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Neck Pain Causes
There are many causes of neck pain. While most are related to posture and muscle strain, there are some areas of concern that one should be aware.
Initially, the history can shed some light on neck pain and it's causes. A patient's occupation, posture habits, onset of pain, charcter of pain and stress at work and home should be noted. Associated symptoms, such as gait or bladder dysfunction should be noted as certain symptom groups can indicate particular disease processes.
Acute pain (recent onset) with limited motion may, especially in a younger person, is likely to follow trauma or a persistant new activity. Neck muscles are usually tender.
Middle age persons with neck pain may present persisting or recurring pain, which is sometimes associated by tingling in the arms or fingers and may even display chest pain from an affected C6 nerve root, sometimes called cervical angina. These symptoms, without a history of trauma, is suggestive of degenerative disc disease, sometimes called arthritis or cervical spondylosis.
Rheumatoid arthritis in the neck usually appears after approximately ten years of peripheral (hands or other joints away from the spine) joint disease and presents with severe neck pain followed by arm pain and progressive radiculopathy or myelopathy.
Radiculopathy is often called a pinched nerve and results in symptoms and signs related to a single nerve root which comes off the spinal cord, travels through the spinal bones and courses down the arms. Most often, radiculopathy is the result of compression of a nerve root by a herniated disc or outgrowths of bone (osteophytes) due to the degenerative process, but may also be caused from a tumor, infection or metabolic disease like diabetes called diabetic neuropathy.
Classic radiculopathy features persistant pain, arm weakness, altered sensations (numbness, tingling, soreness) in an associated sensory area or dermatome, along with reflex abnormality. Atrophy (muscle wasting), muscle twitching and edema or swelling may also occur if enough of the nerve root is involved.
Common nerve root compression involved would present as; The fifth nerve root would cause pain and altered sensations in the shoulder, weakness of the deltoid and bicep muscles, and a decreased bicep reflex. The sixth nerve root compression would cause pain and altered sensations of the first and second fingers, weak wrist extensors, and a reduced brachioradialis reflex.
Myelopathy presents with a group of signs and symptoms caused by involvement of the spinal cord through compression or cord disease. The problem progresses over time. Findings are usually weakness, a feeling of heavy legs, gait disturbances and poor hand coordination. Degenerative disease is the most common cause, however, these symptoms may also be associated with infection, inflammatory diseases, multiple sclerosis, vascular problems, or tumor.
Muscle spasm or strain will often cause pain in the scapular area between the shoulder blades, the top or back of the shoulder and radiating into the neck. This can be associated with stress or poor posture. These problems are often called myofascial pain syndromes and can be associated with areas of chronic strain called myofascial trigger points. One type of chronic syndrome is fibromyalgia, which has specific areas of associated pain. Muscle spasm is among the most common causes of neck pain and usually responds to lifestyle modifications and basic therapeutic measures such as massage, heat, traction and anti-inflammatory analgesics.
Whiplash is a hyperextension injury usually resulting as a result of a rear-end motor vehicle accident. Symptoms of neck stiffness and headache usually occurs 24 to 48 hours after the accident. Chronic pain resulting from whiplash injuries is often from a facet joint syndrome which can be responsible for neck related headaches.
Headache is often found in association with neck pain. Patients with arthritis often complain of occipital (base of head) headaches. As mentioned previous, a facet syndrome is often the cause where articular facets and joint capsules are involved, however, ligaments, disc and nerve roots can also cause headaches. Tension headaches and migraine headaches often have neck pain associated which can can appear before the headache or persist after the headache is gone. Conditions causing neck pain and headaches can be degenerative disc disease or arthritis, rheumatoid arthritis, disc herniation and spinal cord tumors.
Vertigo (feeling of moving or spinning), nystagmus (unintentional jittery movement of the eyes) and tinnitus (ringing in the ears) are symptoms which may accompany neck pain. These group of symptoms may suggest a vascular problem and sometimes are caused by cranial settling due to rheumatoid arthritis. Drop attacks, especially when moving the neck, also suggests vascular disease.
The gradual onset of pain that worsens even with rest may indicate malignancy or infection. Tumors presenting with pain that is worse at night may worsen quickly with the development of radiculopathy and myelopathy. Discitis and osteomyelitis are infections most commonly seen in intravenous drug abusers and are characterized by progressive neck pain and rapidly progressing myelopathy.
In general, the causes of neck pain are related to the musculoskeletal system and are due to muscle spasm, joint and/or nerve problems. Rarely is neck pain due to malignancy, infection or pathological inflammation. The signs to look for, in association with neck pain, that would cause concern and require attention are: fever, night sweats, unexpected weight loss, history of inflammatory arthritis, malignancy, infection, tuberculosis, HIV infection, drug dependency, immunosupression, excruciating pain, intractable night pain or lymph node swelling (lymphadenopathy). Always consult your Doctor for any serious concerns.