Mechanical causes that can cause pain in the neck are
Degenerative Disc: Degenerative disc disease (DDD) occurs as part of
the natural
process of growing older. As people age the intervertebral discs lose their
flexibility, elasticity, and shock absorbing capability. The ligaments that
surround the disc called the annulus fibrosis becomes brittle and are more
easily torn. The ligaments that surround the disc are called the annulus
fibrosis become brittle and are easily torn. Also the soft gel like center of
the disc which is called the nucleus pulposus becomes dry and starts
shrinking. Everyone with degenerative disk changes in their cervical spine may
not have pain. Also people with normal necks have MRI scans can show disc herniations,
degenerative changes, and narrowed spinal canals. When degenerative disc
disease becomes painful, it can lead to several different symptoms including
neck pain and spinal cord compression. These symptoms are due to the fact the
worn out discs cause pain and do not function well as they shrink, and also
due to the space available for the nerve roots and the spinal cord shrinks. As
the discs between the intervertebral bodies start to wear out, the cervical
spine becomes less flexible which results in neck pain and stiffness,
especially at night. Pain radiates down to the back of the shoulder blades or
the arms, numbness and tingling results and sometimes it can also result in
difficulties with hand dexterity or walking. Muscle weakness occurs at later
stage in the process than pain and it is a sign that disease is progressing.
In severe cases of DDD at the level of the neck, there is spinal cord compression, and
symptoms of sciatica, back pain and lower extremity weakness. The
diagnosis of degenerative disc disease is done by a complete physical
examination including checking the flexibility and range of motion of the
neck. Also the examination includes looking for the presence of signs
that suggest that nerve roots or spinal cord are affected by degenerative
changes in the neck. This involves testing the strength of muscles and X-ray
of the neck pain. The X-rays often show narrowing of the spaces between the
vertebral bodies indicating that the disc has become
thin or has collapsed. Also bone spurs form around the edges of the
vertebral bodies and also around the edges of the facet joints in the spine
which can seen on x-ray.
As the disc collapse and bone spurs form, the space available for the nerve
roots and the spinal cord starts to shrink. MRI or CT scan is also done in order to
further asses the changes. The treatment of choice includes non steroidal anti inflammatory drugs and physical therapy
along with cervical collar so as to provide rest to the neck. Surgery is for people who have muscle weakness
due to nerve root or spinal cord compression and when relieving pressure on
the nerves is critical.
Herniated Disc:When the outer lining that surrounds the disc
tears off, the soft center squeezes out through the opening, creating a
herniated, or slipped, or ruptured disc. Tears in the outer lining of the disc
are very painful as pressure
from everyday activities pushes the discs nucleus through the ruptured annulus. There are soft tissue
discs between the bony vertebral bodies in your cervical spine that are called
intervertebral discs. These discs are composed of a soft gel like center
called the nucleus pulposus, and a tough outer lining that surrounds the disc
called the annulus fibrosis. The intervertebral disc creates a joint between
the vertebrae that allows them to move. When the outer lining tears the soft center squeezes out
leading to a herniated disc. The torn annulus and the ruptured
nucleus sometimes irritates the nerve root leading to pain in the shoulders,
arms and the neck at the same time. Herniations can lead pain, numbness, and weakness;
depending on the location of the effected disc in the spine. In
some patients the muscles that are innervated by the nerve root that is being
compressed by the herniation become weak. The pain in
the neck, back, and arms is due to tear in the annulus
fibrosis, pressure from the disc herniation, or from irritation, inflammation
& swelling within the nerve.
The diagnosis of a herniated cervical disc is done by a complete physical
examination of the neck, arms and lower extremities including checking the flexibility
and range of motion of the neck, presence of signs
that suggest that nerve roots or spinal cord are affected by the herniation. This
includes testing reflexes and the strength of the muscles. X-rays are also
performed but are usually normal because the disc is
composed of soft tissue which does not show up on a X-ray. MRI is useful for
locating the disc herniations and also finding out where the nerve roots or
spinal cord are being compressed, while a CT is done to evaluate the bony
structure in the cervical spine, which shows the amount of space that is available for
the nerve roots and spinal cord. The treatment of choice is
non steroidal anti inflammatory drugs and physical therapy along with cervical
collar so as to provide rest to the neck. Surgery is for people who have muscle weakness
due to nerve root or spinal cord compression as muscle weakness is a definite sign
that the nerves are being injured and that relieving the pressure on the
nerves is critical.
Myelopathy: Myelopathy means that there is something
wrong with the spinal cord which is usually at a later stage of cervical
spine disease, and is often first detected as difficulty walking due to
generalized weakness or problems with balance and coordination. This occurs commonly in the
elderly and one of the reasons that these
symptoms occur is that bone spurs and other degenerative changes in the
cervical spine squeeze the spinal cord. It is most commonly caused by spinal stenosis
(which is described in detail below). In the later stages of spinal degeneration,
bone spurs and arthritic changes makes the space in the spinal canal much smaller.
Determining the amount of weakness that is present is used to assess the severity of myelopathy.
As per the system of Nurick, myelopathy is graded from 0 to 5 (5 being the
most severe).
Myelopathy develops
gradually. Patients who have myelopathy have difficulty with tasks that require coordination,
e.g.
walking up and down stairs, fastening buttons. Patients with long history of
neck pain, changes in coordination and weakness should visit their physicians
as soon as possible.
Surgery is best suited for patients with myelopathy and
have evidence of muscle weakness that is being caused by nerve root or spinal
cord compression and that relieving the pressure on the nerves is critical.
Although the benefits of surgery should
be weighed against the risks involved as patients with myelopathy are often old and frail.
Radiculopathy: Is used to describe pain, other symptoms
like numbness, tingling, and weakness in arms or legs that is caused by
some pathology in the nerve roots. This
condition is caused by direct pressure from a herniated disc or
degenerative changes that causes irritation and
inflammation of the nerve roots. Radiculopathy usually results in
pain and numbness that is felt in the arms or legs of the area of skin
supplied the by sensory fibers of the nerve root, along with weakness in the muscles
that are supplied by the same nerve root. The number of roots that are
involved vary from one to several and it sometimes also affects both sides of
the body at the same time.
The most common symptom is pain that radiates down
into the arms from the neck. Sensory symptoms are more common than motor
symptoms and that muscle weakness is a sign that the nerve compression is
severe. The pain can be dull, aching, and
difficult to localize, to sharp, burning, and easy to pinpoint. Radiculopathy
can lead to hypersensitivity to touch as well as numbness in the area of skin
that is supplied by the nerve root. Pain in the arms and neck is usually the
first sign that the nerve roots are irritated by some pathology in the neck. Symptoms such as numbness and tingling, and weakness in
the muscles of the arms are warning signs that the condition may be more
serious. Weakness in the arms is a definite sign that you should see a
physician. The diagnosis
of the condition is done by a complete physical examination including checking
the flexibility and range of motion of the neck, presence of signs
that suggest that nerve roots or spinal cord. This includes testing reflexes
and the strength of the muscles. X-rays are also performed but are usually normal because the disc is
composed of soft tissue which does not show up on a X-ray. MRI is useful for
locating where the nerve roots or
spinal cord are being compressed, while a CT is done to evaluate the bony
structure in the cervical spine, which shows the amount of space that is available for
the nerve roots and spinal cord. The treatment of choice is
non steroidal anti inflammatory drugs and physical therapy along with cervical
collar so as to provide rest to the neck. Surgery is for people who have muscle weakness
due to nerve root or spinal cord compression as muscle weakness is a definite sign
that the nerves are being injured and that relieving the pressure on the
nerves is critical.
Spondylosis: Cervical spondylolysis is the result of the narrowing of the spinal
canal in the neck compressing the spinal cord or spinal nerve roots. It is the
fracture or defect in the pars anticulars (part of the bone between each
of the joints of the back) which results in the vertebral body to slide forward on the
next vertebrae. It can
be unilateral or bilateral and it is usually due to a developmental defect but
it can also be as the result of a fracture. Spondylolysis affects the area of the vertebra
called the pedicle which is the part of the bony ring that protects the
spinal nerves. It often affects middle aged and older people
who have degenerative discs and vertebrae in their neck. When a spondylolysis
is present, the back part of the vertebra and the facet joints are not
connected to the body except by soft tissue.
Symptoms of cervical spondylolysis can be caused by either the spinal cord
compression or nerve root damage which is due to the instability of
the spinal segment. If the spinal cord is
compressed the patient may notice a change in the way they walk as the leg
movements become jerky. The patient also suffers
from general neck pain because of nerve root damage along with weakness in one or both arms. MRI
is used to determine if the spinal cord is
narrowing and also to determine where the narrowing is occurring, degree of compression,
and if nerve roots are involved. Non surgical treatment is
helpful in stabilizing the problems caused by cervical
spondylolysis, although if compression progresses surgery is necessary.
Stenosis: Cervical Stenosis is the narrowing of the vertebrae in the
neck. It is a degenerative disease where the
spinal canal narrows and compresses the spinal cord and nerve
roots. Patients with severe cervical stenosis may experience shooting
pain that feels like an electric shock when they flex
their neck and tip their chin down to their chest. Genetics is thought to play
a role in this disease.
The symptoms of cervical stenosis are the same as disc herniation
except for the fact that disc herniation is acute, while stenosis is a chronic slowly progressive process.
Cervical stenosis is diagnosed when patients with characteristic
symptoms and evidence on X-rays that there is narrowing of the spinal canal. MRI
is also used to determine
if there is narrowing, degree of the compression, and if nerve roots are
involved. Removal of the obstruction usually gives
patients some relief.
How do you find out what is causing your Neck Pain? Doctor's diagnose the causes of
neck pain by taking a comprehensive medical history by asking you a series of detailed questions about the
neck pain, your general health, your family history, your health risks, and much more. Based on this they then order a series of tests to further investigate what the think might be the problem, known as their differential diagnosis.
You can store all your Personal Health Information securely online and
access your medical records 24 hours a day 7 days a week from anywhere in the
world using MyNetRecord.com
For sharing and discussing your health concerns with people
around the world use YourHealthForum.com
YourDiagnosis takes a very comprehensive medical history online using easy to understand questions which you can answer by just clicking on the relevant answers. Once completed it provides a comprehensive list of differential diagnoses as well as a detailed Personal Health Summary
which you can take to your physician. You can also use it to store your medical
history and symptoms history that can be used by your physician(s) at a later
date. This would help you as you will not miss providing important information
to the different doctors you visit.
