Usually arises from diseases of the cervical spine and soft tissues of the neck; typically precipitated by movement and may be accompanied by focal tenderness and limitation of motion.
Trauma to the cervical spine (fractures, subluxation) places spine at risk for compression; immediate immobilization of the neck is essential to minimize movement of unstable cervical spine segments.
Whiplash injury is due to trauma (usually automobile accidents) causing cervical musculoligamentous injury due to hyperflexion or hyperextension. This diagnosis is not applied to pts with fractures, disk herniation, head injury, focal neurologic findings, or altered consciousness.
Herniation of a lower cervical disk is a common cause of neck, shoulder, arm, or hand pain or tingling. Neck pain (worse with movement), stiffness, and limited range of motion are common. With nerve root compression, pain may radiate into shoulder or arm. Extension and lateral rotation of the neck narrows the intervertebral foramen and may reproduce radicular symptoms (Spurling's sign). In young individuals, acute radiculopathy from a ruptured disk is often traumatic. Subacute radiculopathy is less likely to be related to a specific traumatic incident and may involve both disk disease and spondylosis. Clinical features of cervical nerve root lesions are summarized in Table 50-3 Cervical Radiculopathy: Neurologic Features.
Osteoarthritis of the cervical spine may produce neck pain that radiates into the back of the head, shoulders, or arms; can also be source of headaches in the posterior occipital region. A combined radiculopathy and myelopathy may occur. An electrical sensation elicited by neck flexion and radiating down the spine from the neck (Lhermitte's symptom) usually indicates spinal cord involvement. MRI or CT can define the anatomic abnormalities, and EMG and nerve conduction studies can quantify the severity and localize the levels of nerve root injury.
Includes rheumatoid arthritis of the cervical facet joints, ankylosing spondylitis, herpes zoster (shingles), neoplasms metastatic to the spine, infections (osteomyelitis and epidural abscess), and metabolic bone diseases. Neck pain may also be referred from the heart with coronary artery ischemia (cervical angina syndrome).
An anatomic region containing the first rib, subclavian artery and vein, brachial plexus, clavicle, and lung apex. Injury may result in posture- or movement-induced pain around the shoulder and supraclavicular region. True neurogenic thoracic outlet syndrome is uncommon and results from compression of the lower trunk of the brachial plexus by an anomalous band of tissue; treatment is surgical division of the band. Arterial thoracic outlet syndrome results from compression of the subclavian artery by a cervical rib; treatment is thrombolysis or anticoagulation, plus surgical excision of the cervical rib. Venous thoracic outlet syndrome is due to subclavian vein thrombosis producing swelling of the arm and pain. The vein may be compressed by a cervical rib or anomalous scalene muscle. Disputed thoracic outlet syndrome includes a large number of pts with chronic arm and shoulder pain of unclear cause; surgery is controversial and treatment is often unsuccessful.
Pain from injury to the brachial plexus or peripheral nerves can mimic pain of cervical spine origin. Neoplastic infiltration can produce this syndrome, as can postradiation fibrosis (pain less often present). Acute brachial neuritis consists of acute onset of severe shoulder or scapular pain followed over days by weakness of proximal arm and shoulder girdle muscles innervated by the upper brachial plexus; onset often preceded by an infection or immunization. Recovery may take up to 3 years, and full functional recovery can be expected in the majority of pts.
If signs of radiculopathy are absent, differential diagnosis includes mechanical shoulder pain (tendinitis, bursitis, rotator cuff tear, dislocation, adhesive capsulitis, and cuff impingement under the acromion) and referred pain (subdiaphragmatic irritation, angina, Pancoast [apical lung] tumor). Mechanical pain is often worse at night, associated with shoulder tenderness, and aggravated by abduction, internal rotation, or extension of the arm.
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Neck and Shoulder Pain
NECK PAIN WITHOUT RADICULOPATHY
NECK PAIN WITH RADICULOPATHY
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