Neck Pain

CERVICAL DYSFUNCTION

Cause Minor injury causing dysfunction, incl. stiffness in facet joints.

Features of non-specific neck pain

• Deep ache in neck

• Pain may radiate to head or suprascapular area

• Variable restriction of neck movement

• X-rays usually normal. Imaging should be selected conservatively—plain X-ray is not indicated in the absense of red flags and major trauma. MRI is the investigation of choice for radiculopathy, myelopathy, suspected spinal infection and tumours.

Management

• Education with advice, such as good posture

• Basic analgesics (e.g. paracetamol, ibuprofen)

• Neck exercise program (crucial)

• Cervical mobilisation by appropriately trained therapist; consider manipulation by expert (with caution) for stubborn ‘locked’ neck

CERVICAL SPONDYLOSIS

Cause Degenerative disease in older persons.

Features Dull, aching neck pain with stiffness, worse in morning.

Management

• Referral for physiotherapy, incl. warm hydrotherapy

• Regular mild analgesics (e.g. paracetamol)

• NSAIDs: a trial for 3 wks then review (use judiciously)

• Gentle mobilising exercises as early as possible

• Passive mobilising techniques

• Outline general rules to live by including advice re. sleeping and pillows

ACUTE TORTICOLLIS

Torticollis (acute wry neck) means a lateral deformity of the neck and is usually a transient self-limiting, acutely painful disorder with associated muscle spasm of variable intensity. Most likely due to acute dysfunction of mid-cervical facet joints.

Management

• Pain relief—consider antispasmodics (e.g. diazepam)

• Gentle mobilisation exercises

• Muscle energy therapy (very effective)

WHIPLASH SYNDROME

Treatment

• Provide appropriate reassurance and patient education

• Compare the problem with a sprained ankle, which is a similar injury

• Inform patient that an emotional reaction of anger, frustration and temporary depression is common (lasts about 2 wks)

• X-ray recommended

• Rest initially but mobilise as soon as possible

• Cervical collar (limit to 2 d)

• Analgesics (e.g. paracetamol); avoid narcotics

• NSAIDs for 2 wks

• Tranquillisers, mild—up to 2 wks

• Physiotherapy referral

• Neck exercises (as early as possible)

• Heat and massage; ‘spray and stretch’

• Passive mobilisation (not manipulation)