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Neck Pain
Studies show that approximately fifty percent of the population has evidence of degenerative changes in their cervical spine by the age of fifty. These changes happen because the discs that act as shock absorbers between the vertebral bodies of the cervical spine wear out, as we grow older. As the intervertebral disks wear out, they begin to collapse, or herniate, and become less flexible. The common causes of neck pain and cervical disorders include arthritis, injuries, and trauma. In some situations neck pain can also be a warning sign of something more serious such as spinal cord compression, a tumor, or spinal infection. Patients suffering from neck, shoulder, head or arm pain should be examined by a doctor or physician assistant. At the Center for Spine Care, we are dedicated to finding the source of your neck or arm pain. Once a diagnosis is made, Treatment Options will be reviewed. Choose from the following categories to learn more about what can cause Neck Pain:
Anatomy of the Cervical SpineWhat exactly is the spine?
The spinal column has three main sections-the cervical spine, the thoracic spine, and the lumbar spine. The first seven vertebrae form the cervical spine. The mid back, called the thoracic spine, consists of 12 vertebrae. The lower portion of the spine, called the lumbar spine, is usually made up of five vertebrae. However some people have a sixth lumbar vertebra. The normal spine has an "S"-like curve when looking at it from the side. This allows for an even distribution of weight. The "S" curve helps a healthy spine withstand all kinds of stress. The cervical spine curves slightly inward, the thoracic slightly outward, and the lumbar slightly inward. Even though the lower portion of your spine holds most of the body's weight, each segment relies upon the strength of the others to function properly. Cervical Spine (Neck)
Unlike the rest of the spine, there are special openings in each vertebra in the cervical spine for arteries (blood vessels that carry blood away from the heart). The arteries that run through these openings bring blood to the brain. Two vertebrae in the cervical spine, the atlas and the axis, differ from the other vertebrae because they are designed specifically for rotation. These two vertebrae are the reason your neck can move in so many directions. The atlas is the first cervical vertebra-the one that sits between the skull and the rest of the spine. The atlas does not have a vertebral body, but it does have a thick forward (anterior) arch and a thin back (posterior) arch with two prominent sideways masses. The atlas sits on top of the second cervical vertebra, the axis. The axis has a bony knob called the odontoid process, which sticks up through the hole in the atlas. Special ligaments between the atlas and the axis allow for a great deal of rotation. It is this special arrangement that allows the head to turn from side to side as far as it can. The cervical spine is very flexible, but it is also very much at risk for injury from strong, sudden movements, such as whiplash-type injuries. This high risk of harm is due to the limited muscle support that exists in the cervical area, and the fact that this part of the spine has to support the weight of the head-an average of 15 pounds. This is a lot of weight for a small, thin set of bones and soft tissues to bear. Sudden, strong head movements can cause damage. Thoracic Spine (Mid Back)
Lumbar Spine (Low Back)
The lumbar spine's shape has a lordotic curve-shaped like a backward "C". If you think of the spine as having an "S"-like shape, the lumbar region would be the bottom of the "S". The vertebrae in the lumbar spine area are the largest of the entire spine. The lumbar spinal canal is also larger than in the cervical or thoracic parts of the spine. The size of the lumbar spine allows for more space for nerves to move about. Low back pain is a very common complaint for a simple reason. Since the lumbar spine is connected to your pelvis, this is where most of your weight bearing and body movement takes place. Typically this is where people tend to place too much pressure, such as when lifting up a heavy box, twisting to move a heavy load, or carrying a heavy object. These activities can cause repetitive injuries that can lead to damage to the parts of the lumbar spine. Important Structures of the Spine
The vertebral body is the large, round portion of bone. Each vertebra is attached to a bony ring. When the vertebrae are stacked one on top of the other, the rings create a hollow tube for the spinal
cord to pass through. Each vertebra is held to the others by groups of
ligaments. Ligaments connect bones to bones; tendons connect muscles to bones.
There are also tendons that fasten muscles to the vertebrae. The bony ring attached to the vertebral body consists of several parts. The laminae extend from the body to cover the spinal canal, which is the hole in the center of the vertebra. The spinous process is the bony portion opposite the body of the vertebra. You feel this part if you run your hand down a person's back. There are two transverse processes (little bony bumps), where the back muscles attach to the vertebrae. The pedicle is a bony projection that connects the laminae to the vertebral body. Between each vertebra is a soft, gel-like cushion, called an intervertebral disc. These flat, round "cushions" act like shock absorbers by helping absorb pressure. The discs prevent the bones from rubbing against each other. Each disc has a strong outer ring of fibers called the annulus, and a soft, jelly-like center called the nucleus pulposus. The annulus is the strongest area of the disc. It helps keep the disc's center intact. The annulus is actually a strong ligament that connects each vertebra together. The mushy nucleus of the disc serves as the main shock absorber. The nucleus is made up of tissue that is very moist because it has high water content. The water content is what helps the disc act like a shock absorber-somewhat like a waterbed mattress.
The spinal column has real joints (just like the knee, elbow, etc.) called facet joints. The facet joints link the vertebrae together and give them the flexibility to move against each other. The facets are the "bony knobs" that meet between each vertebra. There are two facet joints between each pair of vertebrae, one on each side. They extend and overlap each other to form a joint between the neighboring vertebra facet joint. The facet joints give the spine its flexibility. The facet joints are synovial joints, structures that allow movement between two bones. The ends of the bones that make up a synovial joint are covered with articular cartilage, a slick spongy material that allows the bones to glide against one another without much friction. Synovial fluid inside the joint keeps the joint surfaces lubricated, like oil lubricates the parts of a machine. This fluid is contained inside the joint by the joint capsule, a watertight sac of soft tissue and ligaments that fully surrounds and encloses the joint. Neural Foraminae
The spinal cord is a column of millions of nerve fibers that carries messages from your brain to the rest of your body. It extends from the brain to the area between the end of your first lumbar vertebra and top of your second lumbar vertebra. Each vertebra has a hole in the center, so when they stack on top of each other they form a hollow tube (spinal canal) that holds and protects the entire spinal cord and its nerve roots. The spinal cord only goes down to the second lumbar vertebra. Below this level, the spinal canal contains a group of nerve fibers, called the caude equina. This group of nerves goes to the pelvis and lower limbs. A protective membrane, called the dura mater covers the spinal cord. The dura mater forms a watertight sac around the spinal cord and the spinal nerves. Inside this sac, the spinal cord is surrounded by spinal fluid. The nerve fibers in your spinal cord branch off to form pairs of nerve roots that travel through the small openings between your vertebrae. The nerves in each area of the spinal cord connect to specific parts of your body. This is why damage to the spinal cord can cause paralysis in certain areas and not others. It depends on which spinal nerves are affected. The nerves of the cervical spine go to the upper chest and arms. The nerves of the thoracic spine go to the chest and abdomen. The nerves of the lumbar spine reach to the legs, pelvis, bowel, and bladder. These nerves coordinate and control all the body's organs and parts, and allow you to control your muscles. The nerves carry electrical signals back to the brain that allow you to feel sensations. If your body is being hurt in some way, your nerves signal the brain. Damage to the nerves themselves can cause pain, tingling, or numbness in the area where the nerve travels. Without nerve signals, your body would not be able to function. 
The muscles next to the spine are called the paraspinal muscles. They support the spine and provide the motor for movement of the spine. Joints allow flexibility, and muscles allow mobility. There are many small muscles in the back. Each controls some part of the total movement between the vertebrae and the rest of the skeleton. These muscles can be directly injured, such as when you have a pulled muscle or muscle strain. They can also cause problems indirectly, such as when they are in spasm after injury to other parts of the spine. A muscle spasm is experienced when your muscle tightens up and will not relax. Spasms usually occur as a reflex (meaning that you cannot control the contraction). When any part of the spine is injured-including a disc, ligament, bone, or muscle-the muscles automatically go into spasm to reduce the motion around the area. This mechanism is designed to protect the injured area. Muscles that are in spasm produce too much lactic acid, a waste product from the chemical reaction inside muscle cells. When muscles contract, the small blood vessels traveling through the muscles are pinched off (like a tube pinched between your thumb and finger), which causes a build up of lactic acid. If the muscle cells cannot relax and too much lactic acid builds up, it causes a painful burning sensation. The muscle relaxes as the blood vessels open up, and the lactic acid is eventually washed away by fresh blood flowing into the muscle. 
Doctors sometimes look at a spinal segment to understand and explain how the whole spine works. A spinal segment is made up of two vertebrae attached together by ligaments, with a soft disc separating them. The facet joints fit between the two vertebrae, allowing for movement, and the neural foraminae between the vertebrae allow space for the nerve roots to travel freely from the spinal cord to the body. The spinal segment allows physicians to examine the repeating parts of the spinal column to understand what can go wrong with the various parts of the spine.
Cervical Radiculopathy (Pinched Nerve)When a nerve root leaves the spinal cord and the cervical spine, it travels down into the arm. Along the way, each nerve supplies sensation (feeling) to a part of the skin of the shoulder and arm and supplies electrical signals to certain muscles to move part of the arm or hand. When a nerve is irritated or pinched - by either a bone spur or part of the intervertebral disc - it causes the nerve not work properly. This shows up as: weakness in the muscles the nerve goes to, numbness in the skin where the nerve goes, or pain in the area where the nerve travels. This condition is called cervical radiculopathy. Degenerative Disk Disease
Studies show that approximately fifty percent of the population has evidence of degenerative changes in their cervical spine by the age of fifty. These changes happen because the discs that act as shock absorbers between the vertebral bodies of the cervical spine wear out, as we grow older. As we age, the disc loses some of its water content and, as a result, some of its shock absorbing ability. Like the marshmallow, the first changes that occur in the disc are tears in the outer ring of the disc, called the annulus. Tears in the annulus may occur without symptoms. Therefore, you may not notice when they occur or what caused them. These tears heal by forming scar tissue. Scar tissue is weaker than normal tissue. Repeated injuries and tears cause more wear and tear to the disc. As the disc wears, it loses more of its water content. It becomes less and less "spongy", eventually no longer able to act as a shock absorber. As the disc continues to wear, it begins to collapse. The space between each vertebra becomes smaller. The collapse also affects the way that the facet joints in the back of the spine "line up". Like any other joint in the body, the change in the way the bones fit together causes abnormal pressure on the articular cartilage. Articular cartilage is the smooth shiny material that covers the end of the bones in any joint. Over time, this abnormal pressure causes wear and tear arthritis (osteoarthritis) of the facet joints. Bone spurs may form around the disc and facet joints. It is thought that too much motion in a spinal segment causes the bone spurs to form. Eventually, bone spurs can form around the nerves of the spine, causing a condition called spinal stenosis. Degenerative disc disease can cause bone spurs to form around the nerve roots. This usually occurs inside the foramen - the opening in the cervical spine where the nerve root leaves the spine to travel into the arm. If these bone spurs get large enough, they may begin to rub on the nerve root and irritate it. This causes the same symptoms as a herniated disc. The irritation causes: pain to run down the arm, numbness to occur in the areas to which the nerve provides sensation and weakness in the muscles that the nerve supplies. Fractures and DislocationsFractures and dislocations of the cervical spine demand early and accurate diagnosis so that treatment can quickly be introduced in order to produce a painless, stable neck and prevent pressure on the spinal cord and/or nerves. When the neck is injured in very violent accidents, the bones in the neck can be broken or pulled forcefully out of normal alignment. Fractures and dislocations of the cervical spine are very serious injuries because there is the potential for damage to the spinal cord if the patient is not taken care of very carefully. Herniations
Intervetbral discs act as shock absorbers between the vertebral bodies of the cervical spine. These structures can be damaged during an accident, trauma or during activities of daily living. Injury to the disc may occur when neck motion puts too much pressure on the disc. One of the most painful injuries that can occur is a herniated disc. When a herniation occurs, the material in the center of the disc, called the nucleus pulposus, is pushed out through the fibrous outer ring like structure of the disk called the annulus fibrosis. A herniated disc can put pressure on the spinal cord or nerves to the arms and legs. Pressure on the nerve root from a herniated disc can cause pain, numbness, and weakness along the nerve. There is also evidence that the chemicals released from the ruptured disc may irritate the nerve root, leading to some of the symptoms of a herniated disc - especially pain. In situations when a disc ruptures very quickly, as in the case of an accident, then the nerve does not have any time to adjust to the increased pressure and it may stop working. Herniated discs are more common in early, middle-aged adults. A herniated disc may occur in a disc that has been weakened by the degenerative process. Once weakened, less force is needed to cause the disc to tear or rupture. However, not everyone with a ruptured disc has degenerative disc disease. Likewise, not everyone with degenerative disc disease will suffer a ruptured disc.
InfectionsInfections of the cervical spine are rare, if they are neglected for a period of time, or if there is a delay in diagnosis, they can become a significant source of pain and disability. Bone and joint infections anywhere in the body can be crippling and life threatening, and infections in the cervical spine are no exception. Juvenile Rheumatoid Arthritis Juvenile Rheumatoid Arthritis is a type of inflammatory arthritis
that affects almost 200,000 children in the United States. JRA is a disease
that causes painful, swollen, and stiff joints in children, most commonly
in large joints like the knee. JRA has three well-defined subsets: a monoarticular
form, which means that that the disease affects only
one joint; a polyarticular form, which means that it affects many joints,
and a systemic form, which means that it affects other organs in the body
besides the joints. The systemic form of the disease is most often associated
with high fevers and rash, in addition to arthritis. The polyarticular
and systemic forms of the disease are the two types that commonly affect
the cervical spine. Doctors use the term "malignant" to indicate that a particular tumor or a cancer often spreads to other parts of the body, and can be difficult to cure or treat. This is very different from "benign" cancers, which are much less likely to spread, are easier to treat and control. Mechanical Neck PainA chronic neck ache where the pain stays mainly in the neck may be the result of degenerative disc disease and arthritis of the facet joints of the cervical spine. Doctors sometimes refer to this type of pain as mechanical pain. This term is used because it gets worse when we use our neck more and seems to be coming from the parts of the cervical spine - the mechanical parts that allow us to move our head around and up and down. This type of pain does not come from pinched, or irritated, nerves. The pain seems to come from the inflamed facet joints and from the degenerated disc. As the disc and facet joints become more inflamed when we use our neck to move our head, the muscles around the cervical spine begin to spasm. You can think of a muscle spasm similar to a muscle cramp. Muscles that are cramping eventually cause pain. The spasm occurs as the body's response to try to stop the movement in the cervical spine. Muscle StrainA "muscle strain" of the neck is a common diagnosis given when a patient presents a stiff neck. In some cases, this may represent a true "muscle strain", or "pulled muscle" involving the muscles around the spine of the neck. However, muscle spasm is a common symptom that can result when other areas of the neck are injured. Problems that are commonly referred to as a muscle strain may also involve injury of other soft tissues of the neck including: the disc, the ligaments around the spinal segment, and the muscles. Injury to any, or all, of these structures may cause similar symptoms. Rheumatoid ArthritisRheumatoid Arthritis is among the most debilitating forms of arthritis causing joints to ache, throb and even deform over time. The exact cause of this inflammatory condition is not known, but it is believed to be caused by an attack on the synovium (tissue that lines the joints) by the body's immune system. The upper cervical spine can be damaged by the inflammation that is caused by rheumatoid arthritis. This disease is three times more common in women than in men and usually occurs between the ages of 20 and 50. Just like the gradual destruction of other joints in the body, several joints between the base of the skull and uppermost vertebral bodies in the cervical spine are very susceptible to damage from rheumatoid arthritis. Spinal Stenosis (Cervical Myelopathy)
Perhaps the most serious of the problems caused by degeneration of the spinal segment in the cervical spine is the condition of spinal stenosis. In the late stages of spinal degeneration, bone spurs from the degenerative process can cause a condition known as spinal stenosis. As the bone spurs form, the size of the spinal canal becomes smaller. The bone spurs begin to press on the spinal cord or the nerve roots. Pressure on the nerves in the spinal cord can cause numbness, tingling, or pain in the arms, hands, and legs. This condition is sometimes called cervical myelopathy and is different from the simpler problem where only one nerve root is being pinched by a herniated disc or a bone spur. When there is narrowing of the spinal canal (the bony tube where the spinal cord runs), the whole spinal cord may be affected. This is different than when the bone spurs only narrow one of the foramen (the openings where the nerve roots exit). The symptoms are much different. A pinched nerve from either a herniated disc or a bone spur rarely affects the legs. Cervical myelopathy can affect both the arms and the legs. Spinal Cord InjuriesCervical spine injuries can occur during motor vehicle accidents, in rough contact sports, after a fall, or by hitting your head against a hard surface, such as when diving into a pool that is too shallow. These accidents can cause injuries that range from mild cases of neck pain, called whiplash, to injuries that can cause paralysis of the rest of the body below the level of injury. Each year in the United Sates, there will be approximately 50,000 new spinal cord injuries caused by accidents. A spinal cord injury occurs when the cord itself is crushed, stretched, or torn by the accident. Unfortunately, this is still an injury that can not be reversed or cured by modern medicine. More than half of these injuries involve the cervical spine, and most of them happen to young men. These injuries are incredibly devastating to the patient, their families, and also to their communities. There is currently a lot of research being done on ways to minimize spine injuries by designing cars for better safety, improving protective gear like football helmets, and educating people about the dangers of certain activities. There is also a lot of research being done on how to care for someone immediately after they have had a spinal cord injury, and also what kind of rehabilitation is best for them. Tumors
Tumors of the spine and spinal cord are relatively uncommon. The most common initial symptom that patients with a spinal tumor have is pain. Because neck pain, and pain caused by a cervical (neck) disorder is very common, it is also not a specific symptom of any one disease or medical condition. Spinal cord tumors can be either primary (originating in the spinal cord) or secondary (metastases of cancer that originated elsewhere in the body). Luckily, most neck pain is not due to a tumor. Doctors use the term "benign" to indicate that a particular tumor is unlikely to spread to others parts of the body. Benign tumors can still be a significant problem however, depending upon their location, size, adjacent structures, blood supply, and other factors. Fortunately, most benign tumors can be treated successfully. WhiplashWhiplash is the common term used for a hyperextension injury to the neck. Though the neck is a very flexible structure, it can be injured when the weight of the head exceeds the neck's ability to control its motion. The injury usually happens when the head is suddenly jerked back and forth beyond its normal limits during a car accident, rough contact sports, or a fall. This jerking motion can cause over-stretching and tearing of the neck muscles and ligaments and can cause the discs between the neck vertebrae to bulge, tear or rupture. |
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Neck pain and symptoms caused by a cervical (neck) spine disorder are a very
common problem for many adult Americans. The cervical spine is composed
of many different anatomic structures, including muscles, bones, ligaments,
and joints. Each of these structures has nerve endings that can detect
painful problems when they occur. The different parts of the cervical
spine are normally well balanced and able to handle all of the movements,
stresses, and strains of the body gracefully. However, when the different
parts of the cervical spine are injured or start to wear out, your neck
can be a significant source of pain and discomfort.
The spine is made up of 24 bones, called vertebrae. Ligaments and muscles connect these bones together to form the spinal column. The spinal column gives the body form and function. The spinal column holds and protects the spinal cord, which is a bundle of nerves that sends signals to other parts of the body. The many muscles that connect to the spine help support the upright posture of the spine and move the spine.
The
cervical spine is made up of the first seven vertebrae in the spine. It starts just below the skull and ends just above the thoracic spine. The cervical spine has a lordotic curve, a backward "C"-shape-just like the lumbar spine. The cervical spine is much more mobile than both of the other spinal regions. Think about all the directions and angles you can turn your neck.
The
thoracic spine is made up of the middle 12 vertebrae. These vertebrae connect to your ribs and form part of the back wall of the thorax (the ribcage area between the neck and the diaphragm). The thoracic spine's curve is kyphotic, a "C"-shaped curve with the opening of the "C" in the front. This part of the spine has very narrow, thin intervertebral discs. Rib connections and smaller discs in the thoracic spine limit the amount of spinal movement in the mid back compared to the lumbar or cervical parts of the spine. There is also less space inside the spinal canal.
The lowest part of the spine is called the 
The spinal cord branches off into 31 pairs of nerve roots, which exit the spine through small openings on each side of the vertebra called neural foraminae. The two nerve roots in each pair go in opposite directions when traveling through the foraminae. One goes out the left foramina; the other goes out through the right foramina. The nerve root allows nerve signals to travel to and from your brain to the rest of your body.;void('')){kind=link}
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