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