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Management of Neck Pain

Introduction
Pain located in the neck is a common medical condition. Neck pain can come from any problem in the neck, such as:

* degeneration ( also known as spondylosis),
* neck strain,
* whiplash, injury (car accident or a fall)
* herniated disc (also known as prolapsed/ slipped discs ) or
* a pinched nerve.

Degeneration
This is a progressive disorder and affects adults from the age of 30 onwards. It is common to have mild aches in the neck with some radiation of pain down the shoulders. With bone spur formation, there may be compression of the nerve roots causing shooting pain, tingling sensation and even weakness of the arms and forearms.
Whiplash Injury
All patients with history of injury due to car accidents or sport injuries are prone to pain due to whiplash injury. Often there is muscle spasm after the accident. No attempt to move the neck must be made. They need x-rays to exclude any fractures or subluxation (unstable spine).
If x-rays are normal, treat with oral medications for a few days. By this time, some mobility would have returned.
Whiplash injures the muscular and ligamentous structures in the neck. Oral medications and physiotherapy forms the mainstay of treatment in this group of patients. Facet blocks may be necessary for those with chronic neck pain.
Disc herniation (Prolapsed discs)
With progressive degeneration, the disc can tear and prolapsed out. There is irritation of the nerve root which causes the intense shooting pain down the arm. This results in persistent tingling, burning sensation and weakness. Once neurological deficits are detected, it is important to discuss the need for surgical treatment as delay in treatment will result in permanent weakness or loss of sensation.
Conclusions
It is important to rule out dangerous conditions even with benign symptoms as neck pain. Instability of the spine and nerve damage from prolapsed disc are the main conditions that need exclusion. Good clinical history and examination will pick up most of these cases and if there is doubt regarding neural tissue injury, an MRI may have to be obtained.

Contributing Specialist:

Dr James Tan Siah Heng
Specialist Neurosurgeon
MBBS (Singapore)
FRCS (Edinburgh, Glasgow)
FRCS (Neurosurgery)
6A Napier Road, Gleneagles Annexe Block, #02-42
Singapore 258500
Tel: 6476 7266





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