Cervical Strain

THE CLINICAL SYNDROME

• Acute cervical strain is a group of symptoms that typically includes headaches along with non-radicular neck discomfort that radiates in a nondermatomal pattern into the shoulders and interscapular region.

• These symptoms are commonly accompanied with acute cervical strain.

• It is typical for the trapezius muscle to be damaged, leading to spasms and a restricted range of motion in the cervical spine.

• Although a trauma to the cervical spine and the related soft tissues is most often the cause of cervical strain, it is possible for the condition to arise in the absence of any visible provocation.

• Because more than 93 percent of people across the world use smartphones, it should not come as a surprise that there has been a surge in the number of cases of neck strain caused by improper posture while gazing down at a smartphone screen.

• It is possible to quantify the relationship between the angle of the cervical spine and the screen of the device by taking the cumulative average of the tilt angles of the neck over the course of time.

• If the detected tilt angle is too great, then significant strain is being exerted on the soft tissues and the cervical spine.

• There is a possibility that the soft tissues, facet joints, or intervertebral disks are the sites of the pathologic lesions that are causing this clinical condition.

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SIGNS AND SYMPTOMS

• The most obvious symptom of cervical strain is pain in the neck.
• It is possible that it will start in the occipital region and then radiate in a pattern that is not dermatomal into the shoulders and the area between the scapulae.
• The discomfort caused by cervical strain is frequently made worse by motions that involve the cervical spine and the shoulders.
• Headaches are a common complaint that can be made worse by emotional strain.
• It is typical to have trouble sleeping, as well as difficulties concentrating on even the simplest of chores.
• Depression is a possibility when symptoms persist for a long time.
• During the course of the physical examination, palpation will elicit discomfort; also, spasm of the paraspinous muscle and trapezius will frequently be present.
• When this maneuver is tried, there is usually going to be a decreased range of motion, in addition to an increase in pain.
• Despite the patient's frequent reports of discomfort in the upper extremities, the neurologic examination reveals no abnormalities that need further investigation.

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TESTING

• There is currently no reliable diagnostic test for cervical strain.
• The primary goal of the testing is to uncover a latent pathologic process or another condition that may present symptoms similar to those of cervical strain.
• A bone abnormality of the cervical spine, such as arthritis, a fracture, a congenital anomaly (such as an Arnold-Chiari malformation), or a tumor, can be delineated using plain radiographs.
• There is frequently seen evidence of the lordotic curve becoming straighter.
• Magnetic resonance imaging (MRI) of the cervical spine and, if severe occipital or headache symptoms are present, magnetic resonance imaging (MRI) of the brain should be performed on all individuals who have recently experienced the start of cervical strain.
• In order to rule out occult inflammatory arthritis, infection, and malignancy, screening laboratory tests like a complete blood count, erythrocyte sedimentation rate, antinuclear antibody testing, human leukocyte antigen (HLA)-B27 antigen screening, and automated blood chemistry should be conducted.

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DIFFERENTIAL DIAGNOSIS

• A clinical diagnosis of cervical strain can be established through the use of clinical history, physical examination, radiography, and MRI.
• Pain syndromes such as cervical bursitis, cervical fibromyositis, inflammatory arthritis, and abnormalities of the cervical spinal cord, roots, plexus, and nerves are examples of conditions that can cause symptoms similar to those of cervical strain.

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TREATMENT

• A multidisciplinary approach is the most effective way to treat cervical strain.

• It is fair to begin with physical therapy, which may include heat modalities and deep sedative massage, along with nonsteroidal antiinflammatory medications and skeletal muscle relaxants.

• The cervical epidural block, the blocking of the medial branch of the dorsal ramus, or the intraarticular injection of the facet joint with local anesthetic and steroid are all incredibly successful treatments for relieving the symptoms of the condition.

• Beginning treatment with a tricyclic antidepressant like nortriptyline, which can be taken as a single 25-mg dose before going to bed, is the most effective way to treat underlying sleep disturbances as well as depression.

• When treating pain in this region, an atlanto-occipital block and a cervical facet block are frequently used in combination.

• The atlantooccipital joint is not a true facet joint in the anatomical sense; rather, the technique is equivalent to the facet joint block that is often employed by pain practitioners and may be seen as such because to the similarities between the two.

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COMPLICATIONS AND PITFALLS

• Due to the close proximity of the cervical epidural block and cervical facet block to the spinal cord and exiting nerve roots, it is absolutely necessary that these procedures be performed only by individuals who are well-versed in the anatomy of the region and have prior experience with interventional methods of pain management.
• Because of its close proximity to the vertebral artery and the highly vascular nature of this region, the risk of intravascular injection is significant.
• Seizures can be brought on by the injection of even a very tiny dose of local anesthetic into the vertebral artery.
• After a cervical facet block, ataxia caused by vascular absorption of the local anesthetic is not an unusual complication.
• This is due to the close proximity of the brain and brainstem to the cervical spine.
• After receiving an injection of the cervical facet joints, a significant number of patients report that they experience a temporary worsening of their headache and cervicalgia symptoms.

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