Definition and discussion

Soft tissue damage (stretch, tearing or rupture) to the ligaments, muscles, IVD and other tissues surrounding the cervical spine

Sprain: Injury to ligamentous structures due to overuse or trauma, may cause partial or complete loss of stability

Strain: Injury to muscle and tendon due to over use or trauma Sprain/ strain grading:

Aeiology

About 85% of all neck pain is thought to arise from acute or repetitive neck injury. Potential causes:

  • Direct trauma: falls, RTA, whiplash, sports injury
  • Overuse, fatigue, repetitive microtrauma
  • Postural: may be due to hyper-lordosis or prolonged stress
  • Sudden unguarded movement

History, signs and symptoms

  • Patient may experience immediate pain or pain shortly after the injury
  • Pain may radiate into the occiput or down into the shoulder/upper limb (non-dermatomal pattern)
  • Headache (usually cervicogenic)
  • On observation, local swelling, erythema and possible ecchymosis (bruising) may be present
  • Postural changes and guarded movements may be identified
  • Palpation may reveal local tenderness, joint dysfunction and muscle spasm
  • ROM (range of motion) may be limited in most directions, depending on whether contractile and/or non contractile tissue is involved
  • Positive distraction and compression tests
  • Neurological testing is usually within normal limits; muscle weakness may be present due to pain
  • rays may be used to rule out or confirm structural damage if suspected:
    • Straightening or reversal of the cervical spine curve
    • Stress views to be performed if instability is suspected
    • MRI scan may be good for soft tissue evaluation

At home management

  • Rest, ice (48 hours after injury), heat
  • Passive (stretching) and active ROM exercises to be performed in a pain free range
  • Strengthening should begin with isometric exercises and progress to isotonic as tolerated
  • Medications such as NSAIDs (cataflam or nurofen syrup) and analgesics for pain control and muscle relaxants (norflex)

Monitoring

  • Pain should usually decrease within 3-5 days
  • Discomfort should subside within 1-6 weeks, depending on the degree of injury
  • If athletic, patient should avoid returning to play until off any pain medication

Prognosis

  • Prognosis is usually good for complete recovery in first time cases, however this type of injury may predispose to chronic low back pain
  • Possible complications – joint instability, arthrosis, myofibrosis/periarticular fibrosis (scar tissue)
    • Periarticular fibrosis – post injury fibrous repair of myofascial soft tissue
    • Often the result of significant trauma or prolonged immobilization
    • Palpable nodule causing reduced elasticity of tissue predisposes to recurrent injury