Soft-Tissue Neck Trauma
Clinical Monograph 15
By R. C. Schafer, DC, PhD, FICC
The mechanical relationship between the head and neck has been crudely compared to a brick attached to a flexible rod. As the structural mass of the head is so much greater than that of the neck, it is no wonder that injuries of the neck are so prevalent. Even the person with a short neck and well-developed neck muscles and ligaments is not free of potential injury.
The viscera of the neck serve as a channel for vital vessels and nerves, the trachea, esophagus, and spinal cord, and as a site for lymph and endocrine glands. When the head is in balance, a line drawn through the nasal spine and the superior border of the external auditory meatus will be perpendicular to the ground.
Anterior injuries are more common to the head and chest as they project further forward, but a blunt blow from the front on the head or chest may cause an indirect extension or flexion injury of the cervical spine and soft tissues of the neck. In any neck injury, the injury may not be the product of a single force. For example, while extension, flexion, and lateral flexion injuries are often described separately, rotational, compressive, tensile, and shearing forces are invariably part of the picture.
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The anterior and lateral aspects of the neck contain a variety of vital structures that have no bony protection. Partial protection is provided by the cervical muscles, the mandible, and the shoulder girdle.
After neck injury, a careful neurologic evaluation must be conducted, and every examination should begin with a thorough case history. See Table 1. Note any signs of impaired consciousness, inequality of pupils, or nystagmus. Do outstretched arms drift unilaterally when the eyes are closed? Standard coordination tests such as finger-to-nose, heel-to-toe, heel-to-knee, and for Romberg s sign should be conducted, along with superficial and tendon reflex tests.
Table 1 Typical Questions Asked During the Investigation of Joint Pain
What seems to be the matter?
What do you think caused it?
Where exactly does it hurt?
Does it always hurt there?
Does the pain feel sharp, dull, burning, tingling, boring, or what?
Does it feel deep inside or near the surface?
Does its quality or intensity ever change?
Is it constant or does it come and go?
Does the pain seem to start at one place and spread to another?
Do you notice other things at the time the pain is severe?
When did the pain first arise?
Did it first occur gradually or rapidly?
Was an injury or some unusual activity involved?
At what time of day is the pain worse?
At what time of day is the pain better?
How long have you suffered with this condition?
Have you ever had this condition before and it appeared to go away?
If so, what did you do for it?
Does anything seem to participate an attack?
What aggravates the pain?
What relieves the pain?
What home remedies have you tried and what were their effects?
How has this problem affected your work, activities, or sleep?
How is your health otherwise?
Are you presently being treated for any other condition?
Are you taking any drugs or medications?
What illnesses have you had in the past?
What injuries have you had in the past?
Has anybody else in your family had a condition similar to this?
Do you have any opinion on what might have caused this problem?
Is there anything else you would like to add?
Note: Many of these questions would be pertinent to a complaint other than pain.
GENERAL ASPECTS OF NECK STRAINS AND SPRAINS
Neck strains (Grades 1—3) are common and most frequently involve the erectors. Flexion and extension cervical sprains are also common (Grades 1—3) and frequently involve the anterior or posterior longitudinal ligaments (making cord involvement a suspicion). The capsular ligaments and periarticular straps may be involved and always are when acute hyperkinetic subluxation has occurred. In the neck especially, strain and sprain may coexist and usually do. Severity varies considerably from mild to dangerous.
Neck sprain and disc rupture are usually associated with severe pain and muscle spasm and are more common in adults because of the reduced elasticity of supporting tissues. Pain is often referred when the brachial plexus is involved. Cervical stiffness, muscle spasm, spinous process tenderness, and restricted motion are common. When pain from either a soft-tissue or vertebral lesion occurs, it is often poorly localized and referred to the occiput, shoulder, between the scapulae, arm or forearm (lower cervical lesion), and may be accompanied by paresthesiae. Muscle clues may point to a nerve lesion. See Table 2.
Table 2 Major Muscles of the Neck
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