Cervical Spine Sprain/Strain Injuries Clinical Presentation
- Author: Gerard A Malanga, MD; Chief Editor: Sherwin SW Ho, MD more...
The evaluation of the athlete with a potential neck injury begins with a detailed history. The clinician should obtain the following information from the patient:
Mechanism of injury; how, when, and where the injury took place, with particular attention regarding the position of the head and neck at the time of the injury
Location of the pain
Aggravating and relieving factors (eg, sneezing, coughing, traction)
Presence, location, and duration of any neurologic symptoms
The use of a body pain diagram to understand the athlete’s pain distribution may be helpful in directing further evaluation.
History of a previous neck injury
The clinical picture for cervical spine/strain injuries is similar to all musculotendinous injuries. In cervical strain, pain and stiffness are the main complaints. In acute cervical sprain, the athlete complains of a jammed-neck sensation, with localized pain in the neck. At the time of the injury, the individual experiences pain; however, the pain may subside after a few minutes, allowing the athlete to return to full sport participation. Pain, swelling, and tenderness may become evident as local bleeding occurs into the torn muscle fibers. Neck motion becomes painful and often reaches a peak several hours later or on the following day. Referred pain, especially to the occipital area or the shoulder, is common; however, the patient has no radiation of pain or paresthesia in any of his/her extremities.
The physical examination consists of the following:
A complete neurologic examination, including a thorough testing of the upper and lower extremities for weakness, sensory changes in a dermatomal distribution, or reflex changes
Cervical ROM (active and passive) testing
Spurling and Adson maneuvers
Resistive head pressure
Cervical compression test
Torticollis may be observed on physical examination, but decreased ROM is more commonly noted. The motion that produces stretching of the involved muscles or ligaments is usually the one that is limited. Palpating the injured area commonly reveals tenderness. Pain during rotation, flexion, or extension against resistance indicates inflammation or damage of the respective muscles. Pain in an inflamed facet joint may be elicited by simultaneous neck extension and rotation. When dealing with athletes, as opposed to the rest of the population, it is best to gain the maximal mechanical advantage possible in order to develop the greatest sensitivity in picking up even a minor weakness.
On examination, no neurologic deficits are demonstrable. Evaluation of the athlete’s posture may also be useful, as minor postural inefficiencies may be magnified in the athlete and contribute to muscle strain.
Related Medscape Reference topics include the following:
Cervical spine strains and sprains frequently occur as a result of a whiplash injury, which often occurs as the result of motor vehicle accidents, falls, sports-related accidents, or other traumatic events that cause a sudden jerk of the head and neck.[9, 10, 11, 12] The speed of impact in such mechanisms, proportional to the amount of the energy that is transferred and the amount of acceleration and deceleration, correlates with the severity of the injury. However, it has been demonstrated that zygapophyseal joint pain, rather than soft-tissue pain, is the most common basis for chronic neck pain after whiplash.
Cervical injuries may develop over a time period as well (eg, prolonged unusual posture, chronic repetitive strains of the neck). It is worth noting that several authors have described delayed or late instability with the development of neurologic symptoms in athletes after cervical flexion injuries. Some have proposed that poor muscle conditioning or repetitive muscle injury contributes to late instability, and these investigators have emphasized the importance of regular conditioning and proper warm-ups before athletes compete.
Thomas BE, McCullen GM, Yuan HA. Cervical spine injuries in football players. J Am Acad Orthop Surg. 1999 Sep-Oct. 7(5):338-47. [Medline].
Watkins RG. Neck injuries in football players. Clin Sports Med. 1986 Apr. 5(2):215-46. [Medline].
Wroble RR, Albright JP. Neck and low back injuries in wrestling. Clin Sports Med. 1986 Apr. 5(2):295-325. [Medline].
Zmurko MG, Tannoury TY, Tannoury CA, Anderson DG. Cervical sprains, disc herniations, minor fractures, and other cervical injuries in the athlete. Clin Sports Med. 2003 Jul. 22(3):513-21. [Medline].
Tall RL, DeVault W. Spinal injury in sport: epidemiologic considerations. Clin Sports Med. 1993 Jul. 12(3):441-8. [Medline].
Bogduk N. The anatomy and pathophysiology of neck pain. Phys Med Rehabil Clin N Am. 2003 Aug. 14(3):455-72, v. [Medline].
Panjabi MM, Vasavada A, White AA III. Cervical spine biomechanics. Semin Spine Surg. 1993 Mar. 5(1):10-6.
Holsgrove TP, Cazzola D, Preatoni E, Trewartha G, Miles AW, Gill HS, et al. An investigation into axial impacts of the cervical spine using digital image correlation. Spine J. 2015 Aug 1. 15 (8):1856-63. [Medline].
Kongsted A, Bendix T, Qerama E, et al. Acute stress response and recovery after whiplash injuries. A one-year prospective study. Eur J Pain. 2008 May. 12(4):455-63. [Medline].
Silber JS, Hayes VM, Lipetz J, Vaccaro AR. Whiplash: fact or fiction?. Am J Orthop. 2005 Jan. 34(1):23-8. [Medline].
Cronin DS. Finite element modeling of potential cervical spine pain sources in neutral position low speed rear impact. J Mech Behav Biomed Mater. 2013 Feb 4. [Medline].
Sciubba DM, McLoughlin GS, Gokaslan ZL, et al. Are computed tomography scans adequate in assessing cervical spine pain following blunt trauma?. Emerg Med J. 2007 Nov. 24(11):803-4. [Medline].
Kaiser JA, Holland BA. Imaging of the cervical spine. Spine. 1998 Dec 15. 23(24):2701-12. [Medline].
Beazell JR, Magrum EM. Rehabilitation of head and neck injuries in the athlete. Clin Sports Med. 2003 Jul. 22(3):523-57. [Medline].
Hopkins TJ, White AA 3rd. Rehabilitation of athletes following spine injury. Clin Sports Med. 1993 Jul. 12(3):603-19. [Medline].
Torg JS. Management guidelines for athletic injuries to the cervical spine. Clin Sports Med. 1987 Jan. 6(1):53-60. [Medline].
Cibulka MT. Evaluation and treatment of cervical spine injuries. Clin Sports Med. 1989 Oct. 8(4):691-701. [Medline].
Teitz CC, Cook DM. Rehabilitation of neck and low back injuries. Clin Sports Med. 1985 Jul. 4(3):455-76. [Medline].
Sawyer M, Zbieranek CK. The treatment of soft tissue after spinal injury. Clin Sports Med. 1986 Apr. 5(2):387-405. [Medline].
Langer PR, Fadale PD, Palumbo MA. Catastrophic neck injuries in the collision sport athlete. Sports Med Arthrosc. 2008 Mar. 16(1):7-15. [Medline].
Ellis JL, Gottlieb JE. Return-to-play decisions after cervical spine injuries. Curr Sports Med Rep. 2007 Jan. 6(1):56-6. [Medline].
Torg JS, Glasgow SG. Criteria for return to contact activities following cervical spine injury. Clin J Sports Med. 1991. 1(1):12-26.
Warren WL Jr, Bailes JE. On the field evaluation of athletic neck injury. Clin Sports Med. 1998 Jan. 17(1):99-110. [Medline].
Vegso JJ, Lehman RC. Field evaluation and management of head and neck injuries. Clin Sports Med. 1987 Jan. 6(1):1-15. [Medline].
An HS. Cervical spine trauma. Spine. 1998 Dec 15. 23(24):2713-29. [Medline].
Cole AJ, Farrell JP, Stratton SA. Cervical spine athletic injuries: a pain in the neck. Phys Med Rehabil Clin N Am. 1994 Feb. 5(1):37-68.
Dvorak MF, Fisher CG, Fehlings MG, et al. The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system. Spine. 2007 Nov 1. 32(23):2620-9. [Medline].
Jackson DW, Lohr FT. Cervical spine injuries. Clin Sports Med. 1986 Apr. 5(2):373-86. [Medline].
Villavicencio AT, Hernandez TD, Burneikiene S, Thramann J. Neck pain in multisport athletes. 1: J Neurosurg Spine. 2007 Oct. 7(4):408-13. [Medline].
McLoughlin LC, Jadaan M, McCabe J. Severe sprains of the sub-axial cervical spine in adolescents: a diagnostic and therapeutic challenge: a report of three cases. Eur Spine J. 2014 May. 23 Suppl 2:150-6. [Medline].