Traumatic onset neck pain

Definition

Acute cervical spine trauma encompasses a wide range of potential injuries ranging from a seemingly innocuous fall to a high-energy motor vehicle accident. Most patients present immediately after a traumatic incident, but some may present days to weeks later. The presentation of the individual case will determine urgency considerations. Further information is provided below about traumatic neck pain and specifically Whiplash Associated Disorder (WAD).

Typical signs & symptoms:

Central neck pain
Loss of sensation or paralysis in the body, arms, and/or legs
Pain that radiates from the neck into the arms and/or shoulders

Prevalence

Cervical trauma results primarily from motor vehicle accidents, falls (especially in the elderly), sports activities, and diving into shallow water.

Risk Factors

Age 18-25 (80%) or >65 years (especially if they have risk factors for osteoporosis)
A fall from a height >1 metre or 5 steps
An axial load to the head (e.g., diving, high-speed motor vehicle collision, rollover motor accident, ejection from a motor vehicle, accident involving motorised recreational vehicles, bicycle collision, horse riding accident)
Approximately one third of patients with cervical spine and/or spinal cord injuries have an associated head injury

Prognosis

Most patients with acute neck pain or whiplash will recover completely in a matter of days to weeks. Approximately one third of patients will experience persistent symptoms.

Risk factors for poor outcome

High intensity initial pain is associated with persistent neck pain and disability
There is a positive association between post-traumatic stress symptoms and outcome
Negative expectations of recovery are associated with ongoing neck pain and disability
Self-rated collision severity may be predictive of poor recovery
Decreased initial neck range of motion and initial cold hyperalgesia are predictive of ongoing disability

Other considerations

Canadian C Spine rule

Patients with traumatic neck pain are typically managed through A&E. However, prior to completing a physical examination, it is important to apply the Canadian C Spine Rule if appropriate.

Patients with known vertebral disease (i.e. ankylosing spondylitis, rheumatoid arthritis, spinal stenosis, previous cervical spine surgery), hypermobile patients (inc. Ehlers Danlos syndrome and Marfan’s), Down’s syndrome, and gymnasts should have a higher level of suspicion of cervical spine injury.

Whiplash Associated Disorder (WAD)

Whiplash is subcategory of traumatic neck pain, some specific WAD information is below.

WAD Patient Resources

Whiplash Classification – Quebec Task Force Classification of whiplash-associated disorders

neck pain and associated symptoms in the absence of objective physical signs.
neck pain and associated symptoms in the presence of objective physical signs and without evidence of neurological involvement.
neck pain and associated symptoms with evidence of neurological involvement including decreased or absent reflexes, decreased or limited sensation, or muscular weakness.
neck pain and associated symptoms with evidence of fracture or dislocation.