5. Introduction of neck pain
Neck pain. is the sensation of discomfort in the neck
area. Neck pain can result from disorders of any of the
structures in the neck, including the cervical vertebrae
and intervertebral discs, nerves, muscles, blood vessels,
esophagus, larynx, trachea, lymphatic organs, thyroid
gland, or parathyroid glands. Neck pain arises from
numerous different conditions and is sometimes referred
to as cervical pain.
6. As a professional
Physiotherapist ,Our practice
of field in Neck pain includes _
A. Soft tissues. E .g. Muscles,
ligament,tendon,vessels & nerves.
B. Bones & joints in neck.eg.
Facet joints,Interavertevral joint & Disc.
8. Major and severe causes of neck pain .
• Carotid artery dissection
• Referred pain from acute coronary syndrome
• Head and neck cancer
• Infections: retropharyngeal abscess, epiglottitis, etc.
• Spinal disc herniation – protruding or
bulging discs, or if severe prolapsed.
• Spondylosis - degenerative arthritis and
Osteophytes
• Spinal stenosis – a narrowing of the spinal
canal
9. The more common and lesser neck pain causes
:
• Stress – physical and emotional stresses
• Prolonged postures – many people fall asleep on
sofas and chairs and wake up with sore necks.
• Minor injuries and falls – car accidents, sporting
events and day to day injuries that are really minor.
• Referred pain – mostly from upper back problems
• Over-use – muscular strain is one of the most
common causes
• Whiplash
• Herniated disc.
www.weikepedia.com.
27/07/2013.-1.44am
10. Symptoms &Signs of neck pain
1. Neck pain ,
2.Neck tenderness,
3.Neck swelling,
4.Neck muscle spasm,
5. Neck stiffness.
6.Additional symptoms may include fever,
headache, nausea, vomiting, swollen glands in
the neck, arm weakness, leg weakness, arm
numbness, leg numbness, loss of bladder control,
loss of bowel control, and an inability to walk.
11. Classifications of neck pain
• There are three types or classifications of neck pain:
• Axial neck pain: Axial pain is Musculoskeletal, and is pure
neck or soft tissue pain. Whiplash or muscle strain is an
example.
• Radiculopathy: Cervical radiculopathy refers to neck and
arm pain due to nerve root compression. Symptoms
include arm pain, numbness or weakness.
• Myelopathy: Myelopathy refers to pressure on the spinal
cord, also referred to spinal cord compression. Symptoms
include: neck pain with arm and/or leg weakness,
numbness, or walking problems.
• www.neck pain explain.com
12. Clinical examination of neck pain
• Local examination of neck with
neurological & vascular survey of upper
limb.
• Examination of potential extrinsic
sources of neck symptoms.
• General examination.
• Ref .Outline of orthopedics ,
-Adams & Hamblen 12th edition.
13. Local examination Includes
• Inspection.
-Bone contours ? Deformity.
-Soft-tissue contours .
-Color & Texture of skin.
-Scars & sinuses.
21. Examination of extreinsic sources of
neck pain
- Pain may referred from other organ like
Ears or throat.
- Checking Brachial plexus distribution.
-others organs testing.
23. Investigation for neck pain
• Radiological & Imaginary test.
-X-ray of C/S both view.
-MRI of Cervical spine.
-CT Scan.
-CAT scan.
24. X-ray view for neck .
– AP: Evaluate the lateral masses, equal separation
of spinous processes, best view for vertical
compression fractures, equal disk spaces.
– Lateral: Each cervical vertebra, cartilaginous disk
space, cervical lordotic curve, C2 neural arch,
lamina, spinous process, lateral mass and
articular facet.
– Swimmer's: If the body of C7 not well visualized
on lateral view.
– Odontoid: Visualize dens.
32. Acute neck pain
Acute pain occurs suddenly from an injury
or stress. Most of the time neck pain will
resolve itself within 7-10 days with rest,
ice, and over the counter pain relievers.
For symptoms that persist longer than a
few weeks. Conservative therapy can
include anti- inflammatories pain
medication, injections, physical therapy,
acupuncture, and chiropractic care.
33. Chronic neck pain
• Chronic pain is defined as neck pain
lasting longer than three months.
People who have not found relief through
conservative treatments, and suffer from
chronic pain may benefit from pain
management by Physical therapy or
surgical intervention.
34. Special test for neck pain
• Special tests.
• Arson's test: Indicates occlusion of
subclavian artery. Feel the radial pulse
while abducting, extending, and externally
rotating.
–Ankle clonus: May indicate UMN lesion.
Quickly dorsiflex the foot while cradling the
heel in your palm to relieve the load.
– Ref. by Basic orthopedic Examination
35. Special test for neck pain
– Bakody sign: Indicates cervical radiculopathy.
Patient raises his or her hand on top of the
head.
– Compression: Indicates nerve root tension/
radiculopathy. With the patient seated, press
downward on top of the skull.
– Distraction: Indicates nerve root tension/
radiculopathy. Pull upward on skull.
– Doorbell sign: Indicates nerve root tension/
radiculopathy. Deep palpation of C5.
– Ref. by Basic orthopedic Examination.
36. Special test for neck pain
– Halstead maneuver: Neurovascular
compression. In a seated patient, palpate a
radial pulse, and then pull traction on the
patient's arm downward while the patient
extends the head backward.
– Hoffmann's sign: Myelopathic sign. Flick the
patient's DIP joint of the long finger.
– Jackson's compression: Nerve compression.
Patient is seated and bends the head obliquely
backward; then apply downward pressure on
patient's head.
– Ref. by Basic orthopedic Examination
37. Special test for neck pain
– Lhermitte's sign: May indicate spinal canal
stenosis, multiple sclerosis, cervical disk
impingement, or tumor. Bend the patient's
head forward.
– Rust's sign: Test for a severe sprain or
subluxation. Patient holding the weight of his
or her head in the hands or lifting the head
manually when arising from lying down are
positive signs.
– Swallowing: Indicates anterior spine/
prevertebral space swelling
• Ref. by Basic orthopaedic Examination
38. Treatment of neck pain
• Treatment of neck pain Mainly
depend on etiology & onset of
Condition.
• Main treatment is to treat underlying
causative factors.
Sometime emergency first aid is necessary
for traumatic neck pain
39. Gross management of neck pain
Conservative or non-surgical treatment.
Surgical Treatment.
41. Conservative treatment …….cont
• Rest.
Rest is important for all
acute neck pain with others
reamady.Duration of rest depend on
patient prognosis & causative
factors.Rest with proper positioning
of neck that is seen by therapist or
physician.
49. Surgical Procedures
• Dissectomy.(with or without fusion).
The surgeon removes herniated disc
material that is pressing on a nerve root or
the spinal cord.
• Cervical spinal fusion. Selected bones
in the neck are joined (fused) together.
• Spinal Decompression. Pressure is
reduced on the spinal cord or spinal nerve
roots by removing part of a bone or disc.
51. Post-Operative Physiotherapy
• It is so much important And Skillful than
Conservative stage of Physiotherapy.
• Treatment according to Post-operative
Complains & other complication.
52. Our Message to community
SO be smart &
conscious at
Physically Within
your physical
structures.
53. References
• Book of Basic orthopedics.
• Out line of Orthopedics.
• Ref. international guide line of neck pain.
• www. Wikipedia .com.
• www.myoclinic.com
