Introduction
Anatomy
Cause
Symptoms
Diagnosis
Non-surgical treatment
Surgical treatment
Rehabilitation
Prevention
Neck pain is a very common symptom and frequently occurs among today’s office workers. But it can happen to anyone of any age. For many people, neck pain is a temporary condition that disappears with time. Others need medical diagnosis and treatment to relieve their symptoms.
The neck is supported by seven segments of vertebrae that begin in the upper chest and end at the base of the skull. This section of the spine is known as the cervical spine. The bony vertebrae along with the ligaments provide stability to the spine and the head. The muscles allow for support and motion. The neck has a good range of motion and supports the weight of the head. Unlike the thoracic spine, which is supported by the rib cage, the cervical spine is less protected. The neck is therefore vulnerable to injury and disorders from stress and strains, resulting in pain and restricted motion.
Besides injuries such as sprains, falls or trauma, the most common cause of neck pain is improper posture in everyday activities – may it be standing, sitting, working or resting. This leads to the fatigue and strains of muscles, joints and bones. Without appropriate stretching and relaxation, improper posture would affect the circulation and nutrition of these tissues in the neck, which in turn manifests as pain and stiffness. The pain may even radiate to the shoulders and elbows.
The symptoms include tightness and contraction of the muscles behind the neck, limiting neck movement. This kind of neck muscle soreness caused by fatigue and muscle strain usually does not affect the peripheral nerves, nor does it lead to persistent loss of function of the nerves and the muscles. Usually, symptoms will disappear one or two weeks after appropriate rest and stretching exercises. There should not be any generalised discomfort or systemic pathology.
Occasionally, there may be persistent numbness or decreased sensation or weakness in the limbs. In this case, it is necessary to consult an orthopaedic surgeon to exclude any possible neurological complications due to a mechanical lesion on the nerves radiating from the spinal canal.
An orthopaedic specialist will first obtain the medical history of the patient, then carefully examine the nerves extending from the spine canal to the limbs, test the functional integrity of the muscles, their reflexes and their ability to contract and to relax at will, as well as the patients’ ability to control their bowel and bladder functions.
By using X-ray or CT scans, the specialist will be able to determine if the patient has spinal diseases that cause neck pain, together with neurological dysfunctions such as paraesthesia, weakness of the limbs and disturbance of the bowel and bladder sphincter controls. These diseases include:
1. Soft tissue injuries along the spine.
2. Structural damage of the spinal column due to trauma, chronic stress or excessive loading, which affects the stability and range of motions.
3. Degeneration, inflammation, swelling and the formation of bony spurs at the facet joints, leading to irritation and compression of the nerve roots in their neighbourhood and hence affecting the function of the limbs.
4. Degeneration, dislocation, herniation, calcification and ossification of intervertebral discs, which cause the narrowing and subsequently, compression, of the spinal canal and intervertebral foramen, damaging the functions of the peripheral nervous system in the extremities.
Besides X-ray and CT scans, the orthopaedic specialist may also take blood samples, conduct MRI scans, Positron Emission Tomography (PET) or even Tc-HIDA Scan to find out the causes and assess the severity of the pathological conditions before recommending the mode of treatment and help decide if surgery is needed.
The following is a list of warning signals for any of conditions that require the attention of an orthopaedic specialist:
1. Persistent pain in the neck and back, especially at night, and conditions that do not improve in more than two to three weeks.
2. Neck pain that does not improve in spite of resting, staying in bed or taking anti-inflammatory medication.
3. Weakness of the shoulders and limbs, slow response and clumsiness in the use of hands, difficulty in lifting the legs, increasing difficulties in walking, progressive decrease in walking distance, incontinence and difficulties in controlling bowel movements.
4. Presence of acute or chronic spinal inflammatory diseases, such as rheumatoid arthritis and ankylosing spondylitis.
5. Fracture or dislocation of the vertebral column.
6. Collapse or squashed vertebral bodies, fracture or dislocation of the spinal segments in patients with osteoporosis.
7. Any suspicious cancerous tumour in the spine or spinal cord. Narrowing of the spinal canal and/or the intervertebral foramina, which might impinge the nerves.
9. Recent history of change in appetite, weight loss and easy fatiguability, which might suggest the presence of some genuine systemic pathology.
Most neck and back pain resulting from poor or inappropriate posture improves with a short period of rest and graded exercise. A short period of non-steroid anti-inflammatory medication may be used to control the symptoms of neck and back pain and numbness and stiffness of the neck and shoulders.
Surgery is only necessary when the symptom is progressive, disabling and complicated by persistent neurological dysfunction. An orthopaedic surgeon will recommend surgery if he or she can demonstrate physical signs that are in agreement with the symptoms, supported by relevant findings on CT or MRI images.
Performing a series of neck and back muscle exercises is necessary to strengthen the spinal and abdominal muscles.
An appropriate exercise programme will keep the neck and back muscles strong and make them more adaptive when called into function.
1. Adopt a proper posture while sitting and engaging in other daily activities.
2. Perform regular neck and back muscle exercises to relax the spinal muscles, especially in between long periods of desk work.
3. Beware of your physical limits and work within those limits.
4. Do not lift heavy objects with your back; work close to the load and lift with your hips and knees.
5. Exercise and train your muscles regularly.
6. Control your workload and body weight.
Dr. MAK, Kan-hing