Cervicocranial syndrome and whiplash neck injury
Cervicocranial syndrome - is a painful condition in cervico-occipital junction, resulting from head or neck (cervical spine) trauma or their chronic overload. It causes irritation of pain receptors in ligaments, intervertebral (facet) joints capsules, cervical spine muscles and aponeurosis in an occipital part of the skull (at the nape).
The source of pain in cervicocranial syndrome is chronic overload of supporting structures in this area (head trauma or cervical spine injury). Cervical spine injury by occurrence time may be acute (because of motor vehicle accidents, falls, head impacts, falling neck and occipital injury), or chronic (a sedentary job, infant feeding, etc.).
Cervical (ligaments, muscles) and head whiplash injury mechanism during the car accident or collision (skating, rollerblading, skiing or snowboarding) cause the cervicocranial syndrome.
Acute traumatic neck (cervical spine) and the cervico-occipital junction injury occurs at falling, collision with another moving or stationary object, person (skiing, snowboarding, etc.). By a similar cervical spine injury (contusion) mechanism is occurs a jerk in cervico-occipital junction and intervertebral joints. Because of the cervical spine trauma occurs neck's muscles and ligaments sprain (anterior, posterior, lateral group, or its combinations).
Sometimes the range of motion in the neck may be greater than cervical spine physiological norm. Then the probability of rupture of ligaments and muscles with subluxation of intervertebral (facet) joints and the odontoid process of C2 cervical vertebrae.
Localization of the typical muscle pain points in trauma (injury) or chronic overload the muscles and ligaments of the neck.
Because of the intensity of pain in the nape and neck in the cervical spine trauma or contusion, patient is unable to find a comfortable sleeping position.
Chronic neck (cervical spine) and the cervico-occipital junction trauma is formed by static load of repetitive motion over a long period of time (sedentary work). In this case, for some time, a person experiences discomfort in the neck and head. Acute pain in the cervical spine may cause hypothermia, rapid head movement (head turning aside or backward), uncomfortable neck position during sleep.
On the background of whiplash cervical spine injury and neck pain can occur irritation of the vertebral arteries, which extending in the transverse processes of the cervical vertebrae.
Pain localization in cervicocranial syndrome and whiplash neck injury, radiating from the neck to the area between the shoulder blades or below, in the shoulders.
It should be noted that in addition to neck and head pain (back of the head, temples, crown, forehead), patients may experience and vestibular disorders. Vestibular disorders because of irritation of the vertebral arteries, which are expressed dizziness and unsteadiness when walking, nausea and vomiting. Sometimes the clinical manifestations of cervical-cranial syndrome lead to brain concussion misdiagnosis by some physicians.
At cervical-cranial syndrome are also possible complaints about tinnitus (ringing or buzzing in the ears) and head (cochlear manifestation), numbness of the face, nape, ear and tongue.
Occurs rapid fatigability. On morning after sleeping, there is sense that not get enough sleep. Sometimes on this background may occur insomnia. Overall working capacity and attention will be reduced, occurs irritability.
Vertebral artery, extending in the transverse processes of the cervical vertebrae, can react with vascular spasm (vasoconstriction) and dizziness in cervicocranial syndrome case.
Clinical classification of subaxial (C3-C7 vertebrae) cervical spine injury includes the following types of trauma:
- compression fracture,
- burst fracture,
- flexion-distraction neck injury,
- articular processes dislocation (unilateral or bilateral)
- articular processes fracture.
There is also Allen and Ferguson classification in cervical spine injuries and used in the specialized literature and in scientific research. This cervical spine subaxial (C3-C7 vertebrae) injury classification based on X-ray data and the mechanism of trauma:
- vertical compression,
- articular process subluxation,
- articular processes unilateral dislocation,
- articular processes bilateral dislocation (50% displacement),
- complete dislocation (100% dislocation);
- lateral flexion.
For the diagnosis of neck (cervical spine) injuries and cervical-cranial syndrome patient should consult with a doctor for neurological examination, where also should be evaluated cervical spine biomechanics changes (range of motion, muscle tone and strength, myofascial trigger in neck muscles, etc).
During the patient's neurological examination with neck injury may be detected:
- monoradiculopathy symptoms,
- spinal cord compression symptoms.
Monoradiculopathy occurs in patients with unilateral dislocation. Unilateral dislocation of the articular processes (facet joints) at the C5-C6 vertebrae level is usually manifested in the form of C6 nerve radiculopathy. In this case, the patient complains of muscle weakness during wrist extension, fingers numbness and tingling.
Articular processes (facet joints) unilateral dislocation at the C6-C7 vertebrae level is usually manifested in the form of C7 nerve radiculopathy. In this case, the patient complains of muscle weakness during arms extension at the elbow (triceps), in wrist flexion, as well as numbness and tingling of the index and middle fingers.
Spinal cord compression neurological symptoms occur in cervical vertebrae bilateral dislocation case, which may be exacerbated with subluxation increase.
According to the results of patient examination can be diagnosed and prescribed treatment. In the case of not the fully qualified diagnosis can be performed additional diagnostic procedures:
- neck and brain vessels REG and Doppler ultrasound,
- X-rays of the cervical spine with functional tests,
- cervical spine CT,
- cervical spine MRI.
Cervical spine magnetic resonance imaging (MRI) helps in diagnosing discs damage and the cervical vertebrae dislocation in patients with cervicocranial syndrome.
In case of the cervical spine injury, when conventional treatment does not give a positive effect, in the neck muscles and intervertebral joints can be produced injection of drugs (therapeutic blockade). For this it suffices low doses of anesthetic (Novocaine, Lidocaine) and Cortisone, Diprospan or Kenalog, injected into the affected facet joint lumen.
With a combination of a properly chosen physiotherapy, these injections can give to patient a good and long-lasting effect at headaches and neck pains after the whiplash injury.
Reduction of swelling, inflammation, pain and facet joints and neck muscles range of motion restoration in the cervicocranial syndrome after cervical spine injury treatment is accelerating by physiotherapy.
Depending on the patient's neck pain, headache severity and dizziness after a head or cervical spine injury (cervical-cranial syndrome), following treatments may be prescribed:
- using of a neck brace or corset (Schantz bandage, Philadelphia collar),
- drug therapy (NSAIDs, analgesics, hormones),
- therapeutic blockade - the injection of drugs in pain and trigger points,
- manual therapy,
- physiotherapy (UHF, SMC, etc.),
- medical gymnastics,
- surgical treatment.
Using a cervical orthoses (Miami J, Philadelphia collar) in the treatment of cervicocranial syndrome with sprains and traumatized facet joints after the cervical spine injury.
Using a special neck brace (Philadelphia collar) or neck corset (Schantz bandage) limits the range of motion in the stretched ligaments and injured facet joints capsules at cervico-cranial syndrome (subaxial cervical spine injury). Neck brace (Philadelphia collar) and soft cervical collar (Schantz bandage) creates additional support for a protective muscle tension and spasm, which is always formed in the patient because of the neck injury (cervical spine trauma).
Wearing a cervical-thoracic orthoses (Minerva, SOMI) in the treatment of cervicocranial syndrome with sprains and the cervical facet joints injury after whiplash trauma.
Due to the limitation of movement, using a neck brace (Philadelphia collar) or neck corset (Schantz bandage) eliminate pain symptoms in the neck and nape (cervico-cranial syndrome) much faster. This facilitates rapid range of motion restoration in stretched ligaments and injured facet joints after the cervical spine injury.
If you have any questions on the diagnosis or treatment of neck injuries or cervicocranial syndrome, you can ask them to our neurosurgeon or neurologist: (499) 130–08–09
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