Stiff neck

Introduction Neck stiffness refers to muscle tension in the neck, swelling, stiffness, cramps, cramps, etc., and neck movement is not flexible. Common in fatigue, cervical spondylosis. Neck stiffness is a persistent over-contraction of muscles, which not only reduces the blood supply to the neck muscles, but also causes accumulation of metabolites such as lactic acid, which causes muscle ischemic pain and is a condition based on degenerative pathological changes. Mainly due to long-term cervical vertebrae strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical syndromes of dysfunction.

Cause

The basic pathological change of cervical spondylosis is the degeneration of the intervertebral disc. The cervical vertebra is located between the skull and the thorax. The cervical disc has frequent activities under load-bearing conditions and is susceptible to excessive micro-injury and strain.

The main pathological changes are: early cervical disc degeneration, decreased water content of the nucleus pulposus and fibrous swelling and thickening of the annulus fibrosis, followed by glassy degeneration and even rupture. After cervical disc degeneration, the pressure resistance and tensile strength are reduced. When subjected to the gravity of the skull and the pulling force of the muscles of the head and chest, the degenerated disc can undergo localized or extensive bulging to the periphery, narrowing the intervertebral disc space, overlapping the articular processes, dislocation, and the longitudinal diameter of the intervertebral foramen. Become smaller. As the traction resistance of the intervertebral disc becomes weaker, when the cervical vertebra moves, the stability between adjacent vertebrae decreases and the intervertebral instability occurs, the mobility between the vertebral bodies increases and the vertebral body has a slight slippage, which then appears Bone hyperplasia of the posterior facet joint, hook joint and lamina, degeneration of the ligamentum flavum and ligament, cartilage and ossification.

an examination

Related inspection

Cervical activity check cerebrospinal fluid glucose cerebrospinal fluid glucose (CSF-Glu) neck test neck test

(1) tenderness point paravertebral or spinous process tenderness, tenderness position is generally consistent with the affected segment.

(2) The range of cervical vertebra activity is the examination of flexion, extension, lateral flexion and rotational activity. Nerve root cervical spondylosis patients with limited neck activity, and vertebral artery type cervical spondylosis patients can appear dizziness when moving in a certain direction.

(3) The intervertebral compression test allows the patient's head to tilt toward the affected side. The examiner's left palm is placed flat on the top of the patient's head. The right hand grips the palm and gently slams the back of the left arm. If there is root pain or numbness, it is positive. In patients with severe radicular symptoms, pain, numbness, or exacerbation can occur with gentle pressure on the head.

(4) Intervertebral separation test For patients with suspected root symptoms, the patient sits, hands hold the head and pull up, if the upper limb pain is numb, it is positive.

Differential diagnosis

Differential diagnosis of neck stiffness:

1. The neck muscles are swollen and hardened: the neck muscles are swollen and hardened due to a clinical symptom caused by ossifying myositis. Myositis ossificans is a disease of muscle sclerosis, toe, and hallar deformity caused by deposition of progressive bone structure in muscle and connective tissue. The cause is unclear. Part of it is autosomal dominant. Common in children or youth. The congenital torticollis, torsion and neck muscles that are characterized by abnormalities are swollen and hard, but most do not have pain. Muscles can be involved in the whole body. Strenuous exercise or trauma can cause muscle rupture, hemorrhage and hematoma formation. Most patients have hematoma absorption, but they can also develop muscle stiffness and ossification, and eventually cause the joint muscles to be stiff and crippled.

2, the neck is tough: neck activity is limited, this symptom can be seen in the neck rib syndrome. Cervical rib syndrome is a complex clinical syndrome caused by vascular nerve compression in the thoracic exit area. It is also known as cervical thoracic outlet syndrome, anterior scalene syndrome, pectoralis minor muscle syndrome, rib lock syndrome, and excessive abduction. Syndrome, etc., refers to a series of upper extremity blood vessels and neurological symptoms caused by compression of brachial plexus and subclavian arteries and veins for some reason. Clinically, the main manifestations are pain, numbness of the shoulders, arms and hands, and even muscle weakness, weakness of the hands, cold and purple, and weakening of the iliac artery.

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