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Neck pain/sprain

 

 

What is it?

 

There are many potential pain generators in the neck. These can include for example muscle and ligament injuries, nerve injuries, disc injuries or bone or joint problems. In most cases, it is not possible to easily identify the precise origin of neck pain. Common causes of neck pain include whiplash (from motor vehicle accidents) and occupations involving prolonged or repetitive looking up or down, or in occupations which expose workers to repeated blows to the top of the head.

 

Neck pain is also commonly found in chronic shoulder problems, although is not necessarily a specific neck injury as such.

 

Serious injuries (such as cervical fractures) need to be excluded.

 

 

Symptoms

 

Pain and reduction in range of movement of the neck. The pain is usually (although not always) maximal at the back of the neck, and may radiate either to the head or face (in upper neck injuries) or to the shoulder or arm (in mid-low neck injuries).

 

Pins and needles down the arm can occur relatively commonly. Loss of feeling or loss of movement in the arm may be a sign of serious neck injury.

 

 

Incidence

 

Neck pain is common.


In non-compensable motor vehicle injuries, 99% of whiplash injuries resolve in 12 months. In compensable cases of whiplash, between 4% and 42% of patients report ongoing symptoms several years later.

 

 

Key Points


The ACC outlines the following key points:

 

  1. The importance of GP’s and specialists taking a clinical history including the circumstances surrounding the onset of pain/injury

  2. The mechanism of the injury is important in the severity of injury e.g. motor vehicle accidents

  3. In comparison to the lumbar vertebrae, the cervical spine is both more flexible and less supported (for example by the car seat) and is therefore more at risk of sustaining an injury from acceleration and deceleration forces. Cervical disc lesions are less common and manipulation is easier (but potentially more dangerous) than in lumbar vertebral injuries

  4. Beware of neurological signs, rheumatoid arthritis, possible fractures (especially with underlying disease) and vertebral artery spasm

 

 

Complications

 

The ACC state that chronic neck pain is a serious critical development, and prevention is a high priority. The best opportunity for preventing chronicity is within the first few weeks.

 

  • Chronic neck pain should not be treated as if it were acute or recurrent, because this can lead to multiple investigations and ineffective therapy. This can in turn promote illness behaviour and delay rehabilitation

  • Acute nerve root compression syndrome

  • Neurological sequelae

 

 

 

Management

 

The ACC suggested medical management includes:

 

  • Short term certification of unsuitable for duties – one to two days, but less than one week, a certificate for temporary alternate work

  • Regular review of the patient’s pain and disability (every one to two days)

  • Again review the patient’s pain and disability and response to treatment at one week and then three to six weeks (if required)

  • Check for signs or symptoms of serious disease (RED flags) and psycho-social barriers to recovery (YELLOW flags)

  • At three to six weeks, reassess patients

  • Consider referral to a goal orientated multi-disciplinary (pain management) team which will attempt to promote active patient self-management of their injury by:

    • reactivating the patient
    • providing strategies for symptom control
    • enhancing patient coping and self management
    • helping to deal with psycho-social barriers to recovery.

 

 

Suggestions for When to Refer to Medical Specialist (ACC Treatment Profile Recommendations):

 

  • Nerve root pain that fails to settle

  • Serious spinal pathology

  • Presence of RED flags

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