Neck Pain / Cervical Spondylosis


Neck Pain/Cervical Spondylosis

Neck pain is a common complaint, especially in computer workers. Neck muscles can be strained from poor posture whether it is leaning over your computer or hunching over your workbench. Osteoarthritis is also a common cause of neck pain.

In the neck, there are so many conditions that can cause neck pain. In this article, we will discuss some conditions of the neck and their causes, symptoms, and diagnosis. These conditions are as follows:

Cervical Spondylosis

In this condition, there are degenerative changes in the cervical spine. There are seven small vertebrae that form the neck. In cervical spondylosis, there is an extra bone formation which is called osteophytes. Over the period of time, the discs get thinner, and their ability to absorb shock is lost and the neck becomes more susceptible to injury. Extra bone formation can press or pinch nearby nerve roots or the spinal cord itself, resulting in tingling or “pins and needles” sensation in the extremities and sometimes even pain in the neck and upper limbs.

In some cases, there may be a loss of feeling (sensation) and coordination. Some people may have difficulty in walking. 95% of people experience degenerative changes as they get older. And almost 85% of people over the age of 60 years live with cervical spondylosis.


The most common cause of cervical spondylosis is long-term degeneration and wear-and-tear of the cervical spine. A previous neck injury may also perpetuate the condition. Some long-term activities may increase the risk of developing cervical spondylosis, such as wrong sleeping posture, carrying heavy loads, practicing martial arts, or being a professional dancer or gymnast. It could be genetic because the condition sometimes runs in families.

It usually starts to appear after the age of 40 years, and it progresses over time. Men usually develop it at an earlier age than women. Smoking can also increase the risk.


Neck pain and stiffness, it may spread to the shoulders, arms and hands, and the base of the skull. Moving the head in different directions may make the pain worse. Neck stiffness is more common after a long period of inactivity, for example, after sleeping or taking a long rest. Sometimes, there is compression of the blood vessels and it can affect the blood supply to the brain, possibly resulting in dizziness and even blackouts. Your arms and legs can become weak. If there is compression of nerves then a person will experience tingling and numbness in the upper limb.

Whiplash injury

In this condition there is acceleration/deceleration injury of cervical injury, it’s usually associated with car accidents, any impact or blow that causes your head to jerk forward or backward may cause neck strain. It occurs when excess shear and tensile forces are exerted on cervical structures. Structures injured may include facets/articular processes, facet joint capsules, ligaments, disc, anterior/posterior muscles, fracture odontoid process and spinous processes, TMJ, sympathetic chain ganglia, spinal and cranial nerves.

Signs and symptoms

  • Early symptoms include headaches, neck pain, limited flexibility, a reversal of lower cervical lordosis and decrease in upper cervical kyphosis, vertigo, change in vision and hearing, irritability to noise and light, dysesthesias of the face and bilateral upper extremities, nausea, difficulty in swallowing and emotional lability.
  • Late symptoms include head and neck pain, limitation in flexibility, TMJ dysfunction, limited tolerance to ADLs, disequilibrium, anxiety, and depression.
  • Common clinical findings include postural changes, excessive muscle guarding with soft tissue fibrosis, segmental hypermobility, and gradual development of restricted segmental motion, cranial, and caudal to the injury (segmental hypomobility).


Clinical history and examination, plain film imaging, CT scan, and MRI are helpful in checking the condition of cervical structures.

Thoracic outlet syndrome

The thoracic outlet is the ring formed by the top ribs, at the bottom of the collarbone. In this condition, there is compression of nerves or blood vessels by the rib, collarbone, or neck muscles at the top of the outlet. The boundaries of the thoracic outlet are marked by scalene muscle anteriorly, the middle scalene posteriorly, and the first rib inferiorly.

Causes of thoracic outlet syndrome

Thoracic outlet syndrome can be congenital or acquired. Specific causes include;

  • Cervical rib: it is an extra rib that grows from the cervical spine, the neck part of the spine. 1 and 3 % can have cervical rib, which may grow on one side or both, and may reach down to attach to the first rib or might not be fully formed. Having a cervical rib increases the chance of nerve or blood vessel impingement between the rib or its muscles and ligaments connections sharing this small space. A small percentage of people with a cervical rib develop thoracic outlet syndrome. So many people with a cervical rib are difficult to diagnose, because the bone is tiny in most cases and isn’t noticed, even in X-rays.
  • Abnormal muscle or first rib formation: Some people may have an extra or large scalene muscle or an abnormal first rib or collarbone. Any of these abnormal formations can impinge blood vessels, veins, and nerves.
  • Whiplash: Arm and hand symptoms that stay long after a whiplash injury can develop symptoms of thoracic outlet syndrome.
  • Bodybuilding: Built-up muscles in the neck may cause hypertrophy (large muscles) and impinge nerves or vessels.
  • Repeated overhead motions: People who do repeated overhead activities are more prone to have thoracic outlet syndromes such as swimmers, baseball players, painters, hairstylists, and auto mechanics.
  • Tumor in the neck: On rare occasions, a tumor might be the cause of the impingement of nerves and arteries.

Types and symptoms of thoracic outlet syndrome

Neurogenic thoracic outlet syndrome occurs when there is an impingement of a nerve. This is the most common form.

Symptoms would be like pain, tingling, and numbness in shoulder arm and hand, weakness in shoulder and arm muscles, changes in color and temperature of hand and muscle wasting or atrophy in hand can be seen in case of severe compression of the nerve.

Venous thoracic outlet syndrome occurs when there is an impingement of a vein leading to upper body thrombosis. Only 5%of cases are venous.

Symptoms would be like weakness of pulse in arm, pallor or paleness in hand and involved arm, swelling, weakness, and loss of sensation in involved arm.

Arterial thoracic outlet syndrome occurs when an artery impinges, and sometimes because of a blood clot. It is a rare case.

Symptoms would be like heaviness and sharp shooting pain in the arm, weak pulse in hand, and swelling or redness of the arm.

Diagnosis of thoracic outlet syndrome

There are some physical tests that can differentially diagnose thoracic outlet syndrome. These include;

  • Adson’s test
  • Roos test
  • Wright’s test
  • Costoclavicular test.

If this one of these tests provoking symptoms that means you are positive for thoracic outlet syndrome.

Cervical headache

Headaches are a common complaint with impaired posture. About 15%-20% of chronic and recurrent headaches are diagnosed as cervical headaches and are related to musculoskeletal impairments. Often there is associated tension in posterior cervical muscles, pain at the attachment of cervical extensors, or pain radiating across the top and side of the scalp.

Causes of cervical headache

There are many factors that may cause a cervical headache. These include:

  • Headache may follow soft tissue injury or may be caused by faulty or sustained postures.
  • Nerve irritation or impingement or sustained muscle contractions from faulty posture and emotional tension leading to ischemia.
  • Inflammation and dysfunction of ligaments and joints of the neck.
  • It can be because of temporomandibular joint dysfunction.
  • Other conditions such as allergies, sinusitis or there may be vascular or autonomic involvement as with migraine or cluster headache.

Signs and symptoms of cervical headache

History and symptoms include:

  • Unilateral headaches or bilateral headaches with one side predominant.
  • Pain in the neck or suboccipital region that spreads into the head.
  • Intensity can fluctuate between mild, moderate, or severe.
  • Precipitated by sustained neck postures and movements.
  • May be precipitated by stress also common with other types of headaches.
  • May be related to trauma, degenerative joint disease, or a sedentary lifestyle and postural stresses.
  • More prevalent in females but no familial tendency.
  • Sometimes the pain is radiating to the jaw as if it’s because of TMJ joint dysfunction.

Torticollis (Wryneck)

In this condition there is tightness of the sternocleidomastoid (SCM) muscle, it is painfully twisted and tilted neck and generally tilts to one side while the chin tilts to another side. This condition can be congenital (present at birth) or acquired (because of any pathology to SCM later in life) and it can also be the result of damage to the neck muscles or blood supply. Torticollis sometimes goes away without treatment.

However, there’s a chance of relapse. Chronic wry neck can cause devastating pain and difficulty in performing daily tasks. Fortunately, medications and physiotherapy can relieve pain and stiffness. Sometimes surgery is required to correct the condition. Treatment is very successful if it’s started early. This is especially true for children at an early age.


Wryneck may be inherited. It can also develop in the womb. This may occur if your baby’s head is in the wrong position in the womb. It can also be due to any damage to the muscles or blood supply to the neck. Anyone can develop torticollis after a muscle or nervous system injury. However, most of the time, the cause of wry neck is idiopathic.


  • Temporary torticollis- it is because of swollen lymph nodes, cold, injury to muscles of the neck, and an ear infection.
  • Fixed torticollis- it is because of muscular or bone structure, it is also called permanent torticollis.
  • Muscular torticollis- it is the most common type and most of the time it is because of tightness of one side of the neck muscle (SCM).
  • Klippel-Feil torticollis- it is a rare case of congenital torticollis, there is 2 vertebras of the neck are fused by birth.


It starts slowly and it can be severe at times, some common symptoms include:

  • Pain and stiffness in the neck
  • Chin is facing to one side
  • One-shoulder will be up and one will be down
  • Inability to move your head normally
  • Swollen neck

Sometimes a headache can be there

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