Types of Neck Pain
Axial neck pain
Axial neck pain is caused by the complex interaction
of muscles and ligaments. Also known as cervical strain,
the condition frequently develops as a result of posture,
sleep habits, ergonomics (e.g., computer monitor and
bifocal position), stress, chronic muscle fatigue, postural
adaptation to other primary pain sources (i.e. shoulder,
temporomandibular joint, craniocervical) and cervical
disc or facet joint degeneration). Axial neck pain is
the most common source of neck pain, as well as the
most resolvable. Surgery is only necessary in rare cases
caused by single- or two-level degenerative disc disease
with severe, unrelenting pain. Most patients achieve
relief over time and there is a high rate of spontaneous
resolution. In one study, after just three months of
conservative treatment, 70 percent of the participants
demonstrated complete or partial relief.
Axial neck pain symptoms
Presenting signs of axial neck pain typically include
pain or soreness in the posterior paramedian neck muscles
with radiation to the occiput, shoulder or parascapular
region. Also quite common are stiffness in one or more
directions of motion and headache. Local warmth or tingling
as well as localized areas of muscle tenderness (trigger
points) may also be encountered. Initially a very common
secondary symptom is headache, and often such symptoms
are interpreted and treated as migraines without success.
Whiplash-Associated Disorder (WAD)
Whiplash-Associated Disorder (WAD) is classified as
a special case of acute or subacute pain in the neck
that results from acceleration/deceleration transfer
of energy. Typically, WAD involves multiple pain generators,
including myofascial, ligamentous, discogenic and facet
joint sources. Rear-end motor vehicle crashes and diving
injuries are the most common causes of WAD. Each year
in the United States, there are approximately one million
cases of WAD resulting from motor vehicle accidents.
Prognostic data is largely inconsistent, however, one
of the larger studies observed the resolution of 60
percent of patient symptoms within just one month. The
prevalence of chronic symptoms following acute onset
of WAD is even less clear. WAD chronicity remains the
subject of a lively medical debate because most patients
do not have any readily identifiable injury in either
the acute or chronic stage.
Whiplash-Associated Disorder (WAD) Symptoms
Presenting signs of WAD typically include pain or soreness
in the posterior paramedian neck muscles with radiation
to the occiput, shoulder or parascapular region. Also
quite common are stiffness in one or more directions
of motion and headache. Local warmth or tingling as
well as localized areas of muscle tenderness (trigger
points) may also be encountered. Initially a very common
secondary symptom is headache, and often such symptoms
are interpreted and treated as migraines without success.
Cervical Radiculopathy
Cervical radiculopathy is characterized by motor and/or
sensory changes in the neck and arms, which results
from extrinsic pressure on a cervical nerve root. This
pressure is typically caused by disc material or osteophytes.
A large study in Rochester, Minnesota, has reported
the annual incidence of cervical radicular symptoms
to be 83.2 per 100,000 population, and its prevalence
most significant within a 50- to 54-year age group.
In the study, 90 percent of patients were asymptomatic
or only mildly incapacitated. Surgery is not often required
for resolution of cervical radiculopathy symptoms.
Cervical Radiculopathy Symptoms
Radicular pain, the characteristic symptom of cervical
radiculopathy, is often confused with radiating pain
in clinical practice. Because specific treatments are
exclusively indicated for radicular pain, an accurate
distinction is important. True radicular pain follows
dermatomal patterns and is usually—though not always—unilateral.
Onset is often insidious but may be abrupt, and the
pain is frequently aggravated by arm position and extension
or lateral rotation of the head.
Cervical Myelopathy
A less common cause of neck pain is cervical myelopathy.
Cervical myelopathy also results from extrinsic pressure;
specifically, a decrease in the space available in the
cervical canal for the spinal cord. Underlying causes
can include a small congenital cord diameter, osteophytes,
protruding disc material, dynamic changes in canal diameter
or the vascular supply to the cord. The overall prevalence
of cervical myelopathy is uncertain; however, it is
known to be relatively rare.
Cervical Myelopathy Symptoms
The presentation of cervical myelopathy is subtle and
varied. Mild symptoms may be present for years or paresis
could occur acutely. The more common signs include clumsiness,
weakness and stiffness in the upper and lower extremities.
Common to about half of presenting cases are neck stiffness
and deep, aching pain in the neck, shoulder or arm.
Approximately one third of patients experience radicular
symptoms. Additional warning signs include arm or leg
dysfunction, gait and balance difficulties and nonspecific
urinary complaints such as urgency or hesitancy.
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