Neck sprain

Last updated: August 16, 2023

Summarytoggle arrow icon

Neck sprains and whiplash injuries are commonly caused by direct impact or abnormal neck movement. Neck sprains occur due to overstretching, while whiplash injuries result from abrupt flexion/extension of the neck. Both conditions are diagnosed clinically. After acute injury, cervical spine precautions are maintained until the clinical assessment is complete. Clinical decision rules (e.g., NEXUS C-spine criteria, Canadian C-spine rule) are used to determine whether imaging is required to rule out significant cervical spine injury. Treatment of uncomplicated neck sprains and whiplash injuries involves pain management with nonopiate analgesics, early mobilization, and physiotherapy. Clinically significant cervical spine injuries require urgent specialist consultation.

Definitiontoggle arrow icon

Whiplash injuries are a common cause of cervical strain and sprain.

Etiologytoggle arrow icon

Clinical featurestoggle arrow icon

Common features [1][2]

Any of the following may occur immediately or appear hours to days following injury:

Whiplash injury and mTBI can occur simultaneously and have overlapping symptoms such as headaches, dizziness, and visual disturbances. [6]

Red flags [4][6]

The following red flags in post-trauma patients are concerning for C-spine fracture or neurovascular injury and should prompt further investigation:

The absence of neurologic deficits does not rule out clinically significant cervical spine injury.

Diagnosticstoggle arrow icon

Approach [2][6]

Following acute trauma, maintain C-spine precautions until the initial assessment is complete.

Obtain imaging of the cervical spine in any patient with polytrauma or altered mental status after acute trauma.

Imaging [6][7]

Imaging may be used to rule out fractures, dislocations, ligament damage, and neurovascular injury.

  • CT cervical spine without IV contrast
    • Initial test of choice in most patients with acute nonpenetrating trauma to the neck
    • Also indicated to evaluate any abnormal x-ray findings
  • MRI C-spine without IV contrast
    • Alternative to CT for initial testing
    • Also used to evaluate persistent clinical suspicion of ligamentous or neurologic injury despite normal CT
  • X-ray cervical spine
    • Rarely indicated [7]
    • Views: lateral, anteroposterior, and open-mouth view of the odontoid
  • Vascular studies (e.g., CTA neck, MRA neck): if clinical or imaging findings suggest arterial injury

Treatmenttoggle arrow icon

After vertebral fractures and cervical facet dislocations have been excluded, the treatment of neck sprain and whiplash injury is mainly supportive. [4][6]

  • Offer reassurance.
  • Provide adequate non-opioid pain control. [8]
  • Encourage early mobilization and refer to physiotherapy. [6][9]
  • Arrange follow-up with a primary care provider.

Referencestoggle arrow icon

  1. Zmurko MG, Tannoury TY, Tannouty CA, Anderson DG. Cervical sprains, disc herniations, minor fractures, and other cervical injuries in the athlete. Clin Sports Med. 2003; 22 (3): p.513-521.doi: 10.1016/s0278-5919(03)00003-6 . | Open in Read by QxMD
  2. Teasell R, Mehta S, Loh E. Whiplash Injuries. Curr Treatm Opt Rheumatol. 2020; 6 (4): p.394-405.doi: 10.1007/s40674-020-00162-x . | Open in Read by QxMD
  3. Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine. 1995; 20 (8 Suppl): p.1S-73S.
  4. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  5. Tintinalli JE, Stapczynski JS, Ma OJ, Yealy D, Meckler GD, Cline DM. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9th edition. McGraw Hill Professional ; 2019
  6. Beckmann NM, West OC, Nunez D, et al. ACR Appropriateness Criteria® Suspected Spine Trauma. J Am Coll Radiol. 2019; 16 (5): p.S264-S285.doi: 10.1016/j.jacr.2019.02.002 . | Open in Read by QxMD
  7. Busse JW, Sadeghirad B, Oparin Y, et al. Management of Acute Pain From Non–Low Back, Musculoskeletal Injuries. Ann Intern Med. 2020; 173 (9): p.730-738.doi: 10.7326/m19-3601 . | Open in Read by QxMD
  8. Tameem A, Kapur S, Mutagi H. Whiplash injury. Continuing Education in Anaesthesia, Critical Care & Pain. 2014; 14 (4): p.167-170.doi: 10.1093/bjaceaccp/mkt052 . | Open in Read by QxMD
  9. Berglund A. Occupant- and Crash-Related Factors Associated with the Risk of Whiplash Injury. Ann Epidemiol. 2003; 13 (1): p.66-72.doi: 10.1016/s1047-2797(02)00252-1 . | Open in Read by QxMD

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