Neck pain has many potential causes. The neck is a very mobile and dynamic structure, which has, as its most important function, the provision of support and stability for the head. With the upper chest, it also provides part of the foundation for the mobile support of the shoulder girdles, and hence the upper limbs.
The neck skeleton is the cervical spine, consisting of seven vertebrae, the upper two of which are completely unique and unlike any other vertebrae, separated by five discs. The upper two vertebrae have a unique anatomical structure that does not include an intervening disc.
Within the vertebral column, within the spinal canal, lies the cervical spinal cord. Nerve roots branch off at each vertebral level, the majority of which pass after organisation into peripheral nerves to the shoulders, arms and hands.
The vertebral column provides attachment for complex layers of muscles, tendons and ligaments, which attach both to other levels in the vertebral column and to the chest wall and shoulder girdles. At the upper end, multiple muscle layers attach to the skull, to finely control head position.
The brain, and particularly the balance centres, receive continuous and complex information from all the structures of the neck, to ensure that the relationship of the body and head, and the head’s position in space, are precisely defined and controlled.
Major blood vessels, carrying 20% of the hearts output pass up and down the neck. Anterior to the spinal column, the oesophagus and trachea pass from the mouth and nose to the stomach and lungs.
Most episodes of neck pain are due to one, or a combination of, wear and tear changes in discs and joints, and muscular or ligamento-tendinous strains. They are usually self-limiting, requiring only rest and avoidance of irritating stressors and simple pain relief. For more resistant cases, anti-inflammatory medication and physiotherapy may be helpful.
In a minority of cases, investigation may be required.
As in low back pain, neck pain with other distinct symptoms should prompt medical assessment.
In particular, neck pain occurring after a neck injury or after a high velocity accident should be medically assessed with imaging. Neck pain associated with neurological symptoms or signs like numbness, tingling, weakness in the arms or legs, disturbed bladder or bowel control should similarly be assessed urgently.
Neck pain that is severe, and worsening, or which is associated with systemic disturbance such as fever and weight loss, or with unaccustomed headache, should be assessed by a doctor without delay.
Neck pain, associated with a cervical disc protrusion, may be associated with significant neuralgic arm pain, and rarely with signs and symptoms of cord compression.
In the elderly, fractures, sometimes with minor trauma, can be a manifestation of vertebral osteoporosis. Isolated fractures of the dens, part of the second cervical vertebra, which acts like a pivot for the rotation of the first cervical vertebra, may be of this type.
Whiplash injury – typically strains neck muscles and ligaments, and in more severe cases may cause ligamental tears, disc injury, and injury to facet joints and their capsules.
Muscle strain – overuse injury, which may be consequent on poor neck posture in activity.
Poor posture in a workstation, or associated with awkward access to a maintenance job, are examples of everyday stressors that may present with muscular neck ache.
Often worse with movement, and may have concomitant headache.
Degenerative disc and joint disease affecting the cervical spine. May become symptomatic after an external stressor (eg. fall, motor vehicle accident).
Neck pain and stiffness often improve with rest, and may be helped by anti-inflammatory medication.
Will usually present with neck and arm pain, and neurological symptoms, although on occasion, neck pain may be minor or absent.
This is a consequence of degenerative changes affecting the cervical spine, and is more likely to occur in people who have a small diameter cervical spinal canal from birth. In such people, the development of disc bulges and bony spurs (osteophytes) narrows the already tighter canal and come to impinge on the cervical nerves and spinal cord at a relatively early stage.
In the event of a cervical injury, such people are at increased risk of spinal cord injury and can sometimes suffer cord injury after relatively minor trauma.
Stenosis can lead to the insidious, or abrupt, development of spinal cord dysfunction (cervical myelopathy), which may benefit from surgical decompression with or without stabilisation. Occasionally prophylactic (preventative) cervical decompression is considered.