Broken Neck or Neck Fracture: Causes, Symptoms, Diagnosis, Treatment, Physical Therapy, Recovery Period

A Broken Neck or Neck Fracture is a break in any of the seven bones that constitute the cervical vertebrae. This is potentially a serious medical condition as the spinal cord passes through this region and any damage to the spinal cord can result in permanent impairment.

Vertebral column protects spinal cord. Vertebral column is divided in to multiple segments like neck, chest, lower back and sacrum. The seven upper vertebra known as neck or cervical vertebra forms cervical or neck segment. Facet joint lies between upper and lower cervical vertebra. Fracture of neck vertebra as well as dislocation of facet joint can cause life threatening injury of spinal cord. The fracture of facet joint results in dislocation or subluxation of neck vertebrae. Similarly, fracture of body of vertebra results in collapse of upper vertebral segment. These are potentially serious medical condition as the spinal cord passes through this region and often prone to severe injury resulting in paralysis below the neck. Spinal cord injury may result in permanent impairment like quadriplegia or paraplegia. Broken Neck or Neck Fracture usually caused by high impact traumatic injuries like automobile accidents, fall from a significant height and sporting injuries.

A broken neck or neck fracture is caused by abrupt forceful impact of the head against hard surface or moving object. Neck injuries resulting in broken neck or neck fracture is observed when individual or athlete falls or lands on the head with neck twisted or tilted. Such injuries are observed during contact sports like football or rugby. Car crash or automobile accident is one of the most common cause of broken neck or neck fracture.

Most neck injuries are mild to moderate and caused muscle, ligament or tendon injury. Any injury to the neck is initially treated as a severe neck injury until radiological studies suggest the symptoms are caused by soft tissue injury and excludes fracture or dislocation of neck vertebral column.

Severity of neck injury or fracture is confirmed following X-Ray, CT Scan or MRI studies. Neck injury is considered severe when injury causes fracture, dislocation, spinal nerve laceration or spinal cord injury. The most common cause of broken neck are sports injury, automobile accident, work injury, domestic fall at home, outdoor fall, fall on slippery surface or spontaneous fracture of vertebra as seen in patient suffering with osteoporosis.

Broken Neck or Neck Fracture has variable symptoms which ranges from mild to severe in intensity. Fatal neck injury is rare. Fracture or dislocation of vertebra and facet joint causes moderate to severe pain. Pain is often associated with symptoms caused by pinch of sensory or motor nerve or spinal cord. Sensory nerve irritation or pinch causes tingling and numbness. Similarly, motor nerve irritation causes weakness or paralysis of muscles that are supplied by injured nerve. The symptoms such as pain, tingling, numbness and weakness of muscles are observed over neck, shoulder and upper arm following cervical or neck fracture or dislocation. There may be bruising, skin discoloration and hematoma often observed as well at the site of the injury.

The broken neck or neck fracture is diagnosed by clinical examination and radiological studies. The symptoms such as pain and tingling suggests mild to moderate injury. Similarly, symptoms like severe intractable pain when associated with numbness and weakness or muscle paralysis suggests possible severe neck injury or broken neck. The mild to severe injuries are diagnosed by imaging or radiological studies like MRI or CT scan. The broken neck or neck fracture may be hairline or nondisplaced fracture. The serious injury may cause displace or compound fracture of vertebra as well as complete dislocation of facet joint. The MRI and CT Scan helps to diagnose various types of fracture of vertebrae, dislocation of facet joint, collapse of vertebra, body, foraminal stenosis, narrowing of spinal canal and foraminal stenosis.

As stated earlier, all neck injuries are treated as a severe injury unless proven otherwise. In most cases initial treatment of broken neck or neck injury is provided by paramedics or trained nurses.

The first treatment advised in any traumatic neck injury is to immobilize the neck following initial examination once neck injury is established by history and initial examination. The neck is immobilized by using soft or rigid neck collar. The immobilization of neck is extremely important to prevent displacement or dislocation of fracture or dislocated segment of vertebra. Injured individual following neck injury is kept under close observation to prevent any movement of the neck. Frequent change of position or movement of neck, bed or gurney is avoided so as to prevent any minor displacement of broken or dislocated fragments of fractured bones.

Broken neck resulting in hairline or non-displace fracture is treated with conservative treatment that involves pain medications like NSAIDs and neck braces. The displaced fracture and dislocation is treated by surgical procedure. Surgery involves insertion of bone graft as well as instrumentation. Instrumentation involves use of plates and screws to align displaced fragments of fracture or dislocated bones. The mild to moderate injuries resulting in muscle, tendon or ligament injuries are treated with conservative treatment such as NSAIDs medication, massage treatment and physical therapy.

Physical therapy is advised after the surgical treatment or healing of displaced or non-displaced neck fracture or dislocated segment. Physical therapy for broken neck or neck fracture involves exercise, heat treatment, cold therapy, massage therapy and wax treatment. Physical therapy helps to strengthen the paravertebral muscles, tendons and ligaments. Physical therapy for broken neck or neck injury is a specialized treatment performed by highly trained physical therapist. Physical therapist will take detailed history and perform physical examination to conclude the cause of pain and area of neck that may need aggressive therapy. The physical therapist may ask the individual with broken neck or neck fracture to rate the pain from 0-10 with 0 being the none and 10 being the worst pain that the patient had ever experienced. The history of pain and injury as well as results of examination helps the therapist in localizing the source of pain and cause of soreness in the neck to find the pain generators.

Continuous imbalance posture of neck and lower body causes pain in paravertebral muscles, ligaments and tendon. The pain is caused by overworked of paravertebral muscles resulting in continuous strain over ligaments and tendon. Such abnormal position often causes extra pressure on the facet joints that follows facet joint fatigue and severe neck pain. The overworked muscle, tendon and ligament generates continuous chronic pain and also causes soft tissue swelling. Soft tissue swelling is caused by water retention also known as edema. The swollen soft tissue causes either irritation or pinch of spinal nerve as well as spinal cord.

The therapist will formulate isometric and isotonic muscle exercises to strengthen the neck muscles during the recovery period following broken neck or neck fracture. To begin with, gentle exercises will be advised so as to ease the pain and once the pain tolerance is increased and wound as well as neck fracture is completely healed then more aggressive exercises will be recommended in order to strengthen the muscles of the neck. Apart from strengthening exercises, the therapist will also formulate exercises to improve range of motion and flexibility of the neck. Once an individual is through with the therapy program he or she will be given a home exercise program to further rehabilitate the neck and maintain the range of motion and strength of the neck.

Physical Therapy To Improve Post Traumatic Abnormal Posture: Posture of neck and lower body is extremely important to prevent or provoke chronic pain. Physical therapy to improve posture involves various exercise, periodic posture correction and monitor the progress. Correction of posture may involve NSAIDs treatment for pain, exercise to assist strengthening of paravertebral muscles, massage treatment to relax stiff muscles and wax therapy. Later, individual with broken neck or neck fracture will be considered for occupational therapy so as to maintain correct posture at work.

Occupational therapy for broken neck or neck fracture is a part of physical therapy. Occupational therapy is advised when individual is ready to resume employment and work after recovering from broken neck or neck fracture. The therapy helps to correct the posture white at work, use of neck braces when necessary and improve sitting or standing posture. Such therapy is necessary to learn to maintain the optimum posture to avoid neck and back pain while working in front of computer, listening to lecture or working at the desk. Occupational therapy is also helpful to guide the maintenance of correct posture for individual involved in manual work.

Physical Therapy To Improve Range Of Motion: In most cases of neck injury and after recovery from surgery, the range of motion in neck is restricted. When range of motion is restricted then physical therapist will evaluate the range of motion of the neck and look for any stiffness. Following neck surgery there will be some stiffness of the cervical spine after prolonged period of immobilization because of paravertebral muscle atrophy and stiffness. The therapist will check range of motion in flexion, extension, lateral bending and rotation. The therapist will suggest exercises, heat and cold therapy, ultrasound treatment and cortisone injection therapy to improve range of motion once the fracture has healed completely.

Adjuvant Physical Therapies – In few cases regular physical therapy is followed by following adjuvant physical therapies.

• Ultrasound: This will be directed towards the affected area of optimum pain. The stiffness and muscle atrophy responds to ultrasound treatment so as to mobilize the molecules resulting in friction between the molecules causing warmth.
• Phonophoresis and Iontophoresis: In Phonophoresis, sound waves or ultrasound is used to infiltrate the skin with a steroid to ease the pain whereas Iontophoresis utilizes a machine which produces minute electrical charges to infiltrate the skin to provide medication to the deeper affected area.
• Electrical Stimulation: This treatment is done to stimulate the affected nerves with the help of mild amount of electric current. It gives a feeling as if the area is being massaged.
• Soft Tissue Mobilization: Soft tissue massage is an effective way to calm down inflammation and provide pain relief by relaxing the muscles and joints.
• Traction: This is used to treat the sore muscles and joints in the neck. The therapist will utilize a traction device which will help in relaxing the muscles. This can also be done manually where the therapist will pull at the neck muscles.

Recovering from broken neck or neck fracture can take a long time depending on the extent of damage. Hairline or non-displaced fracture of the neck may take 6-8 weeks for complete healing. Serious injuries resulting in displaced or compound fracture of the cervical or neck vertebra as well as complete dislocation of facet joint may take 3 to 6 months to recover.