Cervical Spine Sprain/Strain Injuries Clinical Presentation

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 eMedicine topics include the following:

• Spinal Cord Trauma and Related Diseases
• Torticollis

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.^{[8, 9]} 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.