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Condition/Disorder Synonyms

  • Neck sprain

  • Neck strain

ICD-9-CM Code

  • 847.0 Sprain of neck

ICD-10-CM Codes

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

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

Preferred Practice Pattern

Key Features

Description

  • 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

Essentials of Diagnosis

  • Symptoms may be delayed for 24 hours2

  • Quebec task force grade levels

  • Diagnosis made by clinical examination and patient history

General Considerations

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

  • Pain may become chronic if musculature strength not regained

Demographics

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

Clinical Findings

Signs and Symptoms

  • 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

Functional Implications

  • Difficulty maintaining sustained sitting postures

Possible Contributing Causes

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

  • Trauma from auto accident, physical abuse, contact sports

Differential Diagnosis

  • 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

Means of Confirmation or Diagnosis

Imaging

  • 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

Findings and Interpretation

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

Treatment

Medication

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