Cervicalgia is the medical term use to describe pain located in the back of the neck, over the cervical spine. 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.
There are multiple diseases that can lead to cervicalgia, but the three most common causes are osteoarthritis of the last cervical vertebrae, traffic accident and sports injuries, and diseases that involve muscle contracture.
What are the symptoms of Cervicalgia?
– 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.
– Upper back pain.
– Pain 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.
Common Causes of this Condition:
There are many different causes of cervicalgia. 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.
- 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 Dayton Orthopedic Surgery, we are experts in the diagnosis and treatment of orthopedic musculoskeletal problems including neck pain. We have decades 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.
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, resulting in less pain, improved function and without the risk of steroid injections or major surgeries.
Call (937) 436-5763 to schedule your consultation with Dayton’s Cervicalgia experts today.