Neck injury

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In medicine, neck injuries are "general or unspecified injuries to the neck. It includes injuries to the skin, muscles, and other soft tissues of the neck.'[1]

Diagnosis

X-ray of the cervical spine should be considered, especially if the patient fulfills any criteria from the Canadian C-Spine Rule clinical prediction rule: [2][3]

  • Age 65 years or more
  • Paresthesias in extremities
  • Dangerous fall ("elevation >=3 ft or 5 stairs; an axial load to the head (e.g., diving); a motor vehicle collision at high speed (>100 km/hr) or with rollover or ejection; a collision involving a motorized recreational vehicle; or a bicycle collision")
  • Inability to rotate the neck 45° to the right and left
    • Only test if "simple rear-end motor vehicle collision, sitting position in ED, ambulatory at any time since injury, delayed onset of neck pain, or absence of midline C-spine tenderness"[4]
  • Glasgow Coma Scale less than 15 (the Canadian C-Spine Rule was only designed for alert patients)

Treatment

Spinal manipulation and home exercises (http://www.annals.org/content/suppl/2011/12/29/156.1_Part_1.1.DC1/156-1-1-supplement.pdf) may help according to a randomized controlled trial.[5]

In patients with recent onset of cervical radiculopathy, semi-hard collar and physiotherapy with exercise may reduce pain.[6]

The role of electrotherapy such as pulsed electromagnetic field therapy (PEMF), repetitive magnetic stimulation (rMS) and transcutaneous electrical nerve stimulation (TENS) is not clear.[7]

Low-level laser therapy may help.[8]

Surgery may provide 1-2 years of improvement for patients with cervical radiculopathy according to a randomized controlled trial.[9]

Medications

It is not clear that ibuprofen 800 mg or cyclobenzaprine 5 mg three times a day is beneficial.[10]

Neurotomy

Neurotomy can help selected types of neck pain.[11]

Prognosis

Many patients with acute idiopathic neck pain have persistent symptoms.[12] Most reduction in pain and disability occur within 76 weeks without much improvement after 6 weeks (at least among the types of patients studied).[12]

References

  1. Anonymous (2015), Neck injury (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Stiell IG, Clement CM, McKnight RD, et al (December 2003). "The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma". N. Engl. J. Med. 349 (26): 2510–8. DOI:10.1056/NEJMoa031375. PMID 14695411. Research Blogging.
  3. Stiell, Ian G; Catherine M Clement, Jeremy Grimshaw, Robert J Brison, Brian H Rowe, Michael J Schull, Jacques S Lee, Jamie Brehaut, R Douglas McKnight, Mary A Eisenhauer, Jonathan Dreyer, Eric Letovsky, Tim Rutledge, Iain MacPhail, Scott Ross, Amit Shah, Jeffrey J Perry, Brian R Holroyd, Urbain Ip, Howard Lesiuk, George A Wells (2009-10-29). "Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial". BMJ 339 (oct29_4): b4146. DOI:10.1136/bmj.b4146. Retrieved on 2009-11-05. Research Blogging.
  4. Stiell IG, Wells GA, Vandemheen KL, et al (October 2001). "The Canadian C-spine rule for radiography in alert and stable trauma patients". JAMA 286 (15): 1841–8. PMID 11597285[e]
  5. Bronfort, Gert; Roni Evans, Alfred V. Anderson, Kenneth H. Svendsen, Yiscah Bracha, Richard H. Grimm (2012-01-03). "Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain". Annals of Internal Medicine 156 (1 Part 1): 1 -10. DOI:10.1059/0003-4819-156-1-201201030-00002. Retrieved on 2012-01-03. Research Blogging.
  6. Kuijper B, Tans JT, Beelen A, Nollet F, de Visser M (2009). "Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial.". BMJ 339: b3883. DOI:10.1136/bmj.b3883. PMID 19812130. Research Blogging.
  7. Kroeling P, Gross A, Goldsmith CH, Burnie SJ, Haines T, Graham N et al. (2009). "Electrotherapy for neck pain.". Cochrane Database Syst Rev (4): CD004251. DOI:10.1002/14651858.CD004251.pub4. PMID 19821322. Research Blogging.
  8. Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM (2009). "Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials.". Lancet 374 (9705): 1897-908. DOI:10.1016/S0140-6736(09)61522-1. PMID 19913903. Research Blogging.
  9. Engquist M, Löfgren H, Oberg B, Holtz A, Peolsson A, Söderlund A et al. (2013). "Surgery Versus Nonsurgical Treatment of Cervical Radiculopathy: A Prospective, Randomized Study Comparing Surgery Plus Physiotherapy With Physiotherapy Alone With a 2-Year Follow-up.". Spine (Phila Pa 1976) 38 (20): 1715-1722. DOI:10.1097/BRS.0b013e31829ff095. PMID 23778373. Research Blogging.
  10. Khwaja SM, Minnerop M, Singer AJ (2010). "Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial.". CJEM 12 (1): 39-44. PMID 20078917.
  11. Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N (1996). "Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain.". N Engl J Med 335 (23): 1721-6. DOI:10.1056/NEJM199612053352302. PMID 8929263. Research Blogging.
  12. 12.0 12.1 Hush JM, Lin CC, Michaleff ZA, Verhagen A, Refshauge KM (2011). "Prognosis of acute idiopathic neck pain is poor: a systematic review and meta-analysis.". Arch Phys Med Rehabil 92 (5): 824-9. DOI:10.1016/j.apmr.2010.12.025. PMID 21458776. Research Blogging.