Neck pain may result from abnormalities in the soft tissues - the muscles, ligaments, and nerves which support the spine as well as the bones and joints of the spine itself. The most common causes of neck pain are soft tissue abnormalities due to injury or prolonged wear and tear. In rare cases, infections or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders or arms.

Degenerative and inflammatory diseases - Degenerative diseases that cause neck pain include osteoarthritis and rheumatoid arthritis. Osteoarthritis usually occurs in middle aged or older people as a result of wear of the joints between the bones in the neck. Rheumatoid arthritis can cause destruction of the joints of the neck in patients of any age. Both of these major types of arthritis can cause stiffness and pain.
Cervical disk degeneration is also a major source of neck pain and arm symptoms such as pain, numbness, and weakness. The disk acts as a shock absorber between the bones in the neck. In cervical disk degeneration (typically age 35 and up), the normal gelatin-like center of the disk degenerates and the space between the vertebrae narrows. As the disk space narrows, added stress is applied to the joints of the spine causing further wear and degenerative disease. The cervical disk may protrude and cause pressure on the spinal cord or nerve roots when the rim of the disk weakens. If the outer covering of the disc actually tears it is possible that the disc material may press on the adjacent nerves. This is known as a herniated cervical disk.

Injury - Because the neck is so flexible and because it supports the head (weighing about 15 pounds), it is extremely vulnerable to injury. Motor vehicle or diving accidents, contact sports, and falls often result in serious and disabling neck injury. The regular use of safety belts in motor vehicles can help to prevent or minimize injury. A "rear end" automobile collision may result in hyperextension, a backward motion of the neck beyond normal limits, or hyperflexion, a forward motion of the neck beyond normal limits. Such strains are collectively called “whiplash” injuries. These common injuries involve the soft tissues, i.e., muscles and ligaments. Severe injury with a fracture or dislocation of the neck may damage the spinal cord and cause paralysis below the level of the injury.

Much less common causes of neck pain include tumors, infections, or congenital abnormalities of the vertebrae.

When should you seek medical care?
If severe neck pain or arm pain occurs following an injury (motor vehicle accident, diving accident, fall), a trained professional, such as a paramedic, should immobilize the patient to avoid the risk of further injury and possible paralysis. Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs. Radiating pain or numbness in your arms or legs with or without weakness should be evaluated by a medical professional.
If there has not been an injury, you should seek medical care when neck pain is:
continuous and persistent
severe
accompanied by pain that radiates down the arms or legs
accompanied by headaches, numbness, tingling, or weakness

Who can treat neck pain?
Many patients seek our care for neck pain, because our specialists at the Virginia Spine Institute are specifically trained in the workings of the musculoskeletal system, including the diagnosis, treatment, and prevention of problems involving the muscles, bones, joints, ligaments and tendons of the spine.

Diagnosing neck pain
Determining the source of the pain is essential to recommend the right method of treatment and rehabilitation.Therefore a comprehensive examination is required to determine the cause of neck pain.
Your orthopaedist will take a complete history of the difficulties you are having with your neck. He or she may ask you about other illnesses, any injury that occurred to your neck and any complaints you have associated with neck pain. Previous treatment for your neck condition will also be noted.
Next, your orthopaedist will perform a physical examination. This examination may include evaluation of neck motion, neck tenderness, and the function of the nerves and muscles in your arms and legs.
X-ray studies often will be done to allow your orthopaedist to look closely at the bones in your neck. These simple diagnostic techniques often help orthopaedists to determine the cause of neck pain and to prescribe effective treatment.

Patients who require further evaluation may undergo one or more of the following examinations:
MRI (magnetic resonance imaging). This non X-ray study allows an evaluation of the spinal cord and nerve roots.
CT (computed tomography). This specialized X-ray study allows careful evaluation of the bone and spinal canal.
Myelogram (injection of a dye or contrast material into the spinal canal). This specific X-ray study also allows careful evaluation of the spinal canal and nerve roots.
EMG (electromyogram). This test evaluates nerve and muscle function.

Your spinal surgeon may supplement your evaluation with blood tests, and, if necessary, will consult with other medical specialists.