The cervical spine- the neck- consists of seven vertebrae which are stacked on top of each other and separated from each other up front by rubbery discs and in back by a pair- one on each side- of what are called uncovertebral joints. These are true joints which are covered with a thin layer of hyaline cartilage.
Right next to these joints, again on either side, are small holes or foramina, where nerve roots from the spinal cord exit. The spinal cord, originating in the brain, runs down a central canal or tunnel, formed by the various elements of the spine. The head weighs about 6-8 pounds depending on a person's intelligence (that's a joke, by the way) and is balanced on this cervical spine column.
Because of the complexity of the structures involved, it is no secret that neck pain can arise as a result of a variety of different causes. Arthritis can develop in the uncovertebral joints thereby narrowing the neural foramina. Since the nerve roots occupy 25 per cent of the volume of the foramina to start, further narrowing can lead to pinching of the nerves. In addition, disc hernation or the flattening of the discs that occurs with aging also can lead to narrowing of the neural foramina as well.
It has been estimated that more than 50 per cent of individuals beyond the age of 45 years have experienced at least one episode of neck pain.
With advancing age, neck pain tends to become more radicular, meaning there is an element of nerve pinching involved.
Pain coming from the cervical spine may be accompanied by pain in the shoulder. A pinched nerve in the neck, particularly a pinched nerve in the upper neck, often presents as shoulder pain. It may also cause pain to radiate down from the neck to between the shoulder blades.
Myofascial pain, pain arising from ligament strain or muscle spasm, can also be a source of discomfort.
Since conditions that cause neck pain and conditions that cause shoulder pain may coexist, it is often difficult to distinguish what problem is most responsible for the symptoms.
Diagnosis is made using a careful history and physical examination. Often times, though, even that can be unrewarding as far as providing an exact diagnosis. Imaging procedures such as magnetic resonance imaging and computerized tomography can be very helpful in sorting things out.
The choice of treatment obviously depends on diagnosis.
Physical therapy, non-steroidal anti-inflammatory drugs (NSAIDS), brief use of a cervical collar, gentle stretching and strengthening exercises, and injections may be useful.
For soft tissue causes, prolotherapy or injections with platelet rich plasma may be useful. Only in cases where there is significant nerve root impingement with progressive loss of function, or significant pressure on the spinal cord is there a need for a surgical solution.