Neck Pain Overview

Neck Pain

Neck pain is one of the more common musculoskeletal disorders. Symptoms can vary in severity and duration depending on the underlying cause. Since there are many potential causes of neck pain, it is important to see a medical specialist for a proper diagnosis and ideal treatment plan. 

Causes of Neck Pain

Causes of neck pain are often grouped into broad categories such as:

  • Traumatic: the result of an injury
  • Degenerative: caused by wear and tear
  • Other causes: which include tumors, infection, and autoimmune disorders

Traumatic

A traumatic cause of neck pain is the result of an injury. An injury is perhaps the most common cause of neck pain. Some injuries are minor and resolve spontaneously on their own and others require medical attention and a prolonged recovery.

  • Muscle strain also known as a pulled muscle, a muscle strain refers to damage to the muscle or its connecting tendons. This can be caused by hyperextension, such as in whiplash, or twisting awkwardly. These are typically minor injuries that heal with rest and medications. 
  • Fracture – a fracture is a broken bone and may be the result of a fall, or high impact injury like a car accident. In older people with osteoporosis (decreased bone density), fractures can occur with minimal trauma. Depending on where the vertebrae is broken, a fracture can be treated with bracing, but can sometimes require surgery. 

Degenerative

Degenerative causes of neck pain refer to wear and tear on the spine.  This is often age related or due to repetitive injury. Chronic neck pain is often caused by degenerative changes. 

  • Canal Stenosis (narrowing) – the spinal cord and spinal nerves pass through canals within the spine. These can narrow due to bony overgrowth (osteophytes), thickening of ligaments (ligamentum flavum hypertrophy), or because of a herniated intervertebral disc. 
  • Herniated disc – The intervertebral discs can slip, protrude, or rupture which can result in canal narrowing and compression of the spinal cord or nerve roots
  • Degenerative disc disease – refers to wear and tear on the intervertebral disc. The disc can be thought of as a gel filled sac (nucleus pulposus) with a fibrous outer layer (annulus fibrosus) that acts as a shock absorber. Overtime, the gel-like center can dry out and the outer layer may break down leading to pain. 
  • Spondylosis – is a general term that refers to age related wear and tear, or degeneration, of the spine
  • Spondylolisthesis – is when one of the bones of the spine, called a vertebrae, slips forward or backwards from its normal position. 

There are other causes of neck pain that are neither due to injury or degenerative changes in the spine. 

  • Tumor – An abnormal growth that may be benign or cancerous. Treatment may be surgery, radiation, chemotherapy, or a combination.  
  • Infection– An infection can affect the bones (osteomyelitis), the discs (discitis), or the space surrounding the spinal cord (epidural abscess). 
  • Auto-immune disorders – autoimmune disorders occur when your immune system misidentifies healthy cells as foreign and attacks them by mistake. Example disorders are rheumatoid arthritis and ankylosing spondylitis

An evaluation by a medical professional is highly recommended to ensure a proper diagnosis

Neck Pain Symptoms

Pain can be isolated to the neck or can cause additional symptoms if nerves are compressed. Symptoms commonly experienced include:

  • Neck pain
  • Arm pain
  • Arm numbness
  • Arm weakness

Diagnosis

A proper diagnosis should be made by a medical professional. Often the diagnosis can be made clinically, meaning based on detailed interview and a careful physical examination. However, sometimes more studies are needed based on the assessment or if symptoms do not improve after initial visits. 

Imaging studies such as x-ray, CT scan, and MRI, are commonly used to make diagnosis.  Each visualizes different body parts and has it’s own strengths and weaknesses. 

  • X-ray uses the passage of electromagnetic waves to create shadow like images of bones and some organs. X-rays are quick and accessible but do a poor job evaluating soft tissues such as muscles and nerves. X-rays also result in a small amount of radiation. 
  • CT scan also known as Computed Tomography, uses a series of x-rays along with computer processing to create detailed cross-sectional images. CT scans produce higher quality images that can also see organs and blood vessels.  However, they are associated with more radiation exposure. 
  • MRI which stands for Magnetic Resonance Imaging, uses a magnetic field and radio waves to create images of the body. MRI does a great job of visualizing tendons, ligaments, nerves, and intervertebral discs. Another benefit is that there is no radiation exposure. Unfortunately, MRI’s often are associated with longer wait times and higher cost. 

Neck Pain Treatments

Treatment for back pain should take into consideration the underlying cause. Typically a stepwise approach to treatments is taken, starting with the least invasive treatments (medications and physical therapy) to the most invasive (surgery). 

Neck Pain Treatments from Least Invasive to Most Invasive
  • Medications – Medications can either be taken orally (by mouth) or applied topically (on the skin). Non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, are common first line treatments. More severe pain may be treated with opioids or muscle relaxants with extreme caution. Topical medications, which can be applied on the skin, include capsaicin cream or lidocaine patches. 
  • Physical Medicine & Rehabilitation – Some common treatments in this category include heat application, physical therapy, and spinal manipulation therapy (SMT).
  • Invasive but non-surgical – These treatments include steroid injections and nerve ablation therapy.
  • Surgical – Often considered a treatment of “last resort”, surgeries can either decompress pressure on the cord or nerves (such as a discectomy or laminectomy) or stabilize the spine (fusion). 

A more comprehensive discussion of the various treatment options can be found in the “treatments” section.