Injection Technique for Cervical Strain

Indications and Clinical Considerations

The muscles of the posterior neck are particularly susceptible to the development of acute and chronic pain symptomatology after acute flexion, extension, or lateral bending injuries to the neck or repeated microtrauma secondary to pressure from purse straps, backpacks, or laptop computer cases. These muscles also are adversely affected by chronic stress, a behavioral abnormality that may manifest itself clinically as cervical strain. Myofascial pain syndrome with its pathognomonic myofascial trigger points also may occur, either alone or in combination with cervical strain.

Cervical strain is the result of microtrauma or macrotrauma to the muscle fibers or the musculotendinous unit of the trapezius and the deep muscles of the posterior neck, including the splenius capitis and splenius cervicis. Clinically, cervical strain manifests as aching, tightness, stiffness, and pain in the neck and upper back, with pain radiating into the ipsilateral shoulder. As mentioned previously, cervical strain may coexist with myofascial pain syndrome, and trigger points also may be present. Symptoms of cervical strain can be reproduced with ipsilateral rotation and contralateral bending of the cervical spine. Tenderness to deep palpation is present, but unless myofascial pain syndrome is also present, trigger points should be absent. The pain, spasm, and other associated symptoms of cervical strain are aggravated with physical or emotional stress. Plain radiographs will often reveal straightening of the cervical lordotic curve in patients suffering from acute cervical strain ( Fig. 20.1 ).