Cervical Strain Treatment & Management

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

Prehospital Care

All persons involved in MVAs who sustain neck injuries should, at a minimum, receive cervical collars prior to transport. Many emergency medical service (EMS) protocols require these patients to be placed on a backboard in full spinal precautions. Because MVAs often involve enough force to seriously injure the cervical spine, such precautions are essential to prevent further injury.

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Emergency Department Care

  • Apply ice to acute strain injuries.
  • Administer analgesia and pain control.
  • Administer muscle relaxants.
  • Soft collars are commonly used but have not been proven effective. A single-blind study with 6-month follow-up conducted by Borchgrevink et al found that patients who received "usual care," with early mobilization and pain control, fared better than similarly treated patients placed in soft collars.[2] This was reinforced by Kongsted et al in 2007.[3]
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Consultations

At various times over the last 2 decades, there have been various calls for early multidisciplinary management including aggressive early physical therapy and other modalities. Current consensus, however, shows that consultations are rarely required for strain injuries; however, follow-up with a physician familiar with rehabilitation therapies is essential for longer-term management, particularly for patients who have experienced an occupational injury.

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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

References

  1. Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine. Apr 15 1995;20(8 Suppl):1S-73S. [Medline].

  2. Borchgrevink GE, Kaasa A, McDonagh D, Stiles TC, Haraldseth O, Lereim I. Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident. Spine. Jan 1 1998;23(1):25-31. [Medline].

  3. [Best Evidence] Kongsted A, Qerama E, Kasch H, et al. Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial. Spine. Mar 15 2007;32(6):618-26. [Medline].

  4. Khwaja SM, Minnerop M, Singer AJ. Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial. CJEM. Jan 2010;12(1):39-44. [Medline].

  5. Pape E, Hagen KB, Brox JI, Natvig B, Schirmer H. Early multidisciplinary evaluation and advice was ineffective for whiplash-associated disorders. Eur J Pain. Jan 30 2009;[Medline].

  6. Beazell JR, Magrum EM. Rehabilitation of head and neck injuries in the athlete. Clin Sports Med. Jul 2003;22(3):523-57. [Medline].

  7. Blackmore CC, Mann FA, Wilson AJ. Helical CT in the primary trauma evaluation of the cervical spine: an evidence-based approach. Skeletal Radiol. Nov 2000;29(11):632-9. [Medline].

  8. Bourbeau R, Desjardins D, Maag U, Laberge-Nadeau C. Neck injuries among belted and unbelted occupants of the front seat of cars. J Trauma. Nov 1993;35(5):794-9. [Medline].

  9. Bylund PO, Bjornstig U. Sick leave and disability pension among passenger car occupants injured in urban traffic. Spine. May 1 1998;23(9):1023-8. [Medline].

  10. Calliet R. Neck and Arm Pain. 2nd ed. FA Davis Co; 1981.

  11. Daffner RH. Controversies in cervical spine imaging in trauma patients. Emerg Radiol. Aug 2004;11(1):2-8. [Medline].

  12. Davis CG. Injury threshold: whiplash-associated disorders. J Manipulative Physiol Ther. Jul-Aug 2000;23(6):420-7. [Medline].

  13. Dickinson G, Stiell IG, Schull M, et al. Retrospective application of the NEXUS low-risk criteria for cervical spine radiography in Canadian emergency departments. Ann Emerg Med. Apr 2004;43(4):507-14. [Medline].

  14. Dreyer SJ, Boden SD. Laboratory evaluation in neck pain. Phys Med Rehabil Clin N Am. Aug 2003;14(3):589-604. [Medline].

  15. Frohna WJ. Emergency department evaluation and treatment of the neck and cervical spine injuries. Emerg Med Clin North Am. Nov 1999;17(4):739-91, v. [Medline].

  16. Galasko CSB, Murray P, Stephenson W. Incidence of whiplash-associated disorder. BCMJ [serial online]. Jun 2002;44(5):237-240. Available at http://www.bcmj.org/incidence-whiplash-associated-disorder#6.

  17. Griffiths HJ, Olson PN, Everson LI, Winemiller M. Hyperextension strain or "whiplash" injuries to the cervical spine. Skeletal Radiol. May 1995;24(4):263-6. [Medline].

  18. Grogan EL, Morris JA Jr, Dittus RS, et al. Cervical spine evaluation in urban trauma centers: lowering institutional costs and complications through helical CT scan. J Am Coll Surg. Feb 2005;200(2):160-5. [Medline].

  19. Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med. Dec 1992;21(12):1454-60. [Medline].

  20. Kappler RE. Cervical Spine. In: Ward RC, et al, eds. Foundations for Osteopathic Medicine. Lippincott, Williams & Wilkins; 1997:541-546.

  21. Ladig D, DeBell LS, Hubert MK. Mosby's Complete Drug Reference 1997. In: Physicians GenRx. Mosby-Year Book, Inc; 1997.

  22. Martinez JA, Timberlake GA, Jones JC, et al. Factors affecting the cervical prevertebral space in the trauma patient. Am J Emerg Med. May 1988;6(3):268-72. [Medline].

  23. McMorland G, Suter E. Chiropractic management of mechanical neck and low-back pain: a retrospective, outcome-based analysis. J Manipulative Physiol Ther. Jun 2000;23(5):307-11. [Medline].

  24. McSwain NE, Martinez JA, Timberlake GA. Cervical Spine Trauma: Evaluation and Acute Management. 1989.

  25. Patel RV, DeLong W Jr, Vresilovic EJ. Evaluation and treatment of spinal injuries in the patient with polytrauma. Clin Orthop Relat Res. May 2004;43-54. [Medline].

  26. Richards PJ. Cervical spine clearance: a review. Injury. Feb 2005;36(2):248-69; discussion 270. [Medline].

  27. Shaffer MA, Doris PE. Limitation of the cross table lateral view in detecting cervical spine injuries: a retrospective analysis. Ann Emerg Med. Oct 1981;10(10):508-13. [Medline].

  28. Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. Dec 25 2003;349(26):2510-8. [Medline].

  29. Sturzenegger M, DiStefano G, Radanov BP, Schnidrig A. Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms. Neurology. Apr 1994;44(4):688-93. [Medline].

  30. Van Goethem JW, Maes M, Ozsarlak O, van den Hauwe L, Parizel PM. Imaging in spinal trauma. Eur Radiol. Mar 2005;15(3):582-90. [Medline].

  31. Wang JC, Hatch JD, Sandhu HS, Delamarter RB. Cervical flexion and extension radiographs in acutely injured patients. Clin Orthop Relat Res. Aug 1999;111-6. [Medline].

  32. Zmurko MG, Tannoury TY, Tannoury CA, Anderson DG. Cervical sprains, disc herniations, minor fractures, and other cervical injuries in the athlete. Clin Sports Med. Jul 2003;22(3):513-21. [Medline].

 
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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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