NECK INJURIES

MANUAL MINORS

From the perspective of an emergency physician working in an emergency department, neck injuries can range from minor bruises to severe injuries affecting the spinal cord.

The evaluation and management of these injuries require a systematic approach to prevent long-term complications and ensure appropriate care. Below are the most common neck injuries and their management:

Category	Description
Fractures	Cervical Vertebrae Fracture: A fracture in the cervical vertebrae caused by direct trauma, car accidents, falls, or sports injuries. It can be stable or unstable, with potential neurological deficits.
Dislocations	Cervical Vertebrae Dislocation: Displacement of a cervical vertebra from its normal position caused by severe trauma. This can result in intense pain, stiffness, and neurological deficits.
Spinal Cord Injuries	Traumatic Spinal Cord Injury: Caused by cervical fractures or dislocations, leading to partial or complete paralysis, loss of sensation, and internal organ dysfunction, depending on the level of injury.
Soft Tissue Injuries	Sprains and Strains: Includes “whiplash” from sudden neck movements, resulting in pain, stiffness, and sometimes mild neurological symptoms.
Soft Tissue Injuries	Contusions and Haematomas: Bruises caused by direct blows, with pain, swelling, and bruising. In severe cases, blood vessels may be affected, with a risk of haematoma formation.
Nerve Compression	Cervical Radiculopathy: Compression of a cervical nerve root, usually caused by herniated discs or spinal stenosis, leading to radiating pain, weakness, and sensory disturbances.
Nerve Compression	Cervical Tunnel Syndrome: Compression of the spinal cord due to spinal canal stenosis, resulting in neck pain, weakness in the limbs, and coordination problems.

Management Protocol

1. Initial Evaluation:

   
   

   • Clinical History and Physical Examination: Identify the cause of trauma, assess neurological symptoms, and check for pain or deformity. Perform a rapid assessment for signs of neurological or vascular compromise.

     
     

   • Immobilisation: If spinal cord injury or fracture is suspected, immobilise the neck with a rigid cervical collar to prevent further injury.

     
     

2. Diagnostic Imaging:

   
   

   • X-rays: To assess fractures, dislocations, or abnormalities in the cervical vertebrae.

     
     

   • CT Scan: For a more detailed evaluation of fractures or dislocations and to detect potential spinal cord injuries.

     
     

   • MRI: Used to evaluate soft tissue injuries such as herniated discs and spinal cord compression.

     
     

3. Initial Treatment:

   
   

   • Pain Management: Administer analgesics and anti-inflammatory medications as needed.

     
     

   • Immobilisation: Continue immobilisation until definitive evaluations are completed.

     
     

   • Soft Tissue Injury Treatment: Apply ice to reduce swelling, and follow up to assess the need for physiotherapy.

     
     

4. Surgical Intervention:

   
   

   • Fractures and Dislocations: Surgery may be necessary to stabilise fractures, reduce dislocations, or decompress the spinal cord in severe cases.

     
     

   • Spinal Cord Injuries: In cases of significant neurological compromise, surgery may be required to decompress the spinal cord and stabilise the spine.

     
     

5. Follow-up and Rehabilitation:

   
   

   • Physiotherapy: To restore range of motion, strength, and functionality of the neck and spine.

     
     

   • Neurological Monitoring: Regular follow-up to assess recovery of neurological function and adjust treatment as needed.

     
     

Each neck injury requires careful evaluation and management to avoid serious complications and promote a full recovery.