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Clinical Evaluation on Tension Neck Syndrome

Medicine

Clinical Evaluation on Tension Neck Syndrome

Introduction

Musculoskeletal injury refers to damage of skeletal and muscular systems which is caused by strenuous activities. The injuries can affect any part of the body including muscles, tendons, bones, joints, and cartilages among other parts (Partanen et al., 2010). Some of the musculoskeletal injuries include bone fractures, ligament sprain, tension neck syndrome, and osteoarthritis among others. This essay will focus on the clinical evaluation of tension neck syndrome.

Overview

Tension neck syndrome encompasses various named syndromes or disorders that involve the areas of a human body around the shoulder and neck areas which are collectively termed as brachial (sholder or arm) and cervico (neck) (Parihar et al., 2016). The syndrome is based on the sensation of the neck and shoulder pain with objective signs of stiff and tender muscle, hard, sensitive areas in the muscles that feel as tight nodules or bands and spasms. Pain can be caused by these sensitive areas in the muscles called trigger points which results to numbness or tingling to radiate to more distant regions of the neck, shoulders, head and upper back though not related to pinched nerves. Unusual sensations produced by these strained muscles can be related to the nervous system and have been thought to be a psychological reaction that leads to rather disturbing descriptions such as “psychogenic rheumatism” or “occupational neurosis”. Tension neck syndrome is mostly found among office workers, assembly line workers, cashiers and packers among other people. The tension is mostly as a result of overworking, fatigue, immobility, sustained postures, strain, chilling as well as psychological factors such as depression and emotional stress (Neupane et al., 2017). The syndrome may be a combination of mental and muscle factors. Muscle factors are associated with repetitive motions of wrists, arms and fingers at a higher speed and this can occur so many times for every work. Additionally, muscle problems can be caused by unusual and stationary postures when using raised elbows or shoulders along with heavy workloads. There are also working conditions which result to mental stress since they have the need for intense concentration and high levels of pressure as well as noise and poor lighting resulting to tension neck syndrome.

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Epidemiology

A study carried out in 2010 on Global Burden of Disease showed that out of 291 conditions neck pain was the fourth highest in terms of disability as measured by YLDs and 21st when it comes to the overall burden. Disability Adjusted Life Years (DALYs) has been increasing over the years as a result of increased neck pain mostly due to growth of the population as well as an increase in the aging population. The number of people experiencing tension neck syndrome is likely increase in the coming decades due to improved child survival and aging population globally mostly in low and middle-income countries (Partanen et al., 2010).

There is a substantial variance in the prevalence rates of neck pain that are reported mostly due to variation when defining neck pain. At any given time, at least 10% of the population reports neck problems with 54% of individuals having experienced neck pain within a number of months. Prevalence is higher in higher income countries compared to low and middle-income countries and it is also higher in women than men. There are high rates of recurrence and chronicity of neck pain with most people who have neck pain not experiencing a complete resolution of symptoms. According to Parihar et al. (2016) at least 30% of the patients with neck pains develop chronic symptoms with 37% of people who experience neck pain reporting problems which are persistent for at least 12 months. The course may be stable or fluctuating in chronic conditions although in most cases it can be said to be recurrent characterized by periods of improvement followed by periods of worsening. Risk factors associated with tension neck syndrome are the same with other musculoskeletal conditions such as psychopathology (for instance poor coping skills, depression and anxiety), smoking, sleeping disorder and sedentary lifestyle among others. However, some of the unique risk factors for this syndrome include history of neck pain and certain sport injuries such as football and wrestling.  

Differential diagnoses

Even though most common causes of neck pain are benign, it is crucial to consider differential diagnoses particularly those people who require referral to specialists and swift treatment. Neupane et al. (2017) explain that neck pain that persists beyond 6 weeks or is associated with red flags may benefit from radiographic evaluation. One of the helpful algorithm to further assess the need for imaging of neck pain after trauma is the Canadian Cervical Spine Rule. Also, routine imaging studies of non specific neck pain such as MRI and X-rays is mostly the first imaging modality following an initial evaluation.  A 2-view examination is sufficient when there is no history of trauma. For symptomatic patients suspected of ligamental injury and spinal instability, flexion and extension views may be appropriate. Further imaging for patients with chronic neck pain is not recommended by the American College of Radiology unless there is a presence of neurologic symptoms and signs (Parihar et al., 2016). When patients have neurologic symptoms, they proceed with MRI without contrast to assess for possible causes such as cervical stenosis, cervical disc herniation and to rule out serious causes such as infection and spinal tumor. MRI has high sensitivity for visualizing spinal/neuroforaminal stenosis and disc herniation. The alternative imaging choice for individuals is the computed tomography (CT) with the myelogram for individuals with contraindications for MRI (that is metal implants, pacemaker). A CT scan tends to be more specific with greater sensitivity for detecting fractures compared to plain x-rays.

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Summary of findings

The tension neck syndrome is caused by the sensation of the neck and shoulder pain. It is among office workers, assembly line workers, cashiers and packers among other people. The tension is mostly as a result of overworking, fatigue, immobility, sustained postures, strain, chilling as well as psychological factors such as depression and emotional stress. Risk factors associated with tension neck syndrome are smoking, sleeping disorder and sedentary lifestyle, history of neck pain and certain sport injuries such as football and wrestling.  In terms of diagnosis, a neck pain that has been persistent for at least 6 weeks may benefit from radiographic evaluation. Tension neck syndrome has been increasing among different individuals globally over the years and is suspected to continue increasing even in the coming decades mostly due to lifestyle among other elements. Some of the routine imaging studies include MRI and X-rays. Patients can proceed to MRI which has sensitivity for visualizing spinal/neuroforaminal stenosis and disc herniation.

References

Neupane, S., Ali, U. I., & Mathew, A. (2017). Text neck syndrome-systematic review. Imperial Journal of Interdisciplinary Research3(7), 141-8.

Parihar, J. K. S., Jain, V. K., Chaturvedi, P., Kaushik, J., Jain, G., & Parihar, A. K. (2016). Computer and visual display terminals (VDT) vision syndrome (CVDTS). medical journal armed forces india72(3), 270-276.

Partanen, J., Ojala, T., & Arokoski, J. P. (2010). Myofascial pain syndrome–fascial muscle pain. Duodecim; laaketieteellinen aikakauskirja126(16), 1921.

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