Whiplash injury results from acceleration-deceleration forces applied to the neck, usually in a road traffic accident when the car of a person wearing a seat belt is struck from behind. Delayed recovery depends in part upon the severity of the initial injury. A simple decision plan based on clinical criteria helps to distinguish those most at risk and who warrant radiography. There is a low probability of serious bony injury if there is no midline cervical tenderness, no focal neurological deficit, normal alertness, no intoxication and no painful distracting injury. CT scans are reserved for those with bony injury. MRI scans occasionally show severe soft tissue injury. Whiplash injuries commonly lead to litigation.
Symptoms of whiplash injury:
Whiplash injury is a common cause of chronic neck pain, although most people recover within a few weeks or, months. The pattern of chronic neck pain is often complex, involving pain in the neck, shoulder and arm. Headache, dizziness, and loss of memory and poor concentration sometimes accompany this. The subjective nature of these symptoms has led to controversy about their cause. The problem is more commonly seen in industrialized countries. It has often been suggested that the syndrome is caused in part by the prospect of financial compensation. This may not be wholly conscious and may be contributed to in part by the conflictive nature of the compensation process. There appears to be a direct relationship between poor prognosis and potential for compensation - elimination of compensation for pain and suffering due to this type of injury may lead to an improved prognosis.
Treatment of whiplash injury:
Treatment is with reassurance (as the patient may be very anxious), analgesia, a short-term collar and physiotherapy. Pain may take a few weeks or months to settle and the patient should be warned of this.
See the other causes of neck pain
Showing posts with label neck pain. Show all posts
Showing posts with label neck pain. Show all posts
Friday, April 3, 2009
Neck pain due to nerve root entrapment (Cervical disc prolapse)
This is caused by an acute cervical disc prolapse or pressure on the root from spondylotic osteophytes narrowing the root canal. Acute cervical disc prolapse presents with unilateral pain in the neck, radiating to the inter-scapular and shoulder regions. This diffuse, aching dural pain is followed by sharp, electric shock-like pain down the arm, in a nerve root distribution, often with pins and needles, numbness, weakness and loss of reflexes. Cervical spondylosis occurs in the older patient with posterior osteophytes compressing the nerve root and causing root pain, commonly at C5/C6 or C6/C7; it is seen on oblique radiographs of the neck. An MRI scan shows facet joint OA and any associated disc prolapse clearly.
Treatment of cervical disc prolapse
A support collar, rest, analgesia and sedation are used as necessary. They should be advised not to carry heavy items. It usually recovers in 6-12 weeks. MRI is the investigation of choice if surgery is being considered or the diagnosis is uncertain . A cervical root block administered under direct vision by an experienced pain specialist may relieve pain while the disc recovers. Neurosurgical referral is essential if the pain persists or if the neurological signs of weakness or numbness are severe or bilateral. Bilateral root pain is a neurosurgical emergency because a central disc prolapse may compress the cervical spinal cord.
See the other causes of neck pain
Treatment of cervical disc prolapse
A support collar, rest, analgesia and sedation are used as necessary. They should be advised not to carry heavy items. It usually recovers in 6-12 weeks. MRI is the investigation of choice if surgery is being considered or the diagnosis is uncertain . A cervical root block administered under direct vision by an experienced pain specialist may relieve pain while the disc recovers. Neurosurgical referral is essential if the pain persists or if the neurological signs of weakness or numbness are severe or bilateral. Bilateral root pain is a neurosurgical emergency because a central disc prolapse may compress the cervical spinal cord.
See the other causes of neck pain
Causes of neck pain and its treatment
Causes of neck pain and its treatment
Unilateral or bilateral muscular pattern neck pain is common and usually self-limiting. It can follow injury, falling asleep in an awkward position, or prolonged keyboard working. Chronic burning neck pain occurs because of muscle tension from anxiety and stress. Spondylosis seen on X-ray increases after the age of 40 years, but it is not always causal. Spondylosis can, however, cause stiffness and increases the risk of mechanical or muscular neck pain. Muscle spasm can be palpable, is tender and may lead to abnormal neck posture (e.g. acute torticollis). Muscular pattern neck pain is not localized but affects the trapezius muscle, the C7 spinous process and the paracervical musculature (shoulder girdle pain). Pain often radiates upwards to the occiput but rarely laterally to the tip of the shoulder. It is commonly associated with unilateral or bilateral tension headaches; pain radiating over the head to the temple and eye, described as like a pressure or tight band. These features are also seen in fibromyalgia.
Following are list of causes of pain in neck or shoulder:
#Trauma (for example, a fall)
#Mechanical or muscular neck pain
#Whiplash injury
#Disc prolapse - nerve root entrapment
#Ankylosing spondylitis
#Shoulder lesions: Rotator cuff tendonitis Calcific tendonitis or bursitis Impingement syndrome or rotator cuff tear Adhesive capsulitis (true 'frozen' shoulder) Inflammatory arthritis or osteoarthritis.
#Polymyalgia rheumatica
#Fibromyalgia
#Chronic (work-related) upper limb pain syndrome
#Tumour
Treatment of neck and shoulder pains:
Patients are given short courses of analgesic therapy along with reassurance and explanation. Physiotherapists can help to relieve spasm and pain, teach exercises and relaxation techniques, and improve posture. An occupational therapist can advise about the ergonomics of the workplace if the problem is work-related.
Unilateral or bilateral muscular pattern neck pain is common and usually self-limiting. It can follow injury, falling asleep in an awkward position, or prolonged keyboard working. Chronic burning neck pain occurs because of muscle tension from anxiety and stress. Spondylosis seen on X-ray increases after the age of 40 years, but it is not always causal. Spondylosis can, however, cause stiffness and increases the risk of mechanical or muscular neck pain. Muscle spasm can be palpable, is tender and may lead to abnormal neck posture (e.g. acute torticollis). Muscular pattern neck pain is not localized but affects the trapezius muscle, the C7 spinous process and the paracervical musculature (shoulder girdle pain). Pain often radiates upwards to the occiput but rarely laterally to the tip of the shoulder. It is commonly associated with unilateral or bilateral tension headaches; pain radiating over the head to the temple and eye, described as like a pressure or tight band. These features are also seen in fibromyalgia.
Following are list of causes of pain in neck or shoulder:
#Trauma (for example, a fall)
#Mechanical or muscular neck pain
#Whiplash injury
#Disc prolapse - nerve root entrapment
#Ankylosing spondylitis
#Shoulder lesions: Rotator cuff tendonitis Calcific tendonitis or bursitis Impingement syndrome or rotator cuff tear Adhesive capsulitis (true 'frozen' shoulder) Inflammatory arthritis or osteoarthritis.
#Polymyalgia rheumatica
#Fibromyalgia
#Chronic (work-related) upper limb pain syndrome
#Tumour
Treatment of neck and shoulder pains:
Patients are given short courses of analgesic therapy along with reassurance and explanation. Physiotherapists can help to relieve spasm and pain, teach exercises and relaxation techniques, and improve posture. An occupational therapist can advise about the ergonomics of the workplace if the problem is work-related.
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