Causes of neck pain

The main causes of neck pain are:

Spasmodic torticollis

In an adult, spasmodic torticollis may occur suddenly. A sharp pain in the neck appears, it becomes fixed in a certain position, which is caused by a spasm of the trapezius or sternocleidomastoid muscle.

The condition usually resolves on its own, but warmth, gentle manipulation of the neck, wearing a rigid collar, muscle relaxants, and analgesia may provide relief.

Torticollis in infants

This condition is the result of damage to the sternocleidomastoid muscle during childbirth. In small children aged 6 months to 3 years, the disease manifests itself in a head tilt to the side (on the affected side, the ear is closer to the shoulder). On the affected side, facial growth slows down, resulting in some facial asymmetry. In the early stages, a tumor-like formation is found in the area of the affected muscle.

If these symptoms are quite persistent, physical therapy procedures aimed at lengthening the affected muscle may be effective. In later treatments, the muscle is dissected (separated) at its lower end.

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Cervical rib

Congenital development of the costal process of the seventh cervical vertebra (C7) is often asymptomatic but may cause compression of the superior thoracic aperture. Similar symptoms, but without demonstration of anatomical abnormalities, are called scalene syndrome or first rib syndrome. With compression of the superior thoracic aperture, the lowest trunk of the body of the brachial plexus and the subclavian artery are compressed. The patient may experience pain and numbness in the hand and forearm (often on the ulnar side); weakness and atrophy of the hand muscles (thenar or hypothenar) are noted. The radial pulse is weakened, and the forearm is cyanotic. X-ray examination establishes the presence of a cervical rib. Arteriography reveals compression of the subclavian artery.

With the help of physical therapy (exercise therapy), it is possible to increase the strength of the muscles that lift the shoulder girdle, which alleviates the symptoms, but removal of the cervical rib may still be required.

Intervertebral disc prolapse

Most often, the discs between C5-C6 and C6-C7 prolapse. Their protrusion (bulging) in the central direction can cause symptoms of spinal cord compression (a neurosurgeon consultation is necessary). Posterolateral protrusion can lead to neck fixation, pain radiating to the arm, weakness of the muscles corresponding to this nerve root, and a sharp decrease in reflexes. X-rays of the cervical spine show a decrease in the height of the affected discs.

Treatment is with nonsteroidal anti-inflammatory drugs (NSAIDs) and a head support collar. As the pain subsides, physical therapy can restore neck mobility.

Neck and spinal cord compression

Cervical spondylosis. (Osteoarthritis of the cervical spine.) Degenerative changes in the intervertebral discs of the cervical spine usually begin earlier than the lesions of the posterior intervertebral joints. Most often, the discs between C5-C6, C6-C7, C7-Th1 are affected. The height of the corresponding discs decreases. Osteophytes form in the central and posterior joints of the vertebrae with the spread of protrusions into the intervertebral openings (and, consequently, with damage to the cervical intervertebral nerves). Sometimes the central osteophytes can compress the spinal cord. Common symptoms are neck pain, neck stiffness, pain along the occipital nerve spreading to the head, shoulder pain, paresthesia in the hands. Muscle weakness is uncommon.

On examination of the patient, limited mobility of the neck is noted, accompanied by crunching; as a rule, a decrease in the corresponding tendon reflex is noted. Sensory and motor insufficiency is usually absent. Changes in the corresponding radiographs correlate rather poorly with the patient's complaints. Treatment is usually conservative, since, despite the fact that pathological changes are permanent, the severity of subjective symptoms gradually weakens on their own. NSAIDs can bring relief. The patient should be advised to wear a rigid collar during the day, and to place a rolled-up towel under the neck at night - prescribe physiotherapy procedures (heat, short-wave diathermy, gentle traction).

Cervical spondylolisthesis

This is a spontaneous displacement, a slipping of the upper vertebra from the vertebra located below it.

Reasons

1. Congenital insufficient fusion of the odontoid process with the 2nd cervical vertebra or its fracture. In this case, the skull, 1st vertebra and odontoid process slide forward onto the 2nd cervical vertebra.
2. Inflammatory softening of the transverse ligament of the first cervical vertebra (for example, as a result of rheumatoid arthritis or as a complication of a nasopharyngeal infection, in which C1 slips forward over C2).
3. Instability in the area of the indicated vertebrae associated with trauma.

The most important consequence of the said spondylolisthesis is the possibility of spinal cord compression. Traction, immobilization with a plaster "jacket", and arthrodesis of the corresponding vertebrae are used in treatment.

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Spinal cord compression

Spinal cord compression may be caused by a displaced or spontaneous fracture (subsidence, collapse) of a vertebra, a prolapsed disc, a local tumor, or an abscess. Radicular pain and motor disturbances in the underlying motor neuron usually occur at the level of the lesion with disturbances in the overlying motor neuron and sensory disturbances below the level of the lesion (spastic weakness, brisk reflexes, plantar deviation of the feet upward, loss of coordination, disturbance of positional sense in the joints, disturbance of vibration sense of temperature and pain sensitivity).

The anatomical features of the spinal cord are such that the sensitivity of its posterior column (the sensation of light touch, positional sense in the joints, vibration sense) is usually impaired on the affected side, and an interruption in conduction in the spinothalamic tract impairs pain and temperature sensitivity on the opposite side of the body 2-3 dermatomes below the level of sensory damage.

Since the spinal cord ends at the L1 level, compression at the level of this vertebra results in disruption of transmission of nerve impulses (information) in the part of the spinal cord of the underlying dermatome. To determine the level of spinal cord damage, mentally add the number of segments corresponding to the affected vertebrae to the number of the supposed affected vertebra: C2-7; +1, Th1-6; +2, Th7-9; +3. T10 corresponds to the level of L1 and L2; Th11-L3 and L4, L1 - sacral and coccygeal segments. Damage to lower lumbar vertebrae can result in compression of the equine tail, which is characterized by muscle pain, sensory disturbances in the affected dermatomes (if the lower sacral dermatomes are affected, then anesthesia of the genitals, urinary retention and defecation disorders are observed).

If such symptoms occur, an urgent consultation with a neurologist is necessary.

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