of spinal fluids) is done if Meningitis is suspected.

  • Age --Osteoarthritis and degenerative disk diseases commonly occur after age 40. AS is common before age 40. Juvenile forms of RA occur before age 14.
  • Sex -- in AS, males are at greater risk than females.
  • Genetics -- AS may be inherited. Both Juvenile RA and AS have been linked to gene HLA-B27.
  • Sports, injuries, or obesity is often associated with Osteoarthritis.

  • If a trauma occurred (e.g., car accident or fall) paramedics normally stabilize the neck before moving the patient to the hospital.
  • For chronic pain:
  1. Applying light heat (heating blanket, warm towel) can relax the muscles and reduce pain.
  2. Massage with oils or creams (Zostrix, Icy hot, or Ben Gay) can also help.
  3. Acupuncture and acupressure can help with pain and muscle relaxation. Your general doctor may refer you to a specialist (e.g., orthopedic, therapist).
  4. Physical therapist (PT) can show you stretching exercises that help the stiffness and pain.
  5. PT or a chiropracter can use sound waves (ultra sound) on the strained muscle.
  6. Non Steroidal Anti-inflammatory Drugs (NSAIDs) can reduce irritation and swelling (inflammation) around the damaged area and reduce pain and stiffness. Serious side effects (stomach ulcers and bleeding) may occur over long use without doctor's supervision.
  7. For severe muscular neck stiffness, muscle relaxants such as Baclofen or Valium may be used.
  8. Corticosteroids such as Depomedrol or Prednisone are strong anti-inflammatory medications that can be injected or taken by mouth. They are used only for severe cases. For example, injections cannot be given more than 1-3 times per year. Side effects include bleeding, thinning of bones, and infections.
  9. Chronic pain can be depressing and anti-depressants may help.
  10. For severe nerve damage, degenerative changes, disk herniation, or fractures surgery may be needed.

  • Contact your physician for further evaluation.

  • All other causes of Neck Pain.
  • Cancers such as Multiple Myeloma, breast, or prostate cancers.
  • Osteoporosis (thin bones can fracture).

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