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The Neck

Loss of the ability to move the neck normally means that the capsules of the facet joints, sensitive ligamentous bags around the joints, are exposed to the risks of over-stretching. A sudden turn or twist of the head without thinking can lead to the ends of the joint movements being reached, when an overstrain injury and fibre damage happens. Joint pain and increasing joint tightness then follows as the capsules tighten further with the scarring of healing and the neck is held in a guarded position. Increasingly less able to cope with stretching, the stiffness can spread throughout the neck and this only becomes obvious when suddenly we can't do something we want to.

There are several potential sources of the pain of facet arthropathy: the muscle spasm which develops in response to the pain; the referred pain in the shoulder and arm from the pathology in the neck and the local pain of the abnormal facet joint. It's possible to feel the particularly tender area of a localised irritable facet joint in the neck while the referred symptoms are much more difficult to describe, being a vague and poorly defined ache in the arm or shoulder areas. Worsening of the neck pain can then interfere with sleeping, leading to added problems such as irritability, tiredness, anxiety and depression.

Turning the neck suddenly, being jarred unexpectedly or towelling the hair vigorously can result in a sudden onset of severe neck pain and loss of movement, a condition referred to as acute wry neck. People can also awake with the same kind of problem, perhaps because they have slept awkwardly and strained the neck. The facet joint locks instantly as the speed and unexpectedness of the activity bypasses our control and stability mechanisms. The sensitive capsular joint surround might be strained in these events or the joint could pinch a synovial membrane fold, resulting in instant, severe pain in the neck and limiting muscle spasm.

The patient's symptoms from an acute wry neck are severe pain, typically on one side of the neck, with considerable loss of range of motion. The neck may be held in an abnormal posture by the strength of the muscle spasm and the person is always very careful to avoid any sudden movements or jars. A sudden movement can cause an agonising increase in the compressive muscle spasm and it can be very challenging to even get down into or get up off the bed. Typically sufferers hold their heads in their hands as they get up and down to  minimise the stresses on the neck as the muscles engage.

An osteopath, physiotherapist or chiropractor can manipulate a locked facet joint early on in the problem with complete relief in some cases. The mechanism may be that the separation of the joint surfaces by the manipulation allows the realignment of the joint or releases the trapped tissue. More often the time to recovery is longer with anti-inflammatories and painkillers necessary for some days until the pain reduces and movements can be restarted. A less severe therapy technique, joint mobilisations, can be used later to clear the joint of any long-term abnormalities of its movement which could make the pain come back again later.


A facet joint lock episode is not the only possible reason for the sudden or a slower onset of neck pain as this can also be caused by a prolapsed disc or inflammatory insult to the nerve. If an original locking injury to the facet joint does not recover well or completely then the nerve root exiting through the narrow foramen can be surrounded by an inflammatory fluid which can gradually thicken into fibrous tissue. This can tether the nerve and if the nerve then suffers a quick stretch, which nerves are especially bad at tolerating, it can set up a very unpleasant syndrome with severe arm, shoulder and neck pain.

Neck pain is typically not a major part of this condition, with patients often giving a history of the neck and arm being unreliable or painful in small ways prior to onset. The full nerve root compression or irritation syndrome may be brought on by a minor mechanical stress which targets the specific vulnerability of the nerve pathology.

 

Further information: whiplash injury compensation

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