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The neck's flexibility makes it susceptible to wear and tear and to injuries that overstretch it, such as whiplash. Also, the neck has the critical job of holding up the head. Poor posture makes that job more difficult. Thus, neck pain, like back pain, is common, and it becomes more common as people age.
The spine contains the spinal cord (see Biology of the Nervous System: Spinal Cord and Spinal Cord Disorders: Overview of Spinal Cord Disorders.). Along the length of the spinal cord, spinal nerves emerge through spaces between the vertebrae to connect with nerves throughout the body. The part of the spinal nerve nearest the spinal cord (spinal nerve root) can be compressed when the spine is injured, resulting in pain. The part of the spine in the neck (cervical spine) consists of seven back bones (vertebrae), which are separated by disks.
The neck also contains muscles and ligaments to support the spine.
Causes
Most of the disorders that can cause low back pain can also cause neck pain, and most involve the spine, the tissues that support it, or both. The most common causes are muscle strains and ligament strains. Other causes include injuries, arthritis, a ruptured or herniated disk, meningitis, and fibromyalgia.
Some disorders cause neck pain but not back pain.
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| Disorders That Cause Only Neck Pain |
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Disorders
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Description
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Some Causes
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Symptoms
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Atlantoaxial subluxation
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The first and second vertebrae are misaligned.
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Traumatic injury (which is the most common cause and is usually immediately fatal)
Rheumatoid arthritis
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People have vague neck pain, and the spinal cord may be compressed, sometimes intermittently. Rarely, compression is fatal.
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Cervical spondylosis (see also Spinal Cord Disorders: Cervical Spondylosis)
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In the neck, the vertebrae and the disks between them degenerate. As a result, the nerves that emerge through the vertebrae may be pinched. Sometimes the spinal canal is narrowed (cervical spinal stenosis) and the spinal cord is compressed.
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Osteoarthritis (usually)
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Pain occurs in the structures around the neck. The pain may extend (radiate) down the nerve, sometimes to the shoulders and upper back. Spinal cord compression may cause weakness and tingling in the hands and feet.
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Temporomandibular joint disorders (see also Temporomandibular Disorders)
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Problems occur in the joint of the jawbone. Women are more commonly affected, usually during their early 20s or their 40s.
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Muscle tension Internal joint derangement (the disk inside the joint is abnormally placed) Arthritis Ankylosis (fusion of joint bones) Hypermobility (looseness of the jaw joint)
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The neck near the jaw may be stiff and painful. Chewing may make the pain may worse.
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Spasmodic torticollis (see also Movement Disorders: Focal and Segmental Dystonias)
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The neck muscles contract, causing the head to tilt and rotate into abnormal positions.
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Unknown (often) Certain drugs, including antipsychotic drugs Possibly inherited
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Contractions may be painful. They may be sustained or occur in spasms, causing jerky movements of the head. Symptoms may begin at any age but usually begin between ages 20 and 60, most often between ages 30 and 50.
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Other disorders that can cause neck pain include a tear in a neck artery's lining (dissection), a blockage or tumor in the esophagus, infections (such as a bone infection), and inflammation of the esophagus or thyroid gland.
Sometimes neck pain is referred pain (see Pain: What Is Referred Pain? ), which originates in another part of the body. Referred neck pain may result from angina or a heart attack.
Symptoms
The neck may be tender, stiff, or both as well as painful. Pain may be worsened by movement. The pain may extend to the shoulders and upper back or may cause a headache. If a nerve is compressed, the pain may shoot down an arm. People may also feel tingling, numbness, or weakness in the arms or sometimes the legs. If the spinal cord is compressed, people may lose control of bladder and bowel functions (incontinence). Other symptoms occur depending on the disorder.
Diagnosis
Doctors can often base the diagnosis on a description of symptoms, risk factors (which may suggest a cause), and results of a physical examination, which includes evaluation of the nervous system (neurologic examination). As part of the physical examination, doctors may move or ask the person to move the neck in all directions to check its range of motion and to determine whether movement makes the pain worse.
X-rays can help identify some disorders, but magnetic resonance imaging (MRI) or computed tomography (CT) may be needed at some point to confirm the diagnosis. If spinal cord compression is suspected, MRI is done immediately. Other tests may also be needed. They include blood tests to check for infection or inflammation and electromyography and nerve conduction studies to determine whether the cause is related to muscles or nerves (see Diagnosis of Brain, Spinal Cord, and Nerve Disorders: Electromyography and Nerve Conduction Studies).
Treatment
Treatment depends on the cause. But often, taking over-the-counter analgesics, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can relieve the pain. If inflammation is not contributing to the pain, acetaminophen is usually recommended instead of NSAIDs because it is thought to be safer. Ice or heat may also help (see Rehabilitation: Treatment of Pain and Inflammation). People are taught how to stand, sit, and sleep in ways that do not strain the neck.
Doctors may recommend wearing a soft neck collar and using contour pillow for 10 to 14 days to help relieve pain and muscle spasms. People with unstable atlantoaxial subluxation may need to wear a rigid collar. Doctors or physical therapists may also suggest stretching exercises.
If more pain relief is needed, doctors may prescribe analgesics. Muscle relaxants, such as carisoprodol, cyclobenzaprine, diazepam, metaxalone, or methocarbamol, are sometimes used, but their usefulness is controversial. Muscle relaxants are not recommended for older people, who are more likely to have side effects.
For spasmodic torticollis, physical therapy or massage can sometimes temporarily stop the contractions. Drugs (including the anticonvulsant carbamazepine and some mild sedatives such as clonazepam), taken by mouth or injected, can usually relieve the pain. But drugs control contractions in only up to one third of people. If the pain is severe or if posture is distorted, botulinum toxin (a bacterial toxin used to paralyze muscles) may be injected into the affected muscles.
For shingles, antiviral drugs may shorten the duration of the symptoms, and wet compresses on the blisters may help relieve pain.
If the spinal cord or a spinal nerve is compressed or if the neck is unstable, surgery is usually needed.
Last full review/revision April 2008 by Sally Pullman-Mooar, MD
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