Cervical Strain 

  • Author: Warren Magnus, DO; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 19, 2011
 

Background

Cervical strain (ICD-9 847.0) is a common injury routinely seen in the ED. Frequently the result of trauma from falls or motor vehicle accidents (MVAs), this condition causes much distress to patients but, with appropriate management, it usually has few long-term sequelae. High-speed injury mechanisms have brought the common term whiplash into use to describe these injuries as well as the more inclusive whiplash-associated disorders (WAD) that has been used in the medical literature. See the images below.

Radiograph of the cervical spine shows a normal loRadiograph of the cervical spine shows a normal lordotic curve. Radiograph of the cervical spine shows straighteniRadiograph of the cervical spine shows straightening of the lordotic curve.

The chief diagnostic challenge in the emergent or urgent setting is to differentiate cervical strain from other causes of neck pain that may result in morbidity or mortality to the patient. Over a longer term, management is focused on a patient's return to daily functioning with accommodation for occupational and lifestyle issues.

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Pathophysiology

A cervical strain is chiefly the result of a stretch injury to the muscular and ligamentous elements of the cervical spine, although some compressive forces can be involved as well depending on the exact mechanism of injury. Such injury can occur acutely, as in a MVA, or the injury can occur over time; repetitive stress injuries to the cervical spine are common and can be difficult to differentiate from other myofascial syndromes affecting the cervical and upper thoracic region. Additionally, a significant number of injuries to the cervical spine can result from abnormal posture. Such injuries can result from occupational situations that result in odd positioning of the neck to overnight sleep positioning related injuries.

Lateral view of the muscles of the neck. Lateral view of the muscles of the neck. External craniocervical ligaments. External craniocervical ligaments.
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Epidemiology

Frequency

United States

Cervical strain is very common with as many as one million cases per year from high-velocity (whiplash type) injuries alone.

International

Throughout the developed and undeveloped world, low-speed trauma to the cervical spine is very common. High-speed trauma is, as with the United States, very high in incidence as well.

Mortality/Morbidity

Mortality is not an issue in this musculoskeletal disease. Morbidity from long-term injury can be significant such as when pain leads to disuse, resulting in loss of function. Significant impediment of occupational functioning exists as a result of cervical spine injuries.

Age

Typically, adults are more commonly affected than children.

  • MVA injury mechanisms more commonly affect adults because of differences in safety requirements and in seat fit (ie, child safety seats generally provide better support of the cervical spine than typical automobile seats).
  • Occupational cervical spine injuries are common and can afflict not only individuals involved in physical labor but also people in primarily desk or office positions. Modern office conditions and ergonomics can have significant impacts on susceptibility.
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Contributor Information and Disclosures
Author

Warren Magnus, DO  Staff Physician, Fremont Medical Center, Las Vegas, NV

Warren Magnus, DO is a member of the following medical societies: American Osteopathic Association

Disclosure: Nothing to disclose.

Coauthor(s)

Paul D Moczarski†, DO  Former Attending Physician, Emergency Resources Group and EmCare, Jacksonville, Florida

Paul D Moczarski†, DO is a member of the following medical societies: American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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External craniocervical ligaments.
Internal craniocervical ligaments.
Lateral view of the muscles of the neck.
Anterior view of the muscles of the neck.
Radiograph of the cervical spine shows a normal lordotic curve.
Radiograph of the cervical spine shows straightening of the lordotic curve.
 
 
 
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