The Epidemiology of Neck Pain

, Medical College of Wisconsin, Milwaukee, Wis.

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Sources of Neck Pain

The human neck is a complex structure that contains the extension of a number of vital visceral structures, including the trachea, esophagus, and the carotid and vertebral arteries, and a musculoskeletal system that provides for support and motion of the head. The cervical spine itself is a series of seven separate bone elements, all with intricate articulations and an elaborate system of ligaments and associated muscles. The first and second cervical vertebrae are different in size and shape from each other and the remaining five vertebrae. However, all of the segments have true synovial joints. The anterior articulations of the vertebrae below C2 occur via intervertebral discs. Both the anterior and posterior joints are surrounded by a fibrous capsule and supported by ligaments and muscles. These joints both allow and limit neck motion. The capsule, ligament, and muscles all contain an abundance of free nerve endings which are capable of transmitting pain impulses. Irritation or damage to these structures causes primary neck pain.

The cervical vertebrae also protect and allow passage of the spinal cord and cervical nerve roots. Pathologic processes such as compression, especially of the nerve roots, are a frequent source of neck pain and referred pain from the neck. Cervical nerves are both sensory and motor so that damage, in addition to pain, may cause numbness, tingling, muscle weakness, and reflex deficits in a specific location. Signs and symptoms along the distribution of a cervical nerve root are called cervical radiculopathy.

The cervical nerve roots C5, C6, and C7 are the most commonly involved and result in characteristic signs and symptoms in the upper extremities. Because the distal-most innervation of C4 is to the top of the shoulder, compression of the C4 nerve root does not produce symptoms below the level of the shoulder, and usually there is no demonstrable muscle weakness or any reflex abnormalities. Damage or irritation of C1, C2, and C3 does not result in reflex or motor deficits but can result in pain in the back of the neck extending along the back of the head. Pain from neck sources other than cervical nerve roots does not result in sensory, motor, or reflex deficits and the pain patterns are not as well defined. Pain reproduction studies have investigated patients with neck pain but without evidence of specific nerve root involvement. Discography and zygapophyseal joint injections[1] were used, indicating that there are a variety of etiologies for neck pain. Other possible sources of neck pain, whose importance has not been established, are the cervical sympathetic nerves and the innervation present in the anterior surface of the dura.

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