What is Cervical Strain?
Cervical strain is a concussion-associated condition characterized by neck pain, neck stiffness, neck or upper extremity weakness, and persistent headache (typically occipital/suboccipital in location) that occurs following head injury in the setting of other concussive symptoms. 1
Pathophysiology
The underlying mechanism involves injury to cervical structures that leads to somatosensory dysfunction and aberrant signaling along cervical afferent pathways traveling to the brain. 1 These pathways normally coordinate cervical and vestibular reflexes and support normal vision and vestibular functioning—when disrupted, they produce the characteristic symptom complex. 1
Clinical Presentation
Primary Symptoms
- Neck pain and stiffness that develops following head trauma 1
- Persistent headache, characteristically located in the occipital or suboccipital region 1
- Neck or upper extremity weakness 1
Physical Examination Findings
- Cervical spine tenderness on midline palpation 1
- Paraspinal and suboccipital muscle tenderness on palpation 1
- Weakness with paracervical strength and upper extremity myotome testing 1
- Limited cervical range of motion 1
- Pain with cervical motion 1
- Paresthesia or weakness (radicular symptoms) in upper extremities 1
- Pain or paresthesia in the occipital region with palpation or head movement 1
Epidemiology and Context
Cervical strain commonly occurs in the context of whiplash-type injuries, with an annual incidence estimated at up to 600 per 100,000 inhabitants in Western Europe and North America. 2 The most frequent sprain and strain injuries affect patients aged 21-60 years. 2 Traffic accidents account for 71.34% of cases, with drivers or passengers being the most commonly affected. 2
Critical Diagnostic Distinction
A crucial clinical challenge is differentiating isolated cervical strain from concomitant etiologies such as whiplash-associated disorder, since cervical strain and concussion share common injury mechanisms. 1 This distinction is essential for determining appropriate management and treatment. 1
Associated Neurological Complications
Neurological symptoms occur in approximately 6.84% of patients with cervical sprains. 2 However, it is important to note that new neurological symptoms rarely appear after initial presentation to the emergency department. 2
Prognosis
Most acute cervical strain improves within 7-8 weeks with conservative management, though approximately 50% of patients may experience some persistent symptoms at one year. 3, 4 This highlights the importance of appropriate early management and patient counseling regarding expected recovery trajectories.