Whiplash injury and arthritis neck 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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Pain in the neck is a common cause of physician visits.
A muscle spasm, brought on by poor posture, sleeping position or stress, is the most frequent causes of neck pain. But an aching neck can be a symptom of a more serious problem such as disc degeneration/herniation, arthritis, and even cancer.
The neck region of the spinal column is called the cervical spine, which consists of seven bones or vertebrae that are shaped like building blocks.
Intervertebral discs separate the vertebrae from one another. These discs allow the spine to move freely and act as shock absorbers when a person moves.
The back of each vertebra forms a canal of bone that runs down the back. This space is called the spinal canal, through which the spinal cord and nerves travel. The spinal cord is surrounded by cerebrospinal fluid and three protective membranes.
A pair of spinal nerves exit each vertebra through small openings called foramina (one to the left and one to the right). The delicate spinal cord and nerves are further supported by strong muscles and ligaments that are attached to the vertebrae.
The discs can be damaged by sudden movement (whiplash), poor posture, or diseases such as arthritis.
Cervical disc disorders are typically marked by intermittent neck pain and sometimes arm pain. Irritated nerves also can lead to numbness or weakness in the arm or forearm, tingling in the fingers and coordination problems. Severe nerve impairment or even paralysis can develop if left untreated.
The joints in the neck deteriorate as people age, leading to osteoarthritis. The symptoms of osteoarthritis are pain radiating to the shoulder or between the shoulder blades and pain that is worse at the start of the day, improves during the day and gets worse again at the close of the day. This pain usually diminishes with rest. Patients with a previous history of a whiplash injury are six times more likely to develop this condition.
Whiplash is one of the most common injuries to the neck and commonly occurs after a rear-end automobile crash. Whiplash symptoms include neck stiffness, shoulder or arm pain, headache, facial pain and vertigo. Pain from a whiplash injury can be caused by tears and bleeding in the muscles that support the neck, ligament rupture, or a disc tearing away from a vertebra.
A medical history, physical exam and diagnostic tests are part of the evaluation of whiplash injury.
An x-ray shows the bones of the neck and determines if there is significant wear and tear or disease of the bone. It also shows whether the bones are aligned (lined-up) properly.
A CT scan produces a more detailed x-ray based image of the spine.
MRI is probably the best test to evaluate soft tissue abnormalities in the spine.
Electromyography tests tests are electrical studies that provide information regarding damage to nerves or muscles.
Patients with neck pain are usually treated conservatively at first. Non-surgical treatments often can provide sufficient relief.
Conservative treatment includes bed rest, reduction of physical activity, physical therapy and a cervical collar, which provides support, reduces mobility, and lessens pain. An injection of corticosteroids may be used to temporarily relieve pain. A cervical traction device may be used to further relieve the pressure on the nerves in the neck.
Treatment of whiplash injuries consists of analgesics, non-steroidal anti-inflammatory drugs, muscle relaxants and aggressive physical therapy. Home cervical traction and manipulation are sometimes helpful. Approximately 65 percent of whiplash patients make a full recovery, 25 percent have minor residual symptoms and 5 to 10 percent develop chronic pain syndromes.
Conservative treatment options may continue for up to eight weeks. If there is severe muscle weakness or progressive symptoms, a more aggressive timetable may be warranted to avoid an irreversible wasting away of the muscles.
Other modalities we have used with success in whiplash include injections of Botox. We have also referred patients for prolotherapy.
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