Neck Pain
The first 7 vertebral bones on the spinal column form the cervical spine and are in the neck region. The neck bears the weight of the head, allows significant amount of movement, and is also less protected than other parts of the spine. All these factors make the neck more susceptible to injury or other painful disorders. Common neck pain may occur from muscle strain or tension in everyday activities including poor posture, prolonged use of a computer and sleeping in an uncomfortable position.
Anatomy
Cervical Spine Anatomy
The spine, also called the back bone, plays a vital role in stability, smooth movement and protection of the delicate spinal cord. It is made up of bony segments called vertebrae with fibrous tissue called intervertebral discs between them. The vertebra and discs form the spinal column from the head to the pelvis, giving symmetry and support to the body.
The spine can be divided into 4 parts: cervical, thoracic, lumbar and sacral region. The cervical spine comprises the first 7 vertebrae of the spinal column, which form the neck.
The cervical spine is highly mobile compared to other regions of the spine such as thoracic or lumbar spine. In contrast to other parts of the spine, the cervical spine has transverse foramina in each vertebra through which the vertebral arteries supply blood to the brain.
Causes of Neck Pain
The most common cause of neck pain is injury to the soft tissues (muscles, ligaments, or nerves) or prolonged wear and tear. Traumatic accidents or falls and contact sports can cause severe neck injuries causing pain in the neck. Neck pain can also come from infections, tumours or congenital abnormalities of the vertebrae. Common conditions producing neck pain include:
- Rheumatoid arthritis: It is an auto-immune disease in which the body's immune system attacks healthy joints, tissues and organs. The condition occurs most often in the upper neck area causing inflammation of the lining (or synovium) of joints resulting in neck pain, stiffness, swelling and loss of function.
- Cervical disc herniation: Disc herniation is the bulging or rupture of the soft fibrous tissue, discs, cushioning the vertebrae. Cervical disc herniation refers to herniation of discs in cervical spine region or neck region. Because of this the soft central portion called nucleus pulposus bulges out through the tear in the capsule. The condition can be caused by the normal ageing or by traumatic injury to the spine. The condition results in painful, burning, tingling or numbing sensations in the neck.
- Cervical Spondylosis: Cervical spondylosis refers to abnormal degeneration of the cartilage and bones in the neck region. The condition results in neck pain radiating to arms or shoulder and neck stiffness that gets worse over time.
- Cervical Stenosis: Cervical stenosis refers to narrowing of the spinal canal that protects the spinal cord and its branching nerves. The condition causes neck pain radiating to arms and hands.
- Degenerative disc disease: Degenerative disc disease refers to gradual deterioration of the disc between the vertebrae and is caused due to ageing. As people age, intervertebral discs lose their flexibility, elasticity and shock absorbing characteristics, resulting in neck pain.
Investigations
Diagnosis of neck pain is made with physical examination and other imaging techniques including electromyography (EMG), X-ray, MRI scan, CT scan, blood tests and bone density assessment.
Spinal Conditions
Cervical Stenosis
Cervical spine refers to neck portion of spine, and cervical spine conditions may result from overuse injuries, trauma and certain diseases. Cervical stenosis refers to narrowing of the spinal canal that protects the spinal cord and its branching nerves. The condition causes neck pain radiating to arms and hands, numbness or weakness in the legs. This condition causes cervical myelopathy and cervical radiculopathy. The abnormal pressure placed on the spinal cord causes damage and results in spinal cord dysfunction. This condition is known as myelopathy. Cervical radiculopathy occurs when the nerve roots connecting the spinal cord are injured or pinched as they exit the spinal canal. Myeloradiculopathy occurs when there is damage to the spinal cord and nerve roots.
Cervical Herniated Disc
Herniation of a disc is an anomalous spine condition characterized by leakage of the inner contents of the intervertebral disc, due to cracks in its outer wall. Herniated disc is commonly seen in the cervical or neck region, a condition called cervical herniated disc (CHD). CHD is followed by arm or neck pain that may arise due to compression of the spinal nerves by the protruding disc material.
Cervical Disc Protrusion
Cervical disc protrusion, commonly known as disc bulge occurs when the spinal discs and associated ligaments are intact, but may form a bulge that will press on the spinal nerves. This condition causes pain in the neck, shoulder and the arms. Usually, the symptoms include a dull, aching, or sharp pain in the neck or the shoulder blades. Sometimes, the pain may radiate along the arms to the hands and fingers. Tingling sensation and numbness may be felt at the fingertips.