Neck pain (cervicalgia) is pain of various nature and intensity that occurs in the cervical region. The symptom is accompanied by dizziness, a feeling of numbness in the back of the head or arm, local redness and swelling of the skin. The neck can hurt with infectious and inflammatory diseases of this area, injuries and degenerative processes in the spine, after a long stay in a forced uncomfortable position. To determine the cause of neck pain, CT, MRI, ultrasound, laboratory tests are prescribed. Analgesics, NSAIDs, and physiotherapy methods are used to relieve the symptom.
Information
The neck periodically hurts 70% of the adult population. These sensations can have different intensity and duration: from short-term discomfort to severe pain syndrome, which complicates daily activities. More often, neck pain is localized in the cervical spine or on the anterolateral surfaces. Usually, patients feel a sudden “lumbago”, which is replaced by persistent pain syndrome. The pains have a different character – throbbing, tingling, squeezing. They can give to the shoulder, shoulder blade, occipital region.
Unpleasant sensations increase with turns and tilts of the head, so a person is forced to turn his whole body. Often, the neck begins to ache after a long stay in an uncomfortable position: patients note that discomfort appeared after a working day at the computer or sewing machine. Many patients associate the development of cervicalgia with hypothermia, the effect of drafts. If the neck is very sore, or the pain is combined with dizziness, numbness in the back of the head, tinnitus, it is necessary to seek qualified medical help as soon as possible.
Classification
Depending on the duration of neck pain, there is an acute form lasting up to 10 days, and chronic cervicalgia, which can be permanent or recurrent. According to the etiopathogenetic classification , there are two forms of cervicalgia:
- Vertebrogenic pain in the neck. It develops due to the primary lesion of the bone-cartilaginous structures of the cervical spine. This group includes spondylogenic cervicalgia associated with bone damage and compression of the spinal cord, and discogenic, due to deformation of the intervertebral discs.
- Nonvertebrogenic neck pain. Includes all other causes of neck pain. Unpleasant sensations can occur during inflammatory processes in the musculoskeletal system, pathologies of internal organs — pharynx, thyroid gland, lymph nodes and salivary glands.
By localization, pain syndrome is distinguished in the front or in the lateral parts of the neck, in the area of the spinal column. Separately, there is a sore throat. Cervicalgia, which radiates into neighboring anatomical areas, is divided into cervicocranialgia (the spread of pain to the occipital region) and cervicobrachialgia (cervical-brachial syndrome).
Why does the neck hurt
Causes of sore throat
A feeling of scratching, scratching in the throat is associated with colds, but unpleasant sensations can often be caused by other reasons (excessively dry indoor air, exposure to atmospheric pollutants). Sometimes the pain syndrome is felt so strongly that patients feel as if their entire neck hurts. With sore throat, conditions such as:
- Laryngitis: atrophic, hemorrhagic, hyperplastic.
- Viral diseases: acute respiratory viral infections, infectious mononucleosis, influenza, etc.
- Bacterial infections: sore throat, diphtheria, scarlet fever.
- Allergic inflammation: laryngotracheitis, pharyngitis.
- Foreign bodies in the throat; meat and fish bones, in children — toy parts.
- Deficient conditions: vitamin deficiency B12 and B2, lack of ascorbic acid, iron.
- Gastroesophageal reflux.
- Rare causes: long styloid process, Cushing syndrome, malignant neoplasms of the throat or vocal apparatus.
Causes of neck pain in the front
Uncomfortable sensations can be localized directly under the chin, in a limited area, but more often they are disturbed by severe spilled pains. Soreness increases when swallowing, turning the head, squeezing the neck with the shirt collar. Neck pain is caused by:
- Thyroid pathologies: acute and subacute thyroiditis, diffuse toxic goiter, Hashimoto’s thyroiditis.
- Injuries: sprains and tears of muscle fibers, blows to the neck area.
- Inflammatory processes: myositis, neuritis, tendinitis.
- Purulent diseases: suppurated cervical cyst, paratonsillary abscess.
- Defeat of lymphoid formations: lymphadenitis, lymphangitis.
- Cervical compression syndrome: radicular, vertebral artery.
- Diseases of adjacent organs: esophagitis, tracheitis.
- Angina attack.
Causes of pain in the cervical spine
Patients complain of neck pain that occurs along its posterior surface. The painful sensations are intense, because of the constant “lumbago” a person is forced to observe the immobility of the head and shoulder girdle. Pain in the cervical spine can be a symptom of the following pathological conditions:
- Degenerative diseases of the spine: cervical osteochondrosis, osteoarthritis, prolapse or herniated disc.
- Bone injuries: compression fractures of the cervical vertebrae, compression of the spinal cord, fractures of the vertebral arches and processes.
- Damage to other structures: ruptures of the supraspinous and interosseous ligaments of the spine, damage to the parotid muscles.
- Systemic connective tissue diseases: Bekhterev’s disease (ankylosing spondylitis), arthritis (rheumatoid, psoriatic), Reiter’s syndrome.
- Infectious processes: osteomyelitis, tuberculosis of the vertebrae.
- Rare causes: the presence of pathological bilateral cervical ribs, Klippel-Feil syndrome.
Causes of side neck pain
Intense pain on the side of the neck usually radiates into the shoulder or ear. A person may feel tingling, burning, pulsation in this area. With severe discomfort, a secondary torticollis is formed, in which the head is constantly tilted to the sick side, and the chin is turned to the healthy side. The most common reasons why there is pain in the neck from the side:
- Pathologies of blood vessels: varicose veins of the neck, atherosclerosis of large cervical arteries feeding the brain.
- Staying in an uncomfortable position: a constantly tilted head when working at the computer, a bad pillow for sleeping, gait features with a tilt of the neck in the same direction.
- Muscle spasms: with a sharp turn of the head, intense physical exertion, after hypothermia.
- A pharyngeal abscess.
- Oncological diseases: neoplasms of the thyroid and parathyroid glands, tumors of the lateral surface of the pharynx and larynx.
- Congenital diseases: Grizel syndrome, pterygoid neck with Shereshevsky-Turner anomaly.
- Rare causes: complications after subarachnoid hemorrhage, meningitis.
Diagnostics
A person who has a sore neck most often turns to an osteopath or a neurologist. The examination is long and complex, in order to make a correct diagnosis, it is necessary to exclude many causes of neck pain. Diagnostic search involves the use of laboratory and instrumental methods aimed at visualizing the affected area and searching for signs of concomitant diseases. The most informative have:
- Sonography. Ultrasound of the neck and other parts of the body is used for rapid non-invasive visualization of all cervical structures, identifying signs of pathology of internal organs that can provoke neck pain. A targeted ultrasound of the thyroid gland, submandibular salivary glands is performed. Duplex scanning helps to assess the state of blood flow in large vessels.
- X-ray imaging. Overview radiography SHOP is used to identify deformities of bone structures, displacement of vertebrae, in which the neck always hurts. A more informative method is considered to be CT of the spine, which allows you to assess the nature and degree of vertebral disorders. MRI is recommended to study the ligamentous apparatus.
- Functional diagnostics. The appearance of neck pain can be caused by a lesion of the muscular apparatus, therefore, it is advisable to perform electromyography. If the radicular nature of the pain is suspected, electroneurography is indicated. A Forestier test is needed to detect cervical kyphosis. The degree of pain syndrome is determined using the McGill questionnaire.
- Laboratory methods. General and biochemical blood tests are required to exclude acute inflammatory processes, in connection with which the neck may hurt. The concentration of thyroid hormones is necessarily determined. In the presence of a general infectious syndrome, bacteriological culture of sputum or a smear from the throat, serological reactions (RIF, ELISA, PCR) are carried out.
If the patient has pain not only in the neck, but also in the throat, an examination by an otolaryngologist is necessary. With intense pain syndrome, especially in elderly patients or in the presence of a history of heart disease, an ECG is recorded to exclude atypical forms of angina and myocardial infarction. In case of serious spinal injuries accompanied by sensitivity disorders or paresis, myelography is performed to assess the condition of the spinal canal.
Treatment
Help before diagnosis
If the neck starts to hurt, you can not delay a visit to the doctor. Cervicalgia requires a thorough diagnosis to determine the causes of unpleasant symptoms. It is necessary to avoid sudden movements in the cervical region, drafts and hypothermia. Before the diagnosis is verified, neck pain is relieved with the help of warming procedures (wrapping the neck area with a wool scarf). If the pain is pronounced strongly, it is allowed to take analgesics from the NSAID group. But these drugs can not be taken for a long time without a doctor’s appointment, because they can cause ulcers and bleeding from the gastrointestinal tract.
Conservative therapy
Medical tactics for cervicalgia depends on the cause of the disease and the intensity of pain. Isolated medical treatment is rarely used, its combinations with modern physiotherapeutic methods are more effective. To relieve neck pain and eliminate the underlying pathology that caused cervicalgia, the following groups of drugs are used:
- NSAIDs. Medications effectively eliminate the inflammatory process and relieve pain. To reduce side effects, it is advisable to use selective COX-2 inhibitors that do not affect the gastrointestinal mucosa.
- Muscle relaxants. The drugs quickly eliminate muscle spasms, after relaxing the muscles, the neck hurts much less. The effect is observed after the first injection, to consolidate the action of the drug is used in courses.
- Anesthetics. They are used for severe neck pain that the patient cannot tolerate. Funds are injected into the affected area in the form of injections (blockades). Prolonged administration of local anesthetics is impractical.
- Antibiotics. The drugs are indicated for bacterial and purulent processes of the cervical region, which caused pain syndrome. In such a situation, uncomfortable sensations in patients stop after the cause is eliminated.
- Vitamins. Preparations of B vitamins, especially thiamine, are actively used in cases where neck pain is chronic. Medications improve the nutrition of spinal roots and nerves.
Physical therapy
To eliminate muscle tension, which caused the neck to ache, a Trench collar is used, which is recommended to be worn for 2-3 weeks. The neck hurts less after local thermal procedures — mud baths and compresses, electrophoresis with anesthetics. Manual therapy techniques are useful for restoring the anatomical position of the vertebrae and discs. Magnetotherapy, acupuncture helps to reduce chronic neck pain. After the acute pain subsides, massage sessions begin, while physiotherapy should be supplemented with physical therapy methods.
Surgical treatment
In case of neck pain caused by spinal column pathology, surgical intervention is necessary. To reduce pressure on the nerve roots, discectomy, foraminotomy and laminectomy are used. When hernias are detected, appropriate operations are performed, and when neoplasms are detected in the cervical part of the body, their surgical removal is performed. Severe degenerative lesions of the spine are an indication for spinal fusion. If the pain in the neck is caused by ulcers or cysts, it is necessary to open and drain them, rinse the formed cavity with antibacterial solutions.
Literature
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