Acute Neck Injury (no fracture)
Acute Neck Injury (no fracture) → Pain and restricted movement, but radiology excludes fracture. Very common: ~1 in 10 adults experience neck pain during their lifetime.
⚡ Common Causes
- 💻 Repetitive Strain Injury – prolonged posture (e.g. desk work, keyboard use) → muscle tension + strain.
- 🚗 Whiplash – after road traffic accidents or falls.
Symptoms: neck pain, occipital headache, stiffness, ± swelling.
– Imaging usually normal.
– Recovery varies; pain may persist up to 12 months.
– 🔎 Longer recovery sometimes associated with compensation claims (“secondary gain”).
- 🧠 Cervical Radiculopathy – nerve root irritation/compression, commonly C6–T1.
– Presents with radiating arm pain, paraesthesia.
– ⚠️ Always perform full neurological exam to exclude motor/sensory deficit.
🔎 Investigations
- 🩻 Cervical Spine X-ray – to rule out fracture.
- 🖥️ CT Cervical Spine if:
- High-impact trauma (RTA, fall from height, axial load).
- Neurological deficit (weakness, numbness).
- Persistent severe pain despite conservative care.
- Inconclusive/poor-quality X-ray.
- Canadian C-Spine Rule positive (e.g. age >65, dangerous mechanism, paraesthesia in extremities).
🛠️ Management
- ⏳ Time & reassurance – most improve within days–weeks.
- 💊 Analgesia – paracetamol, NSAIDs first-line.
- 🚫 Muscle relaxants – not routinely helpful.
- 💉 Opiates (short course) – e.g. tramadol, 3–5 days if severe.
- 🧑⚕️ Physiotherapy – if symptoms persist beyond 2–3 weeks → improves mobility, prevents chronicity.
- 🦺 Cervical collars – not recommended; may delay recovery.
💡 Clinical pearl:
Always screen for “red flags” → neurological deficit, progressive weakness, incontinence, or systemic features (infection, malignancy). These mandate urgent imaging & senior review.
