Neck pain is a common issue especially amongst working adults in Singapore. Long hours in front of computers can place unnecessary strain on neck muscles. Despite it being a common complaint, many adults ‘live with’ the problem and do not seek medical help.

Within the neck lies the cervical portion of the spine, which acts as a vital pathway for the nerves coming to and from the brain to the body. Any dysfunction at this level of the spine can severely impact the hands and upper limbs, and may even affect the rest of the body.

The main issue lies in narrowing of the cervical spinal canal, through which these structures run. Narrowing can result in pressure on the spinal cord and may also cause pressure on the spinal nerves which exit the spinal canal at every segment.

How does neck pain occur?

Generally, neck pain can either be caused by injury or non-injurious reasons. Neck injuries include those sustained during falls, motor vehicular accidents, and blows to the head. Non-injurious or atraumatic neck pain is insidious and generally a result of poor workplace habits.

Workplace ergonomics are generally poor, with a one size fits all approach. Often times, computer monitors and chairs are either not adjustable, or cannot be adjusted fully. Occasionally, monitors are placed in an awkward fashion, necessitating that one work with their neck at an angle.

This problem is especially compounded if there is an underlying neck condition. Generally, any problem in the neck destabilizes the neck, and the body compensates by dynamically activating neck muscles. This places the muscles under strain.

Over time, the muscles may become fatigued and become unable to compensate. This results in a situation known as decompensation, where the patient starts to experience neck pain, and may also start to have other symptoms.

Where does neck pain come from?

There are 3 major components of neck pain, and your neck pain is usually a combination of these 3 sources:

• Muscular pain from overworked neck muscles is characterized as an aching, cramping type of pain at the back of the neck, and may also be experienced at the shoulders and upper back (due to overworked trapezius muscle).
• Discal pain comes from the intervertebral disc, a cartilaginous structure between 2 bones of the spinal column. A tear in the outer fibres (annulus fibrosus) of the disc results in sharp pain, and puts a patient at risk of a disk protrusion.

Facet joint pain is caused by pain arising from joints in the spine, which are known as facet joints. These sometimes can wear out, and can cause neck pain.

Symptoms related to neck pain

• Shooting pain down the arms is caused by pinched nerves in the neck region. This is often described by patients as shooting pain or as an electric current coursing down their arms. It can often be triggered by the patient placing their neck in a specific position. This sort of nerve pain is termed radicular pain.
• Arm or hand numbness and weakness is caused by pinching of the nerves as mentioned previously. Besides causing pain, the nerves also bring sensation from the arms and hands to the brain (numbness) and allows you to move your arms and hands (weakness). Therefore, any pinching of the nerves in the spine can also cause numbness and weakness.
• Tingling/burning/insect crawling sensations can result from pinching of the nerves within the spinal canal. This condition is known as paraesthesia.
• When the cervical spinal canal is severely narrowed (degeneration), there can be a lot of pressure exerted on the spinal cord. This can result in spinal cord softening (myelo-malacia), and may also predispose to injury when falls are sustained (central cord syndrome).

This sort of spinal cord softening results in loss of coordination in the hands, and may lead to the inability to pick up or manipulate small objects. In the asian context, this is commonly manifested as inability to manipulate and use chopsticks or sewing needles/buttons.

In even more severe cases, the patient may experience unsteadiness when walking which can predispose to falls and injury. This condition including the effect on the upper and lower limbs is known as myelopathy.

How will my neck pain be worked up?

Here at our center, we will first conduct a medical interview where we will explore the symptoms and causes of your neck pain. This is followed by a focused examination on the neck and associated areas to detect any signs of neck problems.

This is usually followed by either cervical spine X-rays and/or an MRI scan of the cervical spine to further delineate the underlying cause of your neck pain. Based on the available information, we will then present to you our diagnosis of the condition and discuss treatment methods.

A list of conditions that cause neck pain can be found here.

Treatment of neck pain

Treatment of neck pain is usually undertaken by the treatment of the underlying condition. We provide a full suite of options for surgical and non-surgical treatment of neck pain, and work with a curated team of professionals to manage your neck condition.

Treatments may include:

• Medications for neck, shoulder and arm pain
• Lifestyle modification and workplace ergonomic advice to help you cope and manage work related neck pain
• Neck muscle physiotherapy to strengthen your neck and improve function while relieving pain
• Pain procedures to treat the underlying causes of neck pain
• Surgery to release pinched nerves and stabilize the worn out cervical spine

References:

Related Articles by Dr Yong Ren

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• Treatments for Neck Pain: Understanding the Causes and Management Options
• Neck Pain Solutions: Your Complete Guide
• Strategies for Neck Pain Treatment
• Strategies for Chronic Neck and Shoulder Pain Relief: Transforming Discomfort into Vitality