Neck pain

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neck pain


     Neck pain and symptoms caused by a cervical (neck) spine disorder are a very common problem for many adult Americans. The cervical
spine is composed of many different anatomic structures, including muscles, bones, ligaments, and joints. Each of these structures has nerve
endings that can detect painful problems when they occur. The different parts of the cervical spine are normally well balanced and able to handle
all of the movements, stresses, and strains of the body gracefully. However, when the different parts of the cervical spine are injured or start to
wear out, your neck can be a significant source of pain and discomfort.
     Studies show that approximately fifty percent of the population has evidence of degenerative changes in their cervical spine by the age of
fifty. These changes happen because the discs that act as shock absorbers between the vertebral bodies of the cervical spine wear out, as we grow
older. As the intervertebral disks wear out, they begin to collapse, or herniate, and become less flexible. The common causes of neck pain and
cervical disorders include arthritis, injuries, and trauma. In some situations neck pain can also be a warning sign of something more serious such
as spinal cord compression, a tumor, or spinal infection.
     Any patient suffering from neck, shoulder, head or arm pain should be examined by a doctor in order to determine where the pain
originates and what is causing the pain. The tissues involved in producing the pain must also be identified, and how they are being irritated must
also be understood. The history of the pain and any activities that may have triggered it are also important factors in diagnosis and treatment.
Impairment of movement in any part of the cervical spine can be responsible for pain, discomfort, and disability.
     As a result of the natural wear and tear that occurs with aging, certain parts of the cervical spine start to degenerate and wear out, as we
grow older. This process makes some of the anatomic structures of the cervical spine, the bones, intervertebral discs, ligaments, and muscles less
flexible and less resistant to injury. The following is a list of many common mechanical, inflamatory and traumatic neck disorders:

Degenerative Disc

Degenerative disc disease (DDD) is part of the natural process of growing older. Unfortunately, as we age, our intervertebral discs lose their
flexibility, elasticity, and shock absorbing characteristics. The ligaments that surround the disc, called the annulus fibrosis, become brittle and
they are more easily torn. At the same time, the soft gel-like center of the disc, called the nucleus pulposus, starts to dry out and shrink.
Degenerative disc disease is as certain as death and taxes, and to a certain degree this process happens to everyone. However, not everyone who
has degenerative changes in their cervical spine has pain. Many people who have "normal" necks have MRI's that show disc herniations,
degenerative changes, and narrowed spinal canals. Every patient is different, and it is important to realize that not everyone develops symptoms as
a result of degenerative disc disease.
Herniated Disc

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 each of the vertebral bodies that allows them to flex and extend, rotate slightly, and move with respect to one another.
When the outer lining that surrounds the disc tears, the soft center squeezes out through the opening, creating a "herniated", "slipped", or "ruptured
disc". Each of these terms describes the same process.
Myelopathy

Myelopathy is a term that means that there is something wrong with the spinal cord itself. This is usually 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 type of process
occurs most commonly in the elderly, who can have many reasons for having trouble walking or problems with gait and balance. However, one of
the more worrisome reasons that these symptoms are occurring is that bone spurs and other degenerative changes in the cervical spine are
squeezing the spinal cord. Myelopathy affects the entire spinal cord, and is very different from isolated points of pressure on the individual nerve
roots.
Radiculopathy

Doctors use the term radiculopathy to specifically describe pain, and other symptoms like numbness, tingling, and weakness in your arms or legs
that are caused by a problem with your nerve roots. The nerve roots are branches of the spinal cord that carry signals out the rest of the body at
each level along the spine. This term comes from a combination of the Latin word radix, which means the roots of a tree, and the Latin word
pathos, which means a disease. This disease is often caused by direct pressure from a herniated disc or degenerative changes in the cervical spine
that cause irritation and inflammation of the nerve roots.
Spondylolysis

Cervical spondylolysis is a disorder that narrows the spinal canal in the neck compressing the spinal cord or spinal nerve roots. It's a fracture or
defect in the pars anticulars (a portion of the bone between each of the joints of the back), allowing one vertebral body to slide forward on the
next. Spondylolyosis is sometimes referred to as pars interarticularis defect. It may be unilateral or bilateral and is usually due to a
developmental defect but may be secondary to a fracture. Spondylolysis affects the area of the vertebra called the pedicle. The pedicle is part of
the bony ring that protects the spinal nerves, and is the portion that connects the vertebral body to the facet joints. It's a disease that often times
affects middle-aged and older adults who have degenerative discs and vertebrae in their neck. When a spondylolysis is present, the back part of
the vertebra and the facet joints simply are not connected to the body, except by soft tissue.
Stenosis

Stenosis is a term used to describe a narrowing of various parts of the body. Cervical stenosis is a degenerative disease where the spinal canal and
neural foramina narrow and compress the spinal cord and nerve roots. Stenosis occurs when pressure increases inflaming the facet joints. The
facet joints are overlapping arches that form the spinal canal. These joints are covered with cartilage and a membrane. Degenerative changes and
wear and tear can cause the facet joints to inflame. This disorder is most common in people over 50 years of age. However, genetics and
congenital factors may predispose a person for stenosis.

     Though infections and inflammation of the cervical spine are rare, if they are neglected for a period of time, or if there is a delay in
diagnosis, they can become a significant source of pain and disability. Bone and joint infections anywhere in the body can be crippling and life
threatening, and infections in the cervical spine are no exception. Here is a list of some infectious and inflammatory neck disorders:

Ankylosing Spondylitis

     Ankylosing spondylitis is a rare condition that can cause back and neck pain. It is a rheumatic inflammatory disease that affects the spine
and sacroiliac joints. This disease is three times more likely to develop in men than in women and it usually occurs between the ages of 20 and
40. Although it primarily attacks the spine (usually the low back first), this chronic and painful disease can also attack other joints, tendons and
ligaments, and the chest wall. Though its cause is unknown, ankylosing spondylitis tends to run in families which suggests that genetics plays a
role in the development of this disease. A patient is 10 to 20 times more likely to have ankylosing spondylitis if a parent or sibling also has this
condition.
Juvenile Rheumatoid Arthritis

     Juvenile Rheumatoid Arthritis is a type of inflammatory arthritis that affects almost 200,000 children in the United States. JRA is a
disease that causes painful, swollen, and stiff joints in children, most commonly in large joints like the knee. JRA has three well-defined subsets:
a monoarticular form, which means that that the disease affects only one joint; a polyarticular form, which means that it affects many joints, and a
systemic form, which means that it affects other organs in the body besides the joints. The systemic form of the disease is most often associated
with high fevers and rash, in addition to arthritis. The polyarticular and systemic forms of the disease are the two types that commonly affect the
cervical spine.
Rheumatoid Arthritis

     Rheumatoid Arthritis is among the most debilitating forms of arthritis causing joints to ache, throb and even deform over time. The exact
cause of this inflammatory condition is not known, but it is believed to be caused by an attack on the synovium (tissue that lines the joints) by the
body's immune system. The upper cervical spine can be damaged by the inflammation that is caused by rheumatoid arthritis. This disease is three
times more common in women than in men and usually occurs between the ages of 20 and 50. Just like the gradual destruction of other joints in
the body, several joints between the base of the skull and uppermost vertebral bodies in the cervical spine are very susceptible to damage from
rheumatoid arthritis.

     Cervical spine injuries can occur during motor vehicle accidents, in rough contact sports, after a fall, or by hitting your head against a hard
surface, such as when diving into a pool that is too shallow. These accidents can cause injuries that range from mild cases of neck pain, called
whiplash, to injuries that can cause paralysis of the rest of the body below the level of injury.

Whiplash

exceeds the neck's ability to control its motion. The injury usually happens when the head is suddenly jerked back and forth beyond its normal
limits during a car accident, rough contact sports, or a fall. This jerking motion can cause over-stretching and tearing of the neck muscles and
ligaments and can cause the discs between the neck vertebrae to bulge, tear or rupture.
Disc Herniations

The discs that act as shock absorbers between the vertebral bodies of the cervical spine can be damaged during an accident. When this happens,
the material in the center of the disk can be pushed out from where it normally is, a process called disk herniation. A herniated disk can put
pressure on the spinal cord or nerves to the arms and legs. In situations when a disk ruptures very quickly, as in the case of an accident, then the
nerve does not have any time to adjust to the increased pressure and it may stop working.
Fractures and Dislocations

Fractures and dislocations of the cervical spine demand early and accurate diagnosis so that treatment can quickly be introduced in order to
produce a painless, stable neck and prevent pressure on the spinal cord and/or nerves. When the neck is injured in very violent accidents, the
bones in the neck can be broken or pulled forcefully out of normal alignment. Fractures and dislocations of the cervical spine are very serious
injuries because there is the potential for damage to the spinal cord if the patient is not taken care of very carefully.
Spinal Cord Injuries

Each year in the United Sates, there will be approximately 50,000 new spinal cord injuries caused by accidents. A spinal cord injury occurs when
the cord itself is crushed, stretched, or torn by the accident. Unfortunately, this is still an injury that can not be reversed or cured by modern
medicine. More than half of these injuries involves the cervical spine, and most of them happen to young men. These injuries are incredibly
devastating to the patient, their families, and also to their communities. There is currently a lot of research being done on ways to minimize spine
injuries by designing cars for better safety, improving protective gear like football helmets, and educating people about the dangers of certain
activities. There is also a lot of research being done on how to care for someone immediately after they have had a spinal cord injury, and also
what kind of rehabilitation is best for them.

Treatment
How neck pain is treated depends on what the diagnosis reveals. However, most patients are treated successfully with rest, medication,
immobilization, massage therapy,physical therapy, exercise, activity modifications or a combination of these methods.
     For example, if pain is caused by inflammation as a result of stretching muscles and ligaments beyond their limits, your orthopaedist may
prescribe rest and a neck collar for a specified period of time, as well as medication to reduce inflammation. If medication is prescribed to
reduce pain, it should be used only as directed and should not be taken for extended periods of time. When neck pain persists or is chronic, your
orthopaedist may recommend a rehabilitation program that includes an exercise program and various types of physical therapy to help you relieve
your pain and prevent it from coming back.
     Very few patients require surgery to relieve neck pain. For the vast majority of patients, a combination of rest, medication and physical
therapy will relieve neck pain. Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated
disk or bony narrowing of the spinal canal. Surgery may also be required following an injury, to stabilize the neck and minimize the possibility of
paralysis such as when a fracture results in instability of the neck.
     

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