Neck pain is a common problem with around 50 to 75% of population having this complaint at some time in their lifetime.

Etiology

Neck pain could be a symptom of a host of diseases. These could be minor or sometimes serious. Injury to the soft tissues, namely muscles, tendons, ligaments, bone and cartilage like vertebrae, vertebral or facet joints can lead to neck pain. Injuries to these structures are commonly whiplash injuries which happen while travelling or as a result of poor sitting posture.

Degenerative arthritis of the cervical spine can press upon the spinal nerves and cause neck, shoulder and arm pain. Cervical spondylosis (degenerative spine disease) prolapsed intervertebral disc (PID) can cause local neck pain or neuralgic pain due to pressure on the nerves (cervical radiculopathy).

Intrinsic spinal cord disorders like tumors, demyelination, syringomyelia can cause neck and arm pain. Rarely referred pain from heart, lungs, and some abdominal organs can cause neck and shoulder pain.

Neck pain could be part of a systemic inflammatory disease like polymyalgia rheumatic, rheumatoid arthritis or vasculitis. Acute onset neck pain associated with severe headache and fever could herald meninigoencephalitis (infection of the covering of the brain). Acute severe neck pain in a previously healthy person may suggest a spinal hemorrhage.

Diagnosis

Thus, the key remains in detecting the etiology of neck pain. A thorough history and a detailed neurological examination will lead to a correct diagnosis.

An MRI of the cervical spinal region is indicated in patients with abnormal examination. MRI may also be appropriate in cases with acute onset neck pain, patients with history of injury and in those with associated systemic disorders.

A nerve conduction study and electromyography may be necessary to demonstrate radiculopathy.

Treatment

The treatment of neck pain depends on its cause. In patients with degenerative spine disease and mechanical neck pain a short course of analgesics with neck exercises and advice on proper posture will be sufficient for long term relief. Several websites are freely distributing information about exercises and physical therapy for patients with neck pain due to degenerative spine disease.

In patients with radiculopathy due to PID, bed rest, cervical collar, short course of steroids with analgesics and pregabalin may give relief. In patients not responding to conservative treatment and weakness, spine surgery may be required.