What is Neck Pain?

Your neck supports your head and allows it to turn in many directions. The design of your neck which allows this incredible range of motion also makes it vulnerable.

The cervical spine consists of seven cervical vertebrae, called C1 to C7.
The C1 vertebra is also called the atlas, as it supports the head. The occiput is the bone at the base of the skull that connects to the vertebral column.
Signs and symptoms

Acute Neck Pain
This is pain that is expected to be short in duration. It is pain that is alleviated by treating the cause.
Medically the cause may be inflammation or infection.
Chronic Neck Pain
This is pain that is of a not yet identified cause, is longstanding and that often defies treatments to ease it.

• Pain in your neck

• Pain in jaw
• Pain in shoulders problems in your neck can make other parts of your body hurt, such as your upper back, shoulders or arms.
• Pain in teeth
• Headaches
• Repetitive Strain Injury (RSI)

Muscles cramping in the neck may lead to:

• Headaches
• Whiplash
• Ear Aches
• Dizziness
• Arm problems and RSI
• Digestive Problems
• Vomiting
• Fevers

What causes Neck Pain?

• Stress – physical and emotional stresses
• Prolonged postures – many people fall asleep on lounges and in chairs while sitting and wake with sore necks. Also we work more at desks, sit in cars for long periods and live fast paced and hectic lives. This places more stress and strain on the upper back and neck regions of our spines

• Minor injuries and falls – car accidents, sports and day to day minor injuries may cause neck trauma.Injury. Rear-end collisions often result in whiplash injuries, which occur when the head is jerked forward and back, stretching the soft tissues of the neck beyond their limits
• Food Sensitivities
• Referred pain – mostly from upper back problems and the digestive system, although lower back and pelvic problems may cause secondary neck problems.
• Over-use – muscular strain is one of the most common causes

• Spondylosis - degenerative arthritis and osteophytes
• Spinal stenosis – a narrowing of the spinal canal
• Spinal disc herniation – protruding or bulging discs, or if severe prolapse.
• Severe degeneration – usually as a result of past injuries or whiplash accidents.

Prevention
Most neck pain is associated with poor posture. The goal is to keep your head centered over your spine, so gravity works with your neck instead of against it. Some simple changes in your daily routine may help.

General
Take frequent breaks if you drive long distances or work long hours at your computer.
Keep your head back, over your spine, to reduce neck strain
Avoid tucking the phone between your ear and shoulder when you talk. If you use the phone a lot, get a headset.
Stretch frequently if you work at a desk.
Shrug your shoulders up and down. Pull your shoulder blades together and then relax. Pull your shoulders down while leaning your head to each side to stretch your neck muscles.
Balance your base. Stretching the front chest wall muscles and strengthening the muscles around the shoulder blade and back of the shoulder can promote a balanced base of support for the neck.

Office Ergonomics

• Learn to touch type: Small up and down motions of the head from document to screen creates a repetitious stress on the muscles and joints of the neck. This can lead to neck, shoulder, upper limb pain and headaches.
• Computer Monitors: Get a larger one! A 17 inch monitor should be the minimum but these days even larger monitors are readily available. This reduces the strain on the eyes and the muscles of the neck.
• Computer set-up: Get an ergonomist (someone who is trained in worksite set - up and lay out issues) to come in to your work place. Ergonomists are usually from a variety of backgrounds but are commonly physiotherapists or occupational therapists that have undergone post graduate training in Ergonomics.Adjust your desk, chair and computer so the monitor is at eye level. Knees should be slightly lower than hips. Use your chair's armrests.
  
  
• Laptops: Use a docking port. Laptops are convenient and good for short term use, but as a full time terminal they are poorly laid out. A docking port will allow the user to place the screen and the keyboard in a better relationship to each other. Alternatively plug in an additional keyboard to enable you to raise the laptop and screen into a more suitable position.
• Font: Set the default screen font to a larger size so you are not squinting and stretching forward to read the document which places additional strain on the neck muscles.

• Car: Driving position Sit with good posture when you first sit down then adjust mirrors accordingly. If your head is creeping forwards you will notice the mirrors are now in the wrong place and you will adjust your posture to suit. Ensure your seat height and leg position is correctly and individually adjusted to suit you.

• Sleeping:Do not sleep on your stomach. Sleeping on your stomach causes you to twist the neck for hours at a time resulting in strain to the small joints of the neck. Over time this can do permanent damage. The problem with this advice is that we often sleep on our stomachs without thinking during sleep AND THIS INDICATES that your neck is already in a pattern of tight musclulature that will need treatment. We sleep in our pattern as it is the most comfortable.
  
  
• Pillows:Get a pillow that supports the natural contours of you neck. This will be different for everyone depending on your size, sleep position and existing head/neck posture. Importantly, the head must be relaxed and supported comfortably.
• Breastfeeding: The joints of the neck are particularly susceptible during this period due to bending over the newborn and the release of pregnancy hormones that soften the ligaments. Make sure both mother and baby are well supported to avoid the prolonged head down posture during feeding.
• Posture:Maintaining good upright posture keeps the joints of the neck in their mid position which prevents strain. Seating should encourage good posture, which starts from the lumbar spine and pelvis.

If there is any concern that there may be underlying pathology then you will be referred for the appropriate tests or consultation with either another practitioner within Health Dimensions or your local GP.
Treatment:
Osteopathy:
By releasing tension in muscles and correcting the alignment of the vertebra of the neck most neck pain can be relieved.
In cases where the muscles just under the skull (sub-occipital)are very tight we have found that there is often an organ in the body reflexing to the neck area. The neck problems therefore are a symptom and not the cause. Should this be suspected then the osteopath will cross refer you to another practitioner better able to treat the cause and avoid you having repeated neck problems.

Last Updated ( Saturday, 02 September 2006 )
Disclaimer: This web site is not intended as a substitute for your own independent health professional’s advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider within your country or place of residency with any questions you may have regarding a medical condition.

Cervical disc herniation

Cervical herniated discs less common than lumbar herniated discs
Cervical disc herniations are far less common than lumbar disc herniations for two reasons:

There is far less disc material in the cervical spine
There is substantially less force across the cervical spine
When they do occur, most cervical disc herniations will extrude out to the side of the spinal canal and impinge on the exiting nerve root at the lower level (e.g. C6 at C5-C6) (Figure 1 and Figure 2).

If the space for the nerve root (foramen) is already compromised because of associated disc space collapse or bone spurs (osteophytes), the added impingement of the disc may irritate the nerve root and cause a radiculopathy (arm pain). If the foramen is not compromised, the radiculopathy may be temporary and relieved with conservative treatment.

Treatment options for a cervical herniated disc
In general, most cervical disc herniations will heal with time and conservative treatment and will not require surgery. The following includes an overview of:

Conservative treatments for a cervical herniated dics
Surgical treatments for a cervical herniated disc
Conservative treatments for a cervical herniated disc
As in the lumbar spine, the first line or treatment is generally a couple days of rest and non-steroidal anti-inflammatory drugs (NSAID’s).

If the pain is severe and/or continues for more than a couple of weeks, oral steroids can be useful to decrease inflammation. Oral narcotic agents can be added for severe pain, but should only be taken for a short time (less than two weeks).

If the pain lasts for more than two to four weeks, conservative treatments may include:

Physical therapy for exercises to help relieve the pressure on the nerve root

Chiropractic treatments for manual manipulation to help relieve the pressure on the nerve root

Manual traction to help open up the cervical foramen where the nerve root exits the spinal canal. If this therapy helps relieve the pain, a home traction unit can be prescribed. Traction should be initiated under a physical therapist's supervision.

For pain that does not get better with medical and physical treatments, epidural injections may be considered. Epidural injections effectively relieve pain approximately 50% of the time, and if they do work they may be repeated every two weeks up to a total of three times within one year.

Surgical treatments for a cervical herniated disc
If 6 to 12 weeks of conservative treatment fails to relieve the arm pain, then surgical removal of the disc may be reasonable.

An MRI scan or CT with myelogram can confirm the presence of a disc herniation and the level that is affected. If the patient’s symptoms and neurological deficit match the results of the scan, surgery is reliable in terms of relieving arm pain and has a low complication rate.

The disc may be removed from the back of the neck (posterior approach) or from the front (anterior approach). Generally, surgeons favor the anterior approach for most cervical disc herniations.

Anterior surgical approach for a cervical disc herniation – may be favored if there is any disc space collapse, as the approach allows the surgeon to "jack open" the disc space and place a bone graft to keep it open. This procedure opens up the foramen, which gives the exiting nerve root more room

Posterior surgical approach for a cervical disc herniation– may be favored for a large soft disc that is lateral (to the side of) the canal

Both spine surgeries can usually be done with an overnight stay in the hospital.

Cervical foraminal stenosis

Types of pain from foraminal stenosis
Foraminal stenosis (narrowing of the cervical disc space) may arise without any disc herniation. The majority of symptoms are usually caused by one nerve root on one side. Typically, the condition is characterized by the following:

The pain develops slowly (versus acute pain)

The pain may develop over many years

The pain is not continuous

The pain is related to an activity (such as bicycle riding) or position (such as holding the neck in an extended position)

The condition is caused by enlargement of a joint (the uncinate process) in the spinal canal and can be confirmed by either an MRI scan or a CT with myelogram.

Treatment of pain from foraminal stenosis
Unlike many other back or neck conditions, most conservative treatments for foraminal stenosis (such as pain medications or other modalities) are unlikely to be of much benefit. Traction may provide some pain relief.

Most often, patients choose either activity modification or back surgery to relieve pressure in the nerve root from foraminal stenosis.

Activity modification for foraminal stenosis. If patients are not unduly troubled by foregoing a few activities and are not in a great deal of discomfort, choosing to live with the condition is a reasonable option. Delaying or avoiding back surgery is not dangerous, and back surgery may always be considered at a later date.

Back surgery for foraminal stenosis. This usually includes an anterior cervical discectomy and spine fusion in which the disc is removed and the disc space is distracted open to allow opening of the foramen and give the nerve root more room. A bone graft is left in the disc space to keep in distracted. The surgical procedure is reliable in terms of pain relief and has minimal morbidity (such as postoperative pain). The back surgery can usually be done with an overnight hospital stay and then takes about 2 to 6 weeks to return to normal activities.

Cervical stenosis with myelopathy

Cervical stenosis pinches the spinal cord
As we age, the spine may develop degenerative changes in the joints that can create tightening of the spinal canal. Over time this process may lead to pinching the spinal cord and compromise of coordination of the extremities.

Symptoms of cervical stenosis with myelopathy
People with this condition may note one or more of the following symptoms:

Heavy feeling in the legs

Inability to walk at a brisk pace

Deterioration in fine motor skills (such as handwriting or buttoning a shirt)

Intermittent shooting pains into the arms and legs (like an electrical shock), especially when bending their head forward (known as Lermitte’s phenomenon)

Arm pain (radiculopathy)

Often it is the arm pain that prompts someone with this condition to seek medical treatment, and then the myelopathy is discovered through medical history and physical exam.

Cervical stenosis with myelopathy affects the nerves
Myelopathy affects the nerve tracts that run inside the spinal cord (long tracts) and deficits in these long tracts can be picked up on physical exam. For example:

Muscular tone in the legs will be increased,

Deep tendon reflexes in the knee and ankle will be accentuated (hyperreflexia)

Forced extension of the ankle may cause the foot to beat up and down rapidly (clonus)

Scratching the sole of the foot may cause the big toe to go up (Babinski reflex) instead of down (normal reflex)

Flicking the middle finger may cause the thumb and index finger to flex (Hoffman’s reflex)

Compromised coordination may be evidenced by difficulty walking placing one foot in front of the other (tandem walking)

Diagnostic tests for cervical stenosis with myelopathy
An MRI scan and/or a CT with myelogram can show the tight canal and associated spinal cord pinching. The condition may be present at one or several levels in the spine.

Often, cervical stenosis with myelopathy is associated with some degree of instability, and flexion/extension lateral cervical spine x-rays are useful to rule out abnormal motion and instability.

Somatosensory Evoked Potentials (SSEP), an electrical study, is done by stimulating the arms/legs and then reading the signal in the brain. A delay in the length of time that it takes to get to the brain indicates that there is a compromise of the spinal cord.

Treatment for cervical stenosis with myelopathy
The only effective treatment for myelopathy is surgical decompression of the spinal canal. If the patient also has a radiculopathy (myeloradiculopathy), conservative treatment may help relieve the arm pain.

Myelopathy is a generally progressive condition that develops slowly. Symptoms may not progress for years, and then difficulties with coordination may suddenly increase. Unfortunately, the symptoms rarely improve without spine surgery to decompress the affected area.

Surgical decompression may or may not improve the symptoms. Typically, the main goal of the spine surgery is to arrest the progressive nature of the condition and stabilize the patient’s neurological condition.

Surgical decompression can be performed through an anterior (front) approach or posterior (back) approach. The type of approach is generally dependent on the surgeon’s preference and where the majority of the compression is located (in the front or back).

Often, multiple levels need to be decompressed, so the spine surgery tends to be more involved than that for disc herniations or foraminal stenosis

Cervical osteoarthritis

Pain from cervical osteoarthritis
Just as in the lumbar spine, the facet joints in the cervical spine can degenerate and lead to osteoarthritis of the cervical spine. The pain associated with osteoarthritis tends to:

Radiate to the shoulder or between the shoulder blades

Be worse first thing in the morning, and then improves after getting up and moving around

Gets worse again at the end of the day

Feels better with rest

Osteoarthritis conservative treatments
Treatments for osteoarthritis are usually conservative and may include:

Rest and non-steroidal anti-inflammatory drugs (NSAID’s) to relieve the pain from osteoarthritis and inflammation

Traction and/or chiropractic manipulations to help control chronic symptoms or provide relief for more severe episodes of pain from osteoarthritis

Although osteoarthritis tends to be chronic, the symptoms are rarely progressive and rarely require surgery.

Cervical degenerative disc disease

Disc degeneration
Cervical disc degeneration is a common cause of neck pain, most frequently felt as a stiff neck. Cervical degenerative disc disease is much less common than disc degeneration in the lumbar spine because the neck generally is subjected to far less torque and force. Nonetheless, a fall or a twisting injury to the disc space can spur degeneration, and accumulated wear and tear on the disc over time can also lead to neck pain caused by disc degeneration.

Cervical degenerative disc disease pain and symptoms
In addition to having the low-grade pain of a stiff or inflexible neck, many patients with cervical disc degeneration have numbness, tingling, or even weakness in the neck, arms, or shoulders as a result of nerves in the cervical area becoming irritated or pinched. For example, a pinched nerve root in the C6-C7 segment could result in weakness in the triceps and forearms, wrist drop and altered sensation in the middle fingers or fingertips.

Cervical disc degeneration can also contribute to spinal stenosis, and other progressive conditions, as well as a more sudden disc herniation.

Cervical degenerative disc disease diagnosis
Successful diagnosis of cervical degenerative disc disease begins with a physician reviewing the patient’s history of symptoms and performing a physical examination to measure neck extension and flexibility. During the exam, patients may be asked to perform certain movements and report whether the neck pain increases or decreases.

If a physical exam warrants further investigation, imaging studies such as X-Ray, MRI and possibly a CT scan will be taken. These diagnostic images can confirm whether and where degeneration is occurring, and can identify other conditions (such as calcification or arthritis) that could be causing the symptoms.

Cervical degenerative disc disease treatment
The general treatment is largely the same as for degenerative disc disease in the lumbar spine. That is, conservative care (no-surgical) is recommended as the primary strategy and surgery is only considered if a concerted effort at conservative care fails to provide adequate pain relief or a patient’s daily activity has been significantly compromised.

Conservative care
Patients may find relief by applying ice or heat, using medications to control pain and inflammation, and exercising the neck and shoulder areas (alone or with the help of a professional familiar with neck conditions) to relieve stiffness and maintain flexibility. In addition, neck appliances or traction may be prescribed.

Over the counter and prescription medications can provide relief. These include non-steroidal anti-inflammatories (NSAIDs) and pain relievers like acetaminophen (such as Tylenol). Prescription medications such as oral steroids, muscle relaxants or narcotic pain medications may also be used.

Exercise, specifically stretching as many dimensions of the neck as possible,is essential to maintain flexibility in the neck and relieve chronic stiffness. A specific set of exercises should be developed by a physician or physical therapist. Some exercises that could be done several times a day include:

Chin-to-chest stretch, which stretches the back of the neck

Side-to-side swivel, which involves slowly turning the head to the left and right

Eyes-to-the-sky, where a patient lifts the chin upward to stretch the front of the neck and upper thoracic area

Ear-to-shoulder stretch to extend the sides of the neck as much as possible (this can be facilitated by gently placing a hand on the head but should not involve pulling or pushing the neck and head to the shoulder)

Physical therapy or chiropractic manipulation may also provide relief by helping patients extend the neck and shoulders to increase, at least temporarily, the disc space in the affected vertebral segment

Use of a cervical collar, cervical pillows or neck traction may also be recommended to stabilize the neck and improve neck alignment so the disc compression is not exacerbated as a patient sleeps or relaxes at home

Surgery
If pain is not relieved adequately with six months of conservative care and daily activities become difficult, surgery may be considered. Specifically fusion may be recommended to stop the motion of the affected cervical vertebral segment. This entails removal of the disc, decompression of the nerve root, and insertion of a bone graft or a metal cage device to help maintain or reestablish the normal height of the disc space as well as neck stability and alignment. A cervical plate may be used to promote fusion between the two vertebrae.

Generally, a one-level fusion is done, and in rare circumstances a two-level fusion would be considered. However, patients should know that surgery for neck pain is much less reliable than surgery to relieve arm pain from cervical degenerative disc disease. Thus if the only or predominant symptom is neck pain, fusion surgery should be recommended only as a last resort and after all other treatment options have been exhausted. If a disc space cannot be identified as the probable pain generator, it is reasonable even in cases where conservative treatment has not worked well to avoid surgery.

By: Peter F. Ullrich, Jr., MD
Last updated November 2, 2006
(Originally published September 8, 1999)

Miscellaneous causes of upper extremity pain

Miscellaneous causes:

Rotator cuff tendinitis
Brachial plexus
Carpal tunnel syndrome
Cubital tunnel syndrome
Occipital neuralgia
Reflex sympathetic dystrophy
Rotator cuff tendinitis
The rotator cuff is a set of four muscles (Supraspinatus, Infraspinatus, Subscapularis, and Teres Minor) that lie over the humeral head in the shoulder that help provide shoulder stability. These muscles can become inflamed and produce shoulder pain. The pain tends to be:

Generally worse at night or after activity

Shoulder motion causes pain and is limited

More common in athletes who do a lot of throwing

More common in older individuals (over 50)

If the pain is severe, it can be difficult to distinguish between rotator cuff tendinitis and a cervical radiculopathy. In such cases, an injection of a numbing agent (such as Lidocaine) into the shoulder area can help. If the pain is completely relieved, then the cuff is probably the pain generator (not the nerve).

Tendinitis may be associated with a rotator cuff tear, which can be diagnosed with either an MRI scan or an arthrogram of the shoulder.

NSAID's medications and exercise
Treatment includes NSAID’s and physical therapy exercises to strengthen the rotator cuff. For more severe cases, a steroid injection into the shoulder can help decrease the inflammation. If a tear is present, surgery may be necessary to repair the torn muscle/tendon.

Rotator cuff tendinitis
The rotator cuff is a set of four muscles (Supraspinatus, Infraspinatus, Subscapularis, and Teres Minor) that lie over the humeral head in the shoulder that help provide shoulder stability. These muscles can become inflamed and produce shoulder pain. The pain tends to be:

Generally worse at night or after activity

Shoulder motion causes pain and is limited

More common in athletes who do a lot of throwing

More common in older individuals (over 50)

If the pain is severe, it can be difficult to distinguish between rotator cuff tendinitis and a cervical radiculopathy. In such cases, an injection of a numbing agent (such as Lidocaine) into the shoulder area can help. If the pain is completely relieved, then the cuff is probably the pain generator (not the nerve).

Tendinitis may be associated with a rotator cuff tear, which can be diagnosed with either an MRI scan or an arthrogram of the shoulder.

NSAID's medications and exercise
Treatment includes NSAID’s and physical therapy exercises to strengthen the rotator cuff. For more severe cases, a steroid injection into the shoulder can help decrease the inflammation. If a tear is present, surgery may be necessary to repair the torn muscle/tendon.

Brachial plexitis
Brachial plexitis is an inflammation of the brachial plexus. This is a rare, poorly understood condition.

After the nerve roots leave the cervical spine they combine to form the brachial plexus (a network of nerves). This plexus can become inflamed and cause arm pain. Usually the pain is severe but only lasts for several days, after which the arm becomes weak in multiple different muscles. The weakness may be profound, but will usually get better with time.

Imaging studies of the cervical spine will usually be negative, and if there is any question that the pain is from a pinched nerve root or a brachial plexus inflammation, an EMG study can help differentiate the two conditions

Treatment typically includes oral steroids, rest, and patience.

Carpal tunnel syndrome
The carpal tunnel is created by the wrist bones on the bottom and a ligament over the top. The median nerve runs through the tunnel along with the flexor tendons to the wrist. Pressure within the tunnel can compromise the nerve and lead to carpal tunnel syndrome.

The hallmark of carpal tunnel syndrome is numbness in the thumb, index and middle finger. Additional symptoms can include

Numbness that is worse at night

Weakness in the thumb muscles of the hand (in severe cases)

The condition is more common in pregnant women, middle age women, and people with jobs that include daily repetitive hand motions.

The condition is diagnosed by a Nerve Conduction Study, an electrical study that measures the length of time that it takes for a signal to cross the carpal tunnel. A delay is indicative or carpal tunnel syndrome.

Intitial treatment usually consists of NSAID’s and wrist splints (especially for use at night). If the symptoms persist, cortisone injections can be tried. If conservative measures fail, or there is evidence of nerve damage (such as weak thumb muscles or profound numbness), then the carpal tunnel can be released by surgically incising the ligament to give the nerve root more room. This procedure is a commonly performed surgery and is considered very reliable.

Cubital tunnel syndrome
Also called Ulnar Nerve Compression Syndrome, this condition is caused by compression (pinching) of the ulnar nerve as it passes through the cubital tunnel in the arm (elbow). This will produce numbness in the ring and little finger.

In severe cases, weakness of the hand muscles and the wrist flexor on the side of the arm may be present.

Cubital tunnel syndrome is not as common as carpal tunnel syndrome, and generally does not require surgical intervention.

Numbness commonly occurs at night and is related to the position of the arm.

Sleeping with the elbow flexed will raise the pressure in the cubital tunnel three times more than normal, and sleeping with the hands behind the head will raise the pressure seven times more than normal.

Straightening out the arm will relieve the numbness, and sleeping with the arm out straight helps avoid hand numbness at night.

Occipital neuralgia
Occasionally, either the C2 or C3 nerve root can get pinched as it leaves the spine. These are mostly sensory nerve roots, and if they are pinched it can cause a chronic headache. Pain is generally felt in the back of the head or the occipital region.

The headache can usually be relieved through one or a combination of conservative treatments, including:

An injection of Lidocaine/steroid around the nerve root to relieve the inflammation and numb the area

NSAID’s to relieve the inflammation

Chiropractic manipulations of the upper spine

In very severe cases (which are rare), a surgical decompression of the nerve root may be needed to relieve pressure on the nerve.

Reflex sympathetic dystrophy
Reflex sympathetic dystrophy is a complex, poorly understood condition that can result in chronic pain in the upper extremity. There is usually some traumatic event (injury or surgery) to the upper extremity that starts the pain syndrome. A pain pathway is then set up that continues on after the traumatic injury has resolved.

It is thought that this is a sympathetically mediated condition, in which overactivity in the sympathetic nerves creates constriction of the arteries that supply blood to the arm.

This pathway has not been clearly explained, but it is known that injecting the sympathetic nerves as they come out of the spine (stellate ganglion block) often relieves the pain.

Treatment is most successful if started early in the course of the disease. If it is allowed to proceed very long there can be permanent changes in the nerves and muscles that lead to chronic pain.

The treatment typically includes a combination of:

A stellate ganglion block

Medications that block the sympathetic nerves

Physical therapy (after the block and medications) to mobilize and strengthen the upper extremity.

Types of neck pain

Introduction to types of neck pain
While neck pain (in the cervical spine) is less common than lower back pain (in the lumbar spine), millions of people experience neck pain and/or related arm pain at some point in their life.

The vast majority of episodes of neck pain will get better with time and 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).

This article provides a brief introduction to the most common conditions that cause neck pain and/or arm pain, including the primary symptoms and links to more information.

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 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. Conservative 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.

For patients with neck pain that lasts longer than two weeks to three months, or with predominantly arm pain, numbness or tingling, there is often a specific anatomic abnormality causing the symptoms.

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