Neck pain (located in the cervical spine) is far less common than lower back pain (located in the lumbar spine). However many people experience serious neck pain at some point in their life.
The vast majority of episodes of neck pain will get better with time. These conditions often can be addressed with non-surgical treatments. However, there are a few symptoms that are possible indications of a serious medical condition and patients with these symptoms should seek medical attention immediately.
Progressive neurological deficit (weakness in the arms or loss of feeling and coordination in the arms or legs) could indicate nerve damage. If sustained or increasing pain is accompanied by lack of appetite, unplanned weight loss, nausea and vomiting, or fever/chills/shakes, there could be a spinal tumor or infection.
While many episodes of neck pain have no identifiable anatomical cause, certain types of neck pain and arm pain can be linked to a general cause (such as muscle strain) or a diagnosable condition (such as cervical herniated disc or cervical stenosis).
Acute neck pain
Most episodes of acute neck pain are due to a muscle strain or other soft tissue sprain (ligaments, tendons). This type of injury can be caused by a sudden force (such as whiplash) resulting from a car accident, or from straining the neck (such as a stiff neck from sleeping in the wrong position, or a strain from carrying a heavy suitcase).
Most minor injuries to the ligaments, tendons and muscles in the neck usually heal with time (a couple of days or weeks) because these soft tissues have a good blood supply to bring the necessary nutrients and proteins for healing to take place. Nonsurgical care, such as ice and/or heat, medications, physical therapy, and/or chiropractic or osteopathic manipulations can help alleviate the painful condition while it is healing.
Neck pain radiating down the arm
Pain that radiates down the arm, and possibly into the hands and fingers, is frequently caused by a cervical herniated disc or foraminal stenosis pinching a nerve in the neck. Most commonly, the symptoms are temporary and can be treated successfully with nonsurgical care (such as medication, physical therapy, manipulations). If the pain does not respond within 6 to 12 weeks of conservative treatments, then surgery may be recommended.
Neck pain related to certain activities or positions
Neck pain that develops very slowly and tends to occur during or after certain activities or neck positions is frequently caused by cervical foraminal stenosis. Usually, impingement of one nerve root on one side of the spine causes most of the symptoms.
This type of spinal stenosis is caused by wear or aging related changes in the joints of the neck (facet joints) or at the margins of the discs. These changes may be diagnosed by either an MRI or a CT scan with a myelogram.
As with a herniated disc, the mainstay of treatment for stenosis is medical care (medicine, therapy, exercise, injections, etc.).
If the pain is severe or prolonged, or the functional impairment is sufficient, surgery may be recommended to open up the disc space and give the nerve root more room.
Paradoxically, there are also patients who feel their worst when they first rise in the morning and at the end of the day. These people often feel best when they are moving their neck, and they often prefer warm, sunny days to cool, rainy or overcast days. This may be a sign of Cervical osteoarthritis (neck arthritis)
Range of motion exercises, physical therapy, traction, and manipulations can help preserve motion as well as diminish chronic pain.
There are a number of other, less common cervical conditions. These can cause shoulder pain, wrist pain, elbow pain, or headaches.
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