Neck and scapular pain
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Neck pain is one of the most common afflictions seen in a rheumatology office. To better understand why this occurs, let’s look at the anatomy...
The cervical spine (neck) is made up of seven vertebrae.
C-1, called the atlas) interacts with the occiput of the skull above and with C-2, called the axis, below. The atlas-occipital joint allows flexion and extension, while the atlantoaxial interactio allows rotation. Vertebrae C-3 through C-7 are an allow flexion, extension, lateral bending, and rotation. Flexion centers on C-5 and C-6 and extension on C-6 and C-7, which is why degenerative changes and spine injuries most common at these levels.
Intervertebral disks are found from C2-3 and below. Disk degeneration may be painful. Disc herniation can compress the nerve roots (radiculopathy) or spinal cord (myelopathy). Eight pairs of cervical spinal nerves exit through holes called the intervertebral foramina.
The posterior aspect of the cervical vertebrae contain the facet joints. These joints are subject to degenerative changes that may produce pain with extension combined with lateral bending and rotation.
The muscles of the neck are divided into four major compartments: anterior (flexion), posterior (extension), and the lateral groups (lateral bending). The posterior muscles are the strongest group and most likely to be the source of pain since they are primarily responsible for holding the head upright. The anterior and lateral muscles can be injured in whiplash type injuries.
The most common type of injury is muscle strain. Muscle strains usually resolve within a few days to a couple of weeks, ligament sprains may take up to a couple of months, and disk injuries or herniations with nerve root damage can take 3 to 6 months for full recovery. C
Localized pain in the neck and scapula generally points to muscle strains, ligament sprains, and facet or disk (degenerative) processes.
The lower cervical nerve roots, disks, spinal longitudinal ligaments, and facet joints refer pain to the scapular region. They can produce myofascial pain trigger points. Bothese triggewr points as well as muscle strains in this area are common causes of scapular and periscapular pain.
Cumulative stress related to the workplace can cause many patients to complain of vague symptoms in their neck and upper extremities.
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