Neck Pain

<中文版>

Neck pain is a generalized term describing pain at the neck region. It could be local tenderness or pain associated with movements.

Definition:

Neck pain is a generalized term describing pain at the neck region. It could be local tenderness or pain associated with movements.

Symptoms and signs:

Patient sometimes presents with sudden onset of neck pain on waking up. The pain is so severe that it limits neck movements. Such pain is often referred to wry neck. Some patients may present with chronic neck pain associated with certain particular neck movements. Sometimes the pain may refer to upper limbs. Clinicians should be aware of the red flag symptoms, such as upper limb numbness or weakness, history of high impact injury, history of malignancy, history of rheumatoid arthritis, patient taking steroid, neck pain lasting more than 1 month and patient older than 50 year old.

Before examining the neck, shoulder joints shall be screened for abnormalities. Very often, clinician finds that neck pain is, in fact, part of the symptoms of shoulder joint problems as an unstable shoulder requires stabilization from and hence straining the adjacent neck muscles. Overactive of deltoid, levator scapulae, upper trapezius or scalene muscle may cause localized trigger point with radiating pain to the upper limb or neck. After excluding shoulder pathologies, neck movements will be examined and their range of motion should be documented so that comparison can be made before and after treatment. Neck muscles will then be examined for trigger points. Segmental examination of cervical joints is important to find out any segmental dysfunction. Spurling’s test is a sensitive screening test for cervical radiculopathy. Neurological examination may be necessary to rule out any neurological deficits.

Cause and biomechanics considerations:

Neck pain may be caused by much different pathologies. Neck pain can be originated from localized pathology from bony structures, ligament injury, apophyseal joint problems, nerve entrapments, cervical radiculopathy or as referred pain radiated from nearby structures. Apart from localized causes, it can be part of generalized syndromes, such as rheumatoid arthritis, fibromyalgia or polymyalgia rheumatica. Mechanically, neck pain can be caused by faulty biomechanics as a result of poor posture, inappropriate ergonomic settings, forward drawn head, excessive use of accessory respiratory muscles or from postural abnormality as a result of leg length discrepancies, kyphoscoliosis or weak core muscles.

Investigations:

Often the cause of neck pain can be identified after careful clinical examination. However, for patient with red flag symptoms or neurological signs, X-ray study or MRI imaging may be necessary. If inflammatory diseases are suspected, blood tests for rheumatoid or auto-immune diseases screening should be ordered.

Treatment:

Treatment depends on symptoms and signs of the patient. The aims are to control symptoms, improve motions, correcting biomechanical abnormalities and return to normal daily activities. Analgesics often are required to control pain. Soft neck collar sometimes may help to limit the neck movement and tie the patient off the acute pain period. If muscle trigger points are identified, they should be released with appropriate therapy. Prescribed exercises are indispensible to improve the stability and to retrain the weaken muscles. If the neck pain is chronic from ligament or tendon tears, musculoskeletal physicians may offer prolotherapy to trigger tissue repair. Occasionally, surgery is required to decompress the cervical nerve roots and stabilize the injured cervical spine.

頸痛

頸痛泛指頸部的疼痛，可以是局部壓痛或與頸部活動相關的疼痛。

定義:

頸痛泛指頸部的疼痛，可以是局部壓痛或與頸部活動相關的疼痛。

症狀與表徵:

患者有時醒來頸痛突發，嚴重時頸部活動可受限而引致頭部轉動困難，俗稱落枕。有時頸痛是指某些頸部動作相關的慢性疼痛。頸痛有時亦可轉移到上肢。臨床醫生應注意警惕症狀，例如上肢麻木或無力，頸痛超過一個月，高撞擊創傷、有惡性腫瘤或類風濕性關節炎病史，正在服用類固醇，年齡大於50歲等等。

在檢查頸部之前，首先篩查肩關節有無異常。臨床很多時發現所謂頸痛其實只是肩關節問題的部分表現：為了使不穩定的肩關節保持穩定，三角肌、肩胛提肌、斜方肌上部或斜角肌需額外工作，過勞時引起激痛點並產生放射痛到上肢或頸部。在排除肩部問題後，再檢查頸部活動情況並記錄活動範圍以便做治療前後的對比。然後尋找頸肌的激痛點及頸椎的節段性功能障礙。以Spurling's test篩查頸神經根痛是一項敏感度高的方法。如懷疑有其它神經系統的問題，必須進行相關檢查。

病因及生物力學因素:

頸痛可由多種不同病理因素引起。局部原因可以是頸部的骨、韌帶損傷，骨突關節問題，神經卡壓或頸神經根病變造成；也可以是由鄰近組織產生的轉移痛。除局部原因外，頸痛還可以是全身症狀的一部分，如類風濕性關節炎，纖維肌痛症或風濕性多肌痛等。從生物力學來講，頸痛可因姿勢不良、採用不符合人體工學的設置、工作時頭部長時間向前伸探，過度使用呼吸輔助肌等等所引致。下肢不等長、脊柱側後彎及核心肌群肌力弱等亦可導致不正常姿勢而引發頸痛。

檢驗:

頸痛的病因多數可通過詳細的臨床檢查確定。然而，對於有警惕症狀的患者則必須進行X光或磁力共振（MRI）檢查。若懷疑炎性疾病則要進行有關類風濕或自身免疫性疾病的血液化驗。

治療:

頸痛所用的治療方法取決於患者的症狀和表徵。治療目的是控制症狀、改善功能、糾正生物力學問題及使患者可進行正常的日常生活。止痛方面通常都會使用止痛劑。急性期有時會用軟頸箍限制頸部活動以保護頸部。若肌內有激痛點，應該用適當的方法將其消除。處方運動治療是改善肌群的穩定性及強化肌群力量不可缺少的方法。至於由韌帶、肌腱撕傷導致的慢性頸痛，可用保絡療法激發組織的修復以達治療目的。偶而也會需要手術解除頸神經根的壓迫和固定受傷的脊椎。