Neck pain

M akond

Bones & joint of cervical spine

Brachial plexus

Introduction of neck pain

Neck pain. is the sensation of discomfort in the neck area. Neck pain can result from disorders of any of the structures in the neck, including the cervical vertebrae and intervertebral discs, nerves, muscles, blood vessels, esophagus, larynx, trachea, lymphatic organs, thyroid gland, or parathyroid glands. Neck pain arises from numerous different conditions and is sometimes referred to as cervical pain.

As a professional Physiotherapist ,Our practice of field in Neck pain includes _ A. Soft tissues. E .g. Muscles, ligament,tendon,vessels & nerves.B. Bones & joints in neck.eg. Facet joints,Interavertevral joint & Disc.

Causes of neck pain

• Anomalies in bones & joint.• Trauma.• Poor posture.• Degenerative diseases.• Tumor /Neoplasm.• Muscles stains.• Psychological stress.• Others or ideological.

Major and severe causes of neck pain .

• Carotid artery dissection• Referred pain from acute coronary syndrome• Head and neck cancer• Infections: retropharyngeal abscess, epiglottitis, etc.• Spinal disc herniation – protruding or

bulging discs, or if severe prolapsed.• Spondylosis - degenerative arthritis and

Osteophytes• Spinal stenosis – a narrowing of the spinal

canal

The more common and lesser neck pain causes

:• Stress – physical and emotional stresses• Prolonged postures – many people fall asleep on sofas

and chairs and wake up with sore necks.• Minor injuries and falls – car accidents, sporting events

and day to day injuries that are really minor.• Referred pain – mostly from upper back problems• Over-use – muscular strain is one of the most common

causes• Whiplash• Herniated disc.

www.weikepedia.com. 27/07/2013.-1.44am

Symptoms &Signs of neck pain

1. Neck pain , 2.Neck tenderness, 3.Neck swelling, 4.Neck muscle spasm, 5. Neck stiffness. 6.Additional symptoms may include fever,

headache, nausea, vomiting, swollen glands in the neck, arm weakness, leg weakness, arm numbness, leg numbness, loss of bladder control, loss of bowel control, and an inability to walk.

Classifications of neck pain

• There are three types or classifications of neck pain:

• Axial neck pain: Axial pain is Musculoskeletal, and is pure

neck or soft tissue pain. Whiplash or muscle strain is an example.

• Radiculopathy: Cervical radiculopathy refers to neck and arm pain due to nerve root compression. Symptoms include arm pain, numbness or weakness.

• Myelopathy: Myelopathy refers to pressure on the spinal cord,

also referred to spinal cord compression. Symptoms include: neck pain with arm and/or leg weakness, numbness, or walking problems.

• www.neck pain explain.com

Clinical examination of neck pain

• Local examination of neck with neurological & vascular survey of upper limb.

• Examination of potential extrinsic sources of neck symptoms.

• General examination.

• Ref .Outline of orthopedics , -Adams & Hamblen 12th edition.

Local examination Includes

• Inspection. -Bone contours ? Deformity.

-Soft-tissue contours . -Color & Texture of skin. -Scars & sinuses.

Local examination…………cont

• Palpation. -Skin temperature. -Bone contours. -Soft-tissue contours. -Local tenderness.

Palpation of neck

Local examination ………..cont.

• Movements. -Flexion-extention. -Lateral flexion. -Rotation. Feel there is pain or crepitation on

movement

Movement of neck

Local examination……….cont.

• Neurological state of upper limb. -Muscular system, Fasciculation or Wasting. -Sensory system, dermatome & myotome. -Sweating, moist or dry. -Reflex, Biceps jerk (C6),Triceps

jerk(C7),Brachioradialis( C6).

Neurological examination of neck

Local examination…………..cont.

• Vascular state of upper limb.

-Colour. -Temperature.

-Pulses.

Examination of extreinsic sources of neck pain

- Pain may referred from other organ like Ears or throat.

- Checking Brachial plexus distribution.

-others organs testing.

Investigation for neck pain

•Laboratory test. - CBC, ESR , Hb % , CRP, RA & MT.

Investigation for neck pain

• Radiological & Imaginary test. -X-ray of C/S both view. -MRI of Cervical spine. -CT Scan. -CAT scan.

X-ray view for neck .

– AP: Evaluate the lateral masses, equal separation of spinous processes, best view for vertical compression fractures, equal disk spaces.

– Lateral: Each cervical vertebra, cartilaginous disk space, cervical lordotic curve, C2 neural arch, lamina, spinous process, lateral mass and articular facet.

– Swimmer's: If the body of C7 not well visualized on lateral view.

– Odontoid: Visualize dens.

X-ray of cervical spine

Normal X-ray of Cervical spine

Osteophytes & Degenerative change

Tuberculosis of spine

Rheumatoid arthritis of neck condition

Neck stain due to awakness of sleeping

Neck pain according to onset

•Acute neck pain.•Chronic neck pain

Acute neck pain

Acute pain occurs suddenly from an injury or stress. Most of the time neck pain will resolve itself within 7-10 days with rest, ice, and over the counter pain relievers. For symptoms that persist longer than a few weeks. Conservative therapy can include anti- inflammatories pain medication, injections, physical therapy, acupuncture, and chiropractic care.

Chronic neck pain

• Chronic pain is defined as neck pain lasting longer than three months. People who have not found relief through conservative treatments, and suffer from chronic pain may benefit from pain management by Physical therapy or surgical intervention.  

Special test for neck pain

• Special tests. • Arson's test: Indicates occlusion of

subclavian artery. Feel the radial pulse while abducting, extending, and externally rotating.

–Ankle clonus: May indicate UMN lesion. Quickly dorsiflex the foot while cradling the heel in your palm to relieve the load.

– Ref. by Basic orthopedic Examination

Special test for neck pain

– Bakody sign: Indicates cervical radiculopathy. Patient raises his or her hand on top of the head.

– Compression: Indicates nerve root tension/ radiculopathy. With the patient seated, press downward on top of the skull.

– Distraction: Indicates nerve root tension/ radiculopathy. Pull upward on skull.

– Doorbell sign: Indicates nerve root tension/ radiculopathy. Deep palpation of C5.

– Ref. by Basic orthopedic Examination.

Special test for neck pain

– Halstead maneuver: Neurovascular compression. In a seated patient, palpate a radial pulse, and then pull traction on the patient's arm downward while the patient extends the head backward.

– Hoffmann's sign: Myelopathic sign. Flick the patient's DIP joint of the long finger.

– Jackson's compression: Nerve compression. Patient is seated and bends the head obliquely backward; then apply downward pressure on patient's head.

– Ref. by Basic orthopedic Examination

Special test for neck pain

– Lhermitte's sign: May indicate spinal canal stenosis, multiple sclerosis, cervical disk impingement, or tumor. Bend the patient's head forward.

– Rust's sign: Test for a severe sprain or subluxation. Patient holding the weight of his or her head in the hands or lifting the head manually when arising from lying down are positive signs.

– Swallowing: Indicates anterior spine/ prevertebral space swelling

• Ref. by Basic orthopaedic Examination

Treatment of neck pain

• Treatment of neck pain Mainly depend on etiology &

onset of Condition.

• Main treatment is to treat underlying causative factors.

Sometime emergency first aid is necessary for traumatic neck pain

Gross management of neck pain

Conservative or non-surgical treatment.

Surgical Treatment.

Conservative treatment

•Rest.•Drug therapy.• Physical therapy.•ADL for correction of life.

Conservative treatment …….cont

• Rest. Rest is important for all

acute neck pain with others reamady.Duration of rest depend on patient prognosis & causative factors.Rest with proper positioning of neck that is seen by therapist or physician.

Conservative treatment …….cont

• Drug Therapy.• -Analgesic.• -Anti inflammatory.• -NSAID with ulcerative.• - Injections.• -Others .

Conservative treatment …….cont

•Physiotherapy. -Ice in acute stage or cryotherapy.

-Moist heat. -Contrast therapy. -Hot compression.

Physiotherapy……….cont.

• Electrotherapy. -Superficial Modalities, e.g. IRR. -Deep thermal modalities, e.g. .

MWD,SWD. -Ultrasonic therapy. -LEASER therapy. -TENS therapy. - IFT.

Physiotherapy……….cont

• Exercise therapy. -Neck muscle strengthening

exercise. -Neck mobilizing exercise. -Neck mobilization. -Neck Manipulation technique. -Cervical traction approach.

Physiotherapy……….cont

• Orthotics device. -Cervical collar. -Halter collar. -Hallo cervical

traction . -Contour types

pillows. -Others.

Physiotherapy……….cont

• ADL(Activities for daily living). -Regular exercise. -Proper lying, sitting &

working. - Maintain proper body

alignment -Maintain appropriate

Ergonomics - others ADL.

Neck Ergonomics

Surgical Procedures

• Dissectomy.(with or without fusion). The surgeon removes herniated disc material that is pressing on a nerve root or the spinal cord.

• Cervical spinal fusion. Selected bones in the neck are joined (fused) together.

• Spinal Decompression. Pressure is reduced on the spinal cord or spinal nerve roots by removing part of a bone or disc.

Surgical Procedures

• Artificial disc replacement.• Percutaneous radiofrequency

neurotomy.

Post-Operative Physiotherapy

• It is so much important And Skillful than Conservative stage of Physiotherapy.

• Treatment according to Post-operative Complains & other complication.

Our Message to community

SO be smart & conscious at

Physically Within your physical

structures.

References

• Book of Basic orthopedics.• Out line of Orthopedics.• Ref. international guide line of neck

pain.• www. Wikipedia .com.• www.myoclinic.com

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