Magnetic resonance imaging of subjects with acute unilateral neck pain and restricted motion: a prospective case series

Abstract

Background context: Zygapophyseal joint injury and inflammation have been proposed as causes of acute benign spinal pain, but this etiology has not been investigated.

Purpose: To investigate the presence of periarticular tissue inflammation and zygapophysial joint synovitis in the cervical region using magnetic resonance imaging (MRI) in subjects with acute unilateral cervical pain and limited motion (acute "crick in the neck" <48 hours from onset), as well as the feasibility of recruiting these subjects.

Study design/setting: Three-month case series in a university setting and private radiology clinic.

Patient sample: Five subjects (three women and two men; mean age, 31.6 years; standard deviation [SD], 12.4).

Methods: Each subject was examined by a researcher experienced in manual medicine to assess active range of neck movement and the side and symptomatic segmental level of pain. Subjects then underwent a blinded MRI investigation, which included sagittal images through the entire neck and cervical spine and axial images from C2 to T1. Evidence of capsule or periarticular edema and joint space T2 increase was recorded and scored. Additionally, signs of muscle edema, alignment, disc disease, facet arthritic change, and spinal stenosis were recorded.

Results: Subjects presented with mean current pain of 4.8 (SD, 1.6; visual analog scale, 0-10), worst pain since onset of 7.0 (SD, 0.7), and duration of symptoms of 12.4 hours (SD, 14.1). The plane of active motion most commonly limited was rotation to the painful side, followed by side bending to the painful side and extension. No MRI findings demonstrated clear evidence of synovial effusion or inflammation around the joints of the cervical spine. In some individuals, signs of muscle edema, altered alignment, disc and facet arthrosis, and spinal stenosis were noted, but these did not appear to be related to the side of pain or symptomatic level.

Conclusions: No evidence of cervical joint inflammation was detected, and more sensitive imaging methods may be required to detect inflammatory changes in or around the cervical joints of subjects with acute benign neck pain. Recruitment of subjects with acute "crick in the neck" pain (<48 hours duration) is difficult but feasible over a long data collection period.