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Condition/Disorder Synonyms

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  • Neck sprain

  • Neck strain

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ICD-9-CM Code

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  • 847.0 Sprain of neck

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ICD-10-CM Codes

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  • S13.4XXA Sprain of ligaments of cervical spine, initial encounter

  • S13.8XXA Sprain of joints and ligaments of other parts of neck, initial encounter

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Preferred Practice Pattern

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Key Features

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Description

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  • Whiplash-associated disorders (WAD): injury dysfunction and symptoms

  • Cervical acceleration-deceleration injury (CAD): mechanism of injury

  • Traumatic neck pain from being hit from behind

  • Quick movement through an S-curve causing upper cervical flexion and lower cervical hyperextension2

  • Post-traumatic mechanism of injury to the head/neck, most commonly secondary to motor vehicle accident3

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Essentials of Diagnosis

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  • Symptoms may be delayed for 24 hours2

  • Quebec task force grade levels

  • Diagnosis made by clinical examination and patient history

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General Considerations

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  • More common in women than men, possibly from neck muscle strength and stability

  • Pain may become chronic if musculature strength not regained

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Demographics

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  • Women appear to be at greater risk secondary to less stiffness of the cervical structures4

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Clinical Findings

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Signs and Symptoms

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  • Neck pain5

  • Muscle pain5

  • Stiffness

  • Headaches, 50% to 60%5

  • Dizziness

  • Generalized neck and upper back pain, typically absent of radiculopathy

  • Ringing in the ears

  • Blurred vision

  • Sleep disturbance

  • Guarded and limited active motion of the cervical spine

  • Hypertonic surrounding musculature

  • Compensatory neck motion initiated by global cervical musculature, including sternocleidomastoid and scalenes

  • Potential sympathetic symptoms

  • Post-traumatic psychosocial impairments

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Functional Implications

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  • Difficulty maintaining sustained sitting postures

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Possible Contributing Causes

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  • Occupation that requires prolonged sitting postures including desk work, driving, horseback riding falls, and overhead activities

  • Trauma from auto accident, physical abuse, contact sports

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Differential Diagnosis

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  • Cervical fracture including C2 hangman fracture

  • Odontoid process fracture

  • Examine for complete loss of neck movement, pain with gentle compression/traction, and severe muscle spasm

  • Subcranial instability

  • Cervical radiculopathy

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Means of Confirmation or Diagnosis

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Imaging

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  • Plain film open mouth radiograph essential to rule out odontoid fracture

  • CT Imaging essential to rule out odontoid fracture

  • Radiograph and CT helpful to rule out c-spine factures

  • MRI often negative in the presence of clinical impairments and significant pain with the absence of neurologic involvement6

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Findings and Interpretation

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  • Severe muscle spasm, muscle weakness, or pain upon gentle compression of the cervical spine may indicate fracture1

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Treatment

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Medication

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