Finding the Cause of Your Neck
Pain
Finding
the cause of neck pain begins
with a complete history and physical
examination. After the history
and physical exam, your doctor
will have a good idea of the cause
of your pain. To make sure of
the exact cause of your neck pain,
your doctor can use several diagnostic
tests. These tests are used to
find the cause of your pain, not
to make your pain better. Regular
X-rays taken in the doctor's office
are usually a first step in looking
into any neck problem and will
help determine if more tests are
needed.
Complete
History
A
"complete history" is usually made up of two
parts. The first part is written; a form that you fill
out while you wait to see the doctor. While you fill out
the form, take time to think about everything you can
remember that relates to your neck pain and write it down.
The more you can tell your doctor, the faster he or she
can diagnose the cause and help relieve your pain. The
second part of your history will be answering questions.
Your doctor will ask you to describe when your neck pain
began and the type of pain you are having.
Examples
of questions that might be asked include:
•
When did the pain first begin?
• Have you increased your activity level?
• Have you had an injury, or surgery, to your neck
at any time?
• Does the pain go down into your arms or legs?
• What causes your neck to hurt more or less?
• Have you had any problems with your bowels or bladder?
Physical
Examination
Once
most of the information is gathered, your doctor will give
you a thorough physical exam. During the exam, your doctor
will look at your neck to find out how well it is functioning.
This includes:
•
How well you can bend your neck and roll your head in all
directions
• How well you can twist your neck
• If there is tenderness around the neck
• If there are muscle spasms around the neck and shoulders
Tests
that examine the nerves that leave the spine are also important.
These include:
•
Testing
for numbness in the arms and hands
•
Testing
the reflexes
•
Testing
the strength of the muscles in the arms, hands, and legs
•
Testing
for signs of nerve irritation
X-rays
X-rays
show the bones of the cervical spine. Most of the
soft tissue structures of the spine, such as the nerves,
discs, and muscles, do not show up on X-ray. X-rays
can show problems that affect the bones, such as infection,
fractures, or tumors of the bones. X-rays may also
give some idea of how much degeneration has occurred
in the spine. X-rays alone will not show a herniated
disc. Also, narrowing of the disc space between each
vertebra and bone spurs do show up on X-rays. The
X-rays will be useful in showing how much degeneration
and arthritis are affecting the neck.
Magnetic
Resonance Imaging (MRI)
The
MRI is the most commonly used test to evaluate the
spine because it can show abnormal areas of the soft
tissues around the spine. The MRI is better than an
X-ray because in addition to the bones, it can also
show pictures of the nerves and discs. The MRI is
done to find tumors, herniated discs, or other soft-tissue
disorders. The MRI is painless and lasts about 90
minutes. During the MRI, very detailed computer images
of sections of the spine are taken. Unlike most other
tests, which use X-rays, the MRI uses magnetic fields
and radio waves to see the structures of the neck.
Pictures can also be taken in a cross-section view.
The MRI allows the doctor to clearly see the nerves
and discs without using special dyes or needles. In
many cases, the MRI scan is the only special test
that needs to be done to find the cause of your neck
pain.
MRI Scan Cervical Stenosis
Computer
Assisted Tomography (CAT Scan)
The
CAT scan is a very detailed X-ray, and is very
similar to the MRI. During a CAT scan, cross-section
X-rays, or X-ray "slices", are taken
of the spine. The CAT scan shows the bones of
the spine much better than the MRI; however,
the MRI is better than the CAT scan for showing
soft tissues. The CAT scan is most useful when
your doctor suspects a condition that only affects
the bones of the spine. The CAT scan is commonly
combined with a myelogram to get a better picture
of the spinal nerves. Together, these two tests
can help determine if the pressure on the nerve
is from spinal stenosis or a herniated disc.
CAT
Scan Cervical Stenosis
The
CAT scan is done much like the MRI; you are
on a table that slides into the scanner, while
you lie very still. The CAT scan lasts about
30 to 60 minutes. If dye is used, you will have
restrictions on what you can eat or drink before
the test. After pictures have been taken without
dye, you will be removed from the scanner and
dye will be injected. Then, you will be moved
back into the scanner and more pictures will
be taken.
Myelography
(Myelogram)
Myelography
is used to evaluate an area of the spine called the
subarachnoid space. Myelography is used to find herniated
discs, injury to the spinal nerve roots, or tumors.
During this test, a special dye, which can be seen
on the X-ray, is injected into the spinal sac. Because
the dye weighs more than spinal fluid, the movement
of the dye can be watched as the table is tilted up
and down. By watching the movement of the dye, the
doctor can see the outline of the subarahcnoid space.
If the shape of the spinal sac looks abnormal, or
indented, this may mean there is pressure on the nerves
of the spine. A herniated disc may cause this pressure.
Myelogram Cervical Stenosis
You
will have restrictions on your diet for several hours
before the test. The test begins with the doctor inserting
a needle between two discs in your back. This is done
while you lie on the edge of the table with your chin
on your chest and your knees drawn up toward your
chest. Once the needle is in place, you will turn
over and lie flat on your stomach. Then the nurse
will strap you to the table for your protection. The
doctor will inject dye through the needle in your
back. You may notice a brief burning feeling as the
dye is injected. After the dye is injected, you may
feel warm or flushed. The table will be tilted. As
the table tilts, the dye will flow through the spinal
area. The doctor will watch the flow of the dye and
take X-rays. After X-rays have been taken, the needle
will be removed and you will rest in the hospital
for several hours or maybe overnight.
Electromyogram
(EMG)
An
EMG tests the speed at which the nerve roots send
electrical messages to the brain. The test is done
by inserting tiny needle electrodes into the muscles
of the lower leg. The EMG measures the electrical
signals in the muscles. The EMG can show if a nerve
is being pinched after it branches from the spine.
Before
the test, you may have some restrictions on what you eat
or drink, including certain medications. You will need to
sign a consent form. During the test, you will lie down
or sit so that the muscles being tested are at rest. Then
a needle electrode is inserted into the muscle; you may
feel some discomfort. A metal plate that records the electrical
signal is placed under you. Abnormal electrical activity
can mean that the nerve is being pinched. The test lasts
about an hour.
Bone Scan
A bone scan is used to help locate
the affected area of the spine. In order to perform a
bone scan, a radioactive chemical is injected into the
bloodstream. The radioactive chemical attaches itself
to areas of bone that are undergoing rapid changes for
any reason. Areas of the skeleton that are undergoing
rapid changes appear as dark areas on the film. Once the
affected area is identified, other tests, such as the
MRI scan are done to look more closely at the specific
area.
Laboratory Tests
There are many possible causes of
neck pain. Some of these causes are not related to degeneration
of the spine. Blood tests to look for infection or arthritis
may be necessary. Problems originating in areas other
than the spine may also cause neck pain. If your doctor
feels that you may have a throat problem or a thyroid
problem, other tests may be ordered to make sure the problem
is not coming from these areas.
