Cervicalgia is also known as neck pain, which is an all-too-common, unpleasant pain. Read here to learn the symptoms, diagnosis, and treatment options.
We will discuss other causes for cervicalgia. What symptoms are associated with cervicalgia? How is cervicalgia diagnosed? What are the treatment options for cervicalgia?
What is Cervicalgia, aka Neck Pain?
Cervicalgia is a medical term used to describe neck pain. It is very common and affects approximately 2/3 of the population at some point in their life. Cervicalgia is the 4th major cause of disability. Risk factors include injury, prior history of neck and musculoskeletal pain, jobs that require a lot of desk work, low social support, job insecurity, physical weakness, and poor computer station setup.
Symptoms of Cervicalgia
Symptoms can vary depending on the underlying cause of cervicalgia and the severity of the injury. Common symptoms include:
- Pain in the neck region.
- Stiffness and spasm in the neck and upper shoulder muscles.
- Pain that radiates down the shoulders, arms, fingers and throughout the body.
- Numbness and tingling in the arms and fingers.
- Soreness in the neck or upper shoulder area.
- Difficulties and neck movement.
- Pain that gets worse in a stationary position.
- Shoulder pain.
- Thoracic pain or upper back pain.
- Pain solely in the arm, forearm, hand and fingers.
- Electrical shooting sensations from the neck down through the shoulders and towards the fingers.
- Numbness from the neck down into the hands and fingers.
- Weakness in one or both of arms, hands or fingers.
- Nausea, dizziness, imbalance.
- In severe cases, loss of bowel or bladder control or leg weakness.
- In severe cases, severe neurologic symptoms, dysautonomia, etc.
Atlantoaxial Instability (AAI)
Instability simply means that bones move around too much, usually due to damaged ligaments. In the spine, this can cause nerves to get banged into and joints to get damaged. In the craniocervical junction, instability can cause the upper cervical spinal nerves to get irritated, leading to headaches. In addition, the C0-C1 and C1-C2 facet joints can also get damaged. In addition, there are other nerves that exit the skull here that can get irritated, like the vagus nerve, which can cause rapid heart rate. What’s the Difference Between CCI and AAI? CCI refers to instability in any part of the craniocervical junction…
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Cervical Medullary Syndrome
Cervical Medullary Syndrome is a clinical condition that occurs as a result of inflammation, deformity, or compression of the lower part of the brain. Symptoms can be extensive with fluctuating severity based upon the extent of the underlying injury. For example, mild irritation of the brainstem may cause only mild, intermittent symptoms. The upper cervical spine and brain are complex with multiple structures. These structures reside within the skull and protective confines of the cervical spine. Neither expands to accommodate inflammation, injury, and disease. Rather the delicate tissues of the brain and spinal cord are irritated or compressed. The 4 major conditions that cause cervical medullary syndrome are…
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Common Cervical Radiculopathy symptoms include neck pain, arm pain, shoulder pain radiating down arm to fingers, numbness, tingling, and weakness. Cervical Radiculopathy is a clinical condition in which a nerve or nerves in your neck become irritated or compressed. It is also known as ” a pinched nerve,” The causes are discussed below. It can affect individuals of any age with peak prominence between ages 40-50 years of age. Cervical Radiculopathy is due to spinal nerve inflammation, irritation, or compression. The most common causes of Cervical Radiculopathy are: Disc Injury – The disc is an important shock absorber. Unfortunately, it is susceptible to injury.
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Chiari Malformation Is a medical condition where a part of the brain at the back of the skull abnormally descends through an opening in the skull. It is named after Dr. Hans Chiari who was an Austrian pathologist who in the late 1880’s studied deformities of the brain.The brain is a large structure divided into different parts that reside within the skull. Important parts of the brain called the Cerebellum and Brainstem sit at the base of the skull. The Foramen Magnum is a large hole at the base of the skull that allows the brain to join the spinal canal. The Cerebellum…
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Craniocervical Instability is a medical condition characterized by injury and instability of the ligaments that hold your head onto the neck. Common symptoms of Cranial Cervical Instability include a painful, heavy head, headache, rapid heart rate, brain fog, neck pain, visual problems, dizziness, and chronic fatigue.CCI or neck ligament laxity treatment options depend upon the severity of the instability and clinical symptoms. When appropriate, conservative care should always be the first-line treatment.
Craniocervical Instability Surgery is often recommended when conservative care fails. This involves a fusion of the head to the neck which is a major surgery that is associated with significant risks and complications…
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EDS in Children
Ehlers-Danlos Syndrome (EDS) refers to a group of disorders that affect the body’s connective tissue including skin, tendons, and ligaments. It is a hereditary disorder which means you are born with it. EDS has many different signs and symptoms which can vary significantly from patient to patient. It most commonly affects the skin, joints, and blood vessels. The estimated prevalence for all EDS varies between 1/10,000 and 1/25,000. The three most common types of EDS are: Hypermobile, Classic, and Vascular. We have used these skills and knowledge to treat the loose ligaments commonly found in EDS in children. Treatment options include bone marrow concentrate (BMC) and PRP.
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Ehlers-Danlos Syndrome (EDS)
Disorders that affect and weaken the connective tissues such as tendons and ligaments. It is a hereditary disorder which means you are born with it. EDS has many different signs and symptoms which can vary significantly depending upon the type of EDS and its severity. It most commonly affects the skin, joints, and blood vessels. Joints are typically hypermobile with excessive joint range of motion because of a defect in collagen formation. In most cases Ehlers-Danlos syndrome is inherited. That is to say that you are born with it. The two main ways EDS is inherited are: autosomal dominant inheritance and autosomal recessive inheritance…
Read More About Ehlers-Danlos Syndrome (EDS)
Facet Joint Syndrome
Injury or inflammation of the cervical facet can led to neck, shoulder and headache pain – called “cervical facet syndrome.” Cervical facet syndrome largely involves a joint in the posterior aspect of the cervical spine. It functions to provide stability and guide motion. cervical facet joint injection for cervical facet syndrome Cervical facet pain is common in patients who have sustained a whiplash injury, trauma to the neck or undergone cervical fusion. Physical examination is typically significant for restriction in range of motion along with pain. Each joint has a distinct referral pattern illustrated below. The Centeno-Schultz Clinic are experts at diagnosing and treating cervical facet dysfunction. Injury to the joint is not commonly detected by conventional radiographic studies.
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Loss of Cervical Lordosis
Normal neck curve? All of us, at one time or another, have probably been told to stand or sit up straight. The primary structure that allows us to follow that wise advice and demonstrate good posture is our spine. Likewise, when our posture is poor, this puts strain and pressure on the spine and supporting structures and can create problems down the road.
This emphasis on a straight posture may, understandably, make you envision your spine, which stretches from the base of your skull all the way down to your pelvis, as straight. However, if you could stand sideways in front of a mirror and see all the way through to the spine, a normal spine would have three gentle counterbalancing curves. If there is too much curve at any point or not enough, this can be a problem.
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Spinal stenosis is the narrowing of the central spinal canal and is a cause of significant pain and disability. Common causes of spinal stenosis include disc protrusion, facet overgrowth and ligamentum flavum thickening. Surgery is often chosen when conservative therapies fail despite the lack of convincing evidence that it is a superior treatment option. Are there alternatives to back surgery for spinal stenosis? Yes. Regenexx DDD utilizes precise platelet injections into the facets, muscles, and ligaments to treat the lumbar stenosis, treating all of the components of the issue, which is crucial. Spinal stenosis is often an age-related condition attributed…
Read More About Spinal Stenosis
The temporomandibular joint (TMJ) is the joint connection between your jaw and your skull. If you run your fingers along either side of your jaw line toward your ears, you can actually feel where the jaw bone ends and the skull bone begins. If you open and close your mouth, the difference between the two is dramatic as the jaw bone moves, thanks to the TMJ joint, while the skull bone remains stable. The TMJ and any of its surrounding structures can become painful and inflamed, and this can become so bad that it can prevent patients from even being able to move their jaw bone to chew.
Read More About TMJ
Common Causes of this Condition:
There are many different causes of neck pain. We will discuss some of the most common causes here.
Injury to the muscle (strain) typically results from overuse or traumatic injury. Muscles tend to heal very well on their own because they have a good blood supply. They can improve with conservative measures such as rest, ice, heat, physical therapy, stretching, or just time.
Ligaments are pieces of connective tissue that connect bones to other bones. They provide stability for the cervical spine. Damage or injury to the ligaments can cause excessive motion in the neck, which can lead to wear and tear on other areas of the neck such as the disks, facets nerves, etc. Ligaments could be damaged commonly with whiplash injury. When ligaments are injured, they are usually called sprains. Ligaments, in general, can heal well from minor injuries with conservative care, but anything more than a minor injury usually results in persistent problems. Ligaments do not have a good blood supply so healing on their own is more difficult. The ligaments themselves may or may not hurt but they often cause pain in the structures that they support.
Tendons are the tissue that connects muscles to the bone. The tendons can be injured in a whiplash-type injury as well. Tendons do not heal as well as muscles and are similar to the ligaments in that chronic injury to these can cause instability and stress on other structures of the neck.
Facet joints are the small joints in the back of the spine on both the left and the right sides that provide stability and limits neck rotation. They are susceptible to injury from overuse, wear and tear, arthritis or degenerative joint disease as well as traumatic injuries. Each joint can refer to pain in a specific pattern that is not necessarily exactly where the joint is located anatomically. For example, the C5-6 facet joint can typically result in pain in the shoulder and shoulder blade wing area.
Cervical Disk Injury
The disk is an important shock absorber between the bones of the neck (vertebral bodies). The disks have an inner nucleus, which is a fluid-filled portion and provides a cushion, and an outer surface called the annulus fibrosis is a strong ring of fibers that provides stability to the disk. Disk injuries can result in bulges, protrusions, and herniations, which are outpouching of the disk annulus or nucleus – which if it out pouches backward or to the sides – can irritate the spinal cord or nerve roots. That nerve irritation can send pain down into the shoulders, arms, and hands. Disk pain typically refers to the shoulder blades, depending on the location of the disk that is injured as well.
Spinal Nerve Injury/Compression
At each level of the cervical spine, a nerve exits the spinal column through the bony doorway we call foramen. That nerve root as it comes out the foramen can be irritated, compressed, or inflamed.
The facets, also when arthritic, can overgrow become thick, and cause stenosis (less space around the nerves). Bone spurs can form in the neck from injuries or stress to the bones causing stenosis. Weak and thickened ligaments, such as a thickened ligamentum flavum from excessive wear and tear and injury can cause less space around the spinal cord. These commonly cause electrical or radiating pain from the neck down the arms. Numbness or weakness may occur.
The neck is a series of bones stacked upon one another with disks between, facet joints in the back part and they protect the spinal cord and nerves. For proper stability and function of the neck, the joints, the ligaments, the muscles, the tendons, and the disks must all be appropriately aligned and working in synchrony to keep the neck aligned and stable. Unfortunately, in our more technologically advanced world, we spend a lot of time sitting looking at the computer screens, tablets, cell phones, and that compromises the normal alignment of all these supporting structures. As a result, the neck can lose its natural curve and over time put stress on all the above-mentioned areas and neck pain can develop.
Neck Stress and Psychological Issues
Stress, anxiety, psychological problems can cause a lot of muscle tension in the neck and upper shoulders. If this persists over time without adequate relaxation techniques, this can also alter the alignment and position of the neck resulting in pain, stiffness, and irritation to the above-mentioned structures.
Common Treatments for This Condition
There are treatments for cervicalgia from conservative to the more invasive, like surgery or disc replacement. It is essential to treat the underlying causes of cervicalgia. Conservative measures are used as the first line of treatment when appropriate and can progress to more invasive treatments as necessary. Rarely, sometimes surgery is the only option.
- Rest, heat, ice, anti-inflammatory supplements such as fish oil and turmeric.
- Physical therapy.
- Chiropractic care.
- Medications such as such as nonsteroidal anti-inflammatory medications.
- working on good posture and neutral spine alignment, appropriate ergonomics at work station
- Yoga poses or other modalities that focus on alignment such as Tai Chi, etc.
- Injection-based treatments with steroids
If conservative measures fail, then many patients may be offered a steroid injection with a local anesthetic. That may help diagnose if the pain may be coming from a particular facet joint or nerve and can provide some temporary pain relief. Unfortunately, these steroids have toxicity to cartilage and other orthopedic tissues including bones, and have to be used with caution. These typically only provide short-term pain relief.
Another injection-based option is a nerve block that will just temporarily block the nerve sensation telling your body that a particular neck joint hurts. Again, this would be a temporary relief neck that can be used to diagnose some joint pain and also progress to a more invasive procedure where the actual nerve is burning or bleeding.
Sometimes surgery can be recommended for certain disk/spine or nerve injuries if conservative measures fail. The most common type of surgery for neck problems is core decompression and fusion surgery. In this procedure, the doctor can come from the front or the back of the neck and remove disk material, replace it with bone or a spacer and fuse the cervical bones together with screws and plates. Sometimes remove any bone spurs that may be impinging on the nerve.
Fusion is certainly a big surgery with much higher risks than injections and can be associated with significant complications. Typical complications can include infection, nerve injury, failure of the bones to fuse, and hardware misplacement.
Also, if the surgery does go well, it is almost a guarantee that in 2-5 years, patients will develop adjacent segment disease. This is a condition where additional pressure was placed on the disk and facets above and below the fusion, so this would cause added pain and problems in those areas. Often then can lead to more surgeries.
Surgery is definitely needed if there is some spinal cord or actual nerve root injury. However, if this is not the majority of cases. To use surgery only to treat pain should only be a last resort option.
At the Centeno-Schultz Clinic, we are experts in the diagnosis and treatment of orthopedic musculoskeletal problems including neck pain. We have 15 years of experience treating various neck problems such as the disk, facets, ligaments spinal nerves, tendons, etc. commonly with a patient’s own PRP or bone marrow concentrate containing stem cells. In 2005, we were the first clinic in the world to inject stem cells into disks and we have been extensively using regenerative methods such as PRP and bone marrow concentrate containing stem cells that contain growth factors that can improve the blood flow, reduce inflammation accelerate healing and repair musculoskeletal tissues, thus resulting in less pain, improved function and without the risk of steroid injections or major surgeries. Our registry data had shown positive results from this approach.
Who is at Risk for Experiencing Cervicalgia?
- Neck problems can persist as we get older.
- Jobs that involve a lot of repetitive neck motions, awkward positions or holding in a steady position or looking at computer screens can put extra stress on the neck.
- Injuries such as motor vehicle accidents, trauma or falls, etc. can increase the risk of cervicalgia.
- Some people have genetic factors that predisposed them some more cervical spinal problems over time.
- Smoking can be linked increased neck pain by inhibiting blood flow to structures that already do not get a lot of blood flow.
Reducing the Risks & Prevention of Cervicalgia
- To reduce the risk of cervicalgia, you should always be mindful of her posture of the neck. Perhaps, working with a physical therapist or a skilled postural therapist can be helpful. Egoscue is a great method to help with this as well.
- If you work at a computer often, making sure to set up an ergonomic chair a desk and computer set up.
- Addressing early signs of cervicalgia before they become too severe and require more invasive methods of treatment.
- Avoidance of smoking and practice and stress management techniques can help as well.
Cervicalgia is typically diagnosed initially by taking a detailed history and physical examination. The doctor will examine neck range of motion, tender spots, stability testing, perform a full neurologic examination, etc. Sometimes imaging is ordered such as x-rays, MRI, CT scan if surgery is warranted and sometimes a specialized x-ray called a digital motion x-ray that does a great job of looking at instability. Sometimes specific nerve conduction tests can be performed as well.
DON’T TAKE NECK PAIN LIGHTLY, GET YOURSELF CHECKED NOW:
Neck pain is a progressive condition that can continue to worsen over time if you do not take action. Taking pills and hoping that it will go away is not effective. Dependence on medication also poses significant risks, including increasing your risk for heart attack, GI bleed, kidney and liver problems, and dependence or addiction. Diagnosing the problem early allows for easier less invasive treatment options to help you. Reparative injections such as those we specialize in at the Centeno-Schultz clinic work well to help cervicalgia, are not helped by conservative therapy alone and possess little risks. Schedule an in-person or telemedicine consultation with a musculoskeletal board-certified fellowship-trained physician and learn about your regenerative treatment options. Act now while the issue is small and treatment is available.
You want to get your life and level of activity back to normal as soon as possible.
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