Neck Trauma and Injuries

Here you can find information about
some of the most common neck injuries defined and described,
as well as specialized and various anatomical, diagnostic and
symptomatic detailed information.

Neck injuries, also known as cervical spine injuries come in a variety of types and can range from mild to severe. They may come from an accident or long term wear and tear. Below you can find information about some of the most common neck injuries defined and described, as well as specialized and various anatomical, diagnostic and symptomatic detailed information. This may come in handy while trying to determine a type of neck injury or define the cause for one.

Please, keep in mind that damage to one anatomical part in your neck often means damage to others. For example one of the most usual cases – a whiplash - may result in one or several diagnoses, including ligament sprain, muscle strain and/or disc injury. The reason behind this is simple - all parts of your neck are connected, and all muscles and tendons are connected as well. Bones, joints, soft tissue and nerves – they all work together as one to hold up and move your head and connect to the rest of the upper body (but not only).

What are neck injuries

Since many critical organs and structures remain at risk from neck trauma, clinical manifestations may vary greatly. The presence or absence of symptoms can often be misleading and is generally serving as a poor predictor of underlying damage. For example, only 10% of patients with blunt vascular damage develop symptoms within the first hour. When trying to help an injured person, use all available sources to establish the mechanism of injury, and always inform your doctor through all gathered detail.

Background

Speaking of neck injury, there is a multitude of organ systems (for example: neurological, airway, vascular, gastrointestinal, etc.) that are tightly compressed into a compact conduit. For that reasons few emergencies pose as great a challenge as neck trauma and a single penetrating wound is capable of serious and considerable harm.

Furthermore, seemingly innocuous wounds may not manifest clear signs or symptoms. Keep in mind that airway occlusion and exsanguinating hemorrhage pose the most immediate life risks. Potentially lethal injuries could be easily overlooked or discounted. In any case you should consult a doctor and trained medical staff. Certain neck injuries can cause damage to the nervous system.

This is caused by irritation of the nerve roots, impact on the spinal cord, pinch or stretch of a nerve. Neck injuries that affect the nervous system are quite complicated to diagnose, treat and cope in comparison with soft tissue trauma or mild to moderate joint injuries. Injury to the spinal cord is dangerous and often results in life long disability, paralysis, even death.

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Common Injuries
Some of the most common neck injuries, what causes them and how they should be treated

Penetrating trauma

More than 95% of penetrating neck wounds result from guns and knives, with the rest most typically resulting from road accidents, household injuries, industrial accidents and injuries at the workplace, and sports injuries.

Blunt trauma

Blunt trauma to the neck typically results from motor vehicle crashes but also occurs with sports-related injuries (eg, clothesline tackle), strangulation, blows from the fists or feet, and excessive manipulation (ie, any manual operation such as chiropractic treatment or physical realignment or repositioning of the spine).

Neck Trauma and Injuries Affecting Soft Tissue

In many cases the damage from a neck injury is limited to the soft tissue. Nevertheless almost every type of cervical spine injury affects muscles. Here are some of the most neck injuries that have an impact on muscles, tendons and ligaments. Some of these injuries can and often will occur along with more serious injury types.

“Neck Kink”

A "crick" or "kink" is a term used by people to describe the pain after sleeping with the neck positioned in an awkward way. These type of injury could arise from sudden movement or working at the computer for long hours, or sudden movements of the neck. Keep in mind this is not a legit medical diagnosis. The underlying reason for the neck “kinks” is usually a muscle spasm, trigger points, arthritis or even a disc problem. If the pain lasts longer than a week or disrupts your usual activities, get it checked by a medical specialist.

Neck Sprain

Injuries of the neck, known as sprains are connected to ligaments – or the connective tissue that hold your bones together. Neck sprains are usually caused by sudden twists or harsh movements or falls that overstretch the joint. Neck strains could also be repeated stress to the joint. Symptoms incl. swelling, reduced flexibility and pain. Sprain cases are described as mild, moderate or severe.

Muscle Strain

Strain is an injury to muscles that move the spine. Sometimes they do affect the neck, but most of the strains occur in the lower back. Lifting heavy objects is a usual cause of muscle strain. Symptoms incl. muscle spasms, reduced flexibility and pain. If the pain lasts longer than a couple days and is disrupting your usual activities, you should most definitely see a doctor.

Whiplash

WAD or “whiplash is actually a whole set of symptoms following an injury in which the head is thrown fast into hyperextension and then forward, very much in a whiplash manner. It's usual in car accidents, but is also caused by sports injuries, rapid falls or trauma.
Whiplash Associated Disorders or WAD is not a medical diagnosis. It's more of an event that may result in a combination of neck strain or sprain and other related injuries.

Herniated Disc

Herniated disc occurs when the nucleus pulposis (the soft substance placed on the inside of the disc) is severely pushed out. Usual symptoms include pain, weakness, numbness, pins and needles in the arm.

Stingers and Burners

As the common name suggests, stingers and burners are (usually temporary) injuries to the nerve root or brachial plexus. They are most common among football players, boxers and other contact sport athletes. Such conditions are often caused by an abrupt tilt of the head.
Another case is when the head and shoulder are forced in the opposite directions at the same time. Symptoms usually are burning, stinging, numbness and weakness, and also warmth and “electrical” sensation down the arm.

Neck Fracture

A neck fracture is a term used to point at a break in a cervical bone. This could be caused by trauma, a fall or degenerative changes in the spine. The type and severity of the break is often determined by the angle of force at impact. The most serious neck fractures are accompanied by a cervical dislocation.

Cervical Dislocation

Dislocation occurs when a neck bone moves out its normal position. In this case a spinal instability is often present. A dislocation may be accompanied by fracture. Mild dislocations sometimes go “back in place” on their own. The soft tissue trauma is treated by wearing a collar.

Spinal Cord Injury

A spinal cord injury occurs when a fracture, dislocation or other neck injury damages the spinal cord. If the spinal cord is damaged at the 3rd cervical vertebra or above, the person may die or need a respirator to live. People living with SCI often endure a lifelong disability with complete or incomplete paralysis below the level of injury.

Symptoms
Common Neck trauma symptoms

The anterior – the larynx and trachea - and lateral regions are considerably exposed to trauma and injuries. Cardiovascular manifestations vary from bleeding to symptoms normally associated with a cerebrovascular accident.

Symptoms related to the aerodigestive tract incl. dyspnea, hoarseness, dysphonia, dysphagia and others. Central Nervous System (CNS) problems usually incl. paresthesias, weakness, plegia, and paresis.

Signs of laryngeal or tracheal injury

• Voice alteration
• Subcutaneous emphysema and/or crepitus
• Hoarseness
• Dyspnea
• Distortion of the normal anatomic appearance
• Hemoptysis
• Stridor
• Drooling
• Pain on palpation or with coughing or swallowing
• Pain with tongue movement
• Crepitus (note: noteworthy in only 1/3 of cases)
• Air frothing, sucking, hissing or bubbling through the neck wound

Signs of esophageal and pharyngeal injury

• Dysphagia
• Bloody saliva
• Sucking neck wound
• Bloody nasogastric aspirate
• Pain and tenderness in the neck
• Resistance of neck with passive motion testing
• Crepitus
• Bleeding from the mouth or nasogastric tube

Signs of carotid artery injury

• Decreased level of consciousness
• Dyspnea secondary to compression of the trachea
• Thrill
• Bruit
• Pulse deficit
• Contralateral hemiparesis
• Hemorrhage
• Hematoma
• Signs of jugular vein injury (incl. hematoma, external hemorrhage, hypotension)

Signs of spinal cord or brachial plexus injury

• Diminished upper arm capacity
• Fecal incontinence
• Paralytic ileus
• Poor rectal tone
• Hypoxia and hypoventilation
• Signs of cranial nerve injury
• Urinary retention
• Horner syndrome
• Neurogenic shock
• Quadriplegia
• Pathologic reflexes
• Brown-Séquard syndrome
• Loss of the bulbocavernous reflex
• Priapism

Treatment
Treatment of neck injuries may be symptomatic or conservative, but in some cases may require surgery.

Neck Injuries Treatment

Treatment of neck injuries may be symptomatic or conservative, but in some cases may require surgery. Treatment has two main objectives: to reduce the pain and discomfort of the patient and prevent recurrence of symptoms. In the treatment non-steroidal anti-inflammatory drugs may be used, as well as epidural steroid injections and a variety of other approaches - cervical collar to immobilize, anatomic pillows, physical therapy and the like.

Mortality/Morbidity

Zone I injuries are associated with the highest morbidity and mortality rates. Initially missed cervical injuries secondary to neck trauma result in a mortality rate of greater than 15%. Ten percent of neck wounds lead to respiratory compromise. Loss of the airway patency may occur precipitously, resulting in mortality rates as high as 33%. Trauma is more common among males than females. Most people who experience neck trauma are adolescents and young adults.

Rehabilitation
Treatment and rehabilitation guidelines for neck injuries

Usually, urgent surgical exploration of a penetrating wound to the neck is indicated for the following:

• Continued blood loss, expanding hematoma, hypovolemic shock, and/or pulse deficit
• Airway obstruction, impending airway obstruction, open trachea, and/or air bubbling from the wound site
• Neurological deficit
• Blood in the aerodigestive tract, hemoptysis, and/or hematemesis
• New-onset bruit

Rehabilitation in cervical trauma is a complex procedure that involves specific measures appointed by your doctor and physiotherapist. Consulting a specialist is mandatory and is much needed to prepare a special program, tailored to the specific complaints and the specific history of injury/disease. In neck injury rehabilitation a manual techniques for pain relief are used often. This greatly helps the recovery of the affected areas. In certain cases an appointed program of exercises could be performed at home.

Prevention
Prevention of neck injuries

Frequency

Neck trauma accounts for 5-10% of all serious traumatic injuries. Approximately 3500 people die every year from neck trauma secondary to hanging, suicide, and accidents. [*United States]

Prevention of injuries to the neck can be facilitated by full caution while carrying out routine or specific activities - sports, driving, biking, workplace incidents and others. Always use the recommended protective gear during sports or performing specific work tasks. Regular check-ups will help you find various diseases “on time”, some of which can occur in the early stages without clearly noticeable symptoms.

Active movement and exercise can affect your overall good condition and prevent the discomfort of getting stuck, bad posture during long hours of work, which carries many underlying risks.

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