Cervical Sprain and Strain Clinical Presentation

Updated: Oct 05, 2017
  • Author: Oregon K Hunter, Jr, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
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Presentation

History

The most common symptoms of cervical disorders are suboccipital cervicogenic headache and/or ongoing or motion-induced neck pain. Other symptoms associated with cervical strain include the following:

  • Neck pain
    • At the time of accident, neck pain may be minimal, with an onset of symptoms occurring during the subsequent 12-72 hours.
    • Nonspecific neck and shoulder pain (a variety of cervical radiculopathies) may indicate an injury to a disc in the upper cervical spine. [37]
  • Headache
    • Headache is a frequent symptom of cervical strain. [40]
    • Neck structures play a role in the pathophysiology of some headaches, but the clinical patterns have not been defined adequately.
    • Increased muscle hardness (determined by palpation) is significantly increased in patients with chronic tension-type headaches.
    • Facet joints and intervertebral disc damage have been implicated in the pathology of headaches due to neck injury. [8]
    • No specific pathology on imaging or diagnostic studies has been correlated with cervicogenic headaches.
  • Shoulder, scapular, and/or arm pain
  • Visual disturbances (eg, blurred vision, diplopia)
  • Tinnitus
  • Dizziness - This may result from injury to facet joints that are supplied with proprioceptive fibers; when injured, these fibers can cause confused vestibular and visual input to the brain. [8]
  • Concussion
  • Neurologic symptoms - These may include weakness or heaviness in the arms, numbness, and paresthesia.
  • Difficulty sleeping due to pain
  • Disturbed concentration and memory
    • Late whiplash syndrome includes symptoms such as headache, vertigo, disturbances in concentration and memory, difficulty swallowing, and impaired vision. These cognitive impairments remain poorly understood.
    • Many patients with these changes have abnormal results on single-photon emission CT (SPECT) scans or P300 event-related potentials. [41]
    • Bladder or bowel dysfunction - These may be symptoms of complication of myelopathy (spinal cord involvement).
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Physical

The physical examination is a vital part of the diagnosis of cervical stress and strain injuries. Various signs and symptoms may be noted during the physical examination. Observation of the patient's general appearance may yield information about pain behavior, verbal or nonverbal.

Spinal examination

During the postural assessment, the clinician may note the following findings: stiffness of the neck, forward head, flexed neck, rounded shoulders, asymmetry of the neck or shoulders, neck tilt or rotation, and one shoulder higher or tighter than the other.

Palpation may reveal rigidity (loss of motion or postural abnormality), spasm tightness, muscle hardness, crepitation, swelling, enlargement of joints, tenderness, tender points, and trigger points. [42, 43] Palpation of the zygapophysial joints may be helpful in determining the painful joints, because of osteoarthritis or posttraumatic irritation of the joint capsule. Painful cervical facet joint – loading maneuvers confirm the clinical diagnosis of cervical facet syndrome following a whiplash injury.

Decreased active and passive ROM may be noted. Impaired cervical ROM (particularly in the sagittal plane) is useful in distinguishing between asymptomatic persons and those with persistent whiplash-associated disorders. [44] Special methodology for measuring cervical ROM compared healthy persons with individuals suffering from chronic whiplash. Using mean coefficient of variation (MCV) and total cervical range of motion (TCROM), the TCROM was significantly lower and the MCV was significantly higher in injured patients as compared with healthy individuals. [45]

After acute whiplash injury, neck mobility is significantly reduced. After 3 months, however, mobility has been found to be similar between control subjects and patients with whiplash injury. [46]

Cervical neurocompression by way of cervical extension may cause parascapular or arm pain by narrowing the neural foramen (causing nerve root compression) or by causing pressure on the facet joints.

Neurologic examination

This includes the following:

  • Mental status: Mood disturbance, such as anxiety or depressive affect, may be noted
  • Motor function: If cervical radiculopathy is present, the strength or bulk of the involved upper extremity may be decreased in a myotomal distribution; if myelopathy is present, weakness of upper and lower extremities may be noted
  • Circumference: The dominant arm and forearm are usually slightly larger than are those of the nondominant side
  • Reflexes in cervical radiculopathy: In cervical radiculopathy, muscle stretch reflexes (MSRs) may be decreased in a myotomal pattern in the affected upper limb; however, they should remain normal in the lower limbs
  • Reflexes in cervical myelopathy: In cervical myelopathy (cervical spinal cord involvement), the MSRs arising from a given level of the cord may be decreased in the upper limbs; however, MSRs in the lower limbs may be increased, with spasticity of the lower extremities, a positive Babinski sign, and a positive Hoffman sign
  • Sensation: If cervical radiculopathy is present, pain or 2-point discrimination of light touch may be reduced in a radicular dermatomal pattern in the involved upper extremity
  • Coordination: With radiculopathy or myelopathy, coordination may be decreased in the involved upper extremity
  • Gait: In cases of cervical myelopathy, the patient's gait pattern may be abnormal as a result of spasticity; the presence of spasticity implies an upper motor neuron dysfunction, in contrast with injury to the peripheral nerves
  • Provocative maneuvers: The Spurling test uses cervical extension and lateral bending while the examiner applies a downward axial load; this test may provoke (reduce) radicular symptoms in a patient with cervical radiculopathy
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Causes

Common traumatic events or factors that may lead to cervical strain/sprain injuries include motor vehicle accidents, lifting or pulling heavy objects, awkward sleeping positions, unusual upper-extremity work, and prolonged static positions.

Flexion/extension injuries may precipitate a myeloradiculopathic presentation in a patient with cervical spondylosis. Nerve root or spinal cord compression may occur from neural ischemia due to the preexisting stenosis that accompanies cervical spondylosis. Flexion/extension injuries, blows to the head, or neck injury while lifting heavy objects may precipitate an acute exacerbation of cervical spondylosis.

Repetitive or abnormal postures may contribute to cervical sprains and strains.

In a study by Giannoudis and colleagues, no dose-response association between the magnitude of trauma severity and the incidence of whiplash injury was found. [47]

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