Emergency Medicine

NECK INJURIES

230 Surgical Emergencies

(iv) Hypoglossal nerve: deviation of the tongue to the affected side.

(v) Cervical sympathetic cord: Horner’s syndrome, with partial

ptosis, a constricted pupil, and decreased sweating on the same

side of the face.

2 Refer any of these injuries to the surgical team.

OESOPHAGEAL INJURY

DIAGNOSIS AND MANAGEMENT

1 Oesophageal injury in the neck causes dysphagia, drooling and localized

pain, with the development of surgical emphysema.

2 Refer this rare condition to the surgical team for immediate admission.

Neck sprain

DIAGNOSIS

1 Neck sprain is most commonly associated with hyperextension injuries

resulting from sudden deceleration in a motor vehicle collision.

(i) The lay term for this mechanism of injury is ‘whiplash’. In

practice, neck sprain occurs with other directions of impact,

including hyperflexion.

2 The resultant neck pain and stiffness often go unnoticed at the time of

injury. Patients typically present 12–24 h later, often with symptoms

of headache.

3 The pain may radiate to the shoulders and arms, causing paraesthesiae, but

neurological examination does not show any objective deficit. Neck

movements are restricted by pain.

4 Cervical spine X-ray may show loss of the normal anterior curvature due to

muscle spasm.

MANAGEMENT

1 Treat the patient with a non-steroidal anti-inf lammatory analgesic drug

(NSAID), such as ibuprofen 200–400 mg orally t.d.s. or naproxen 250 mg

orally t.d.s., and encourage early mobilization.

2 Refer the patient to the physiotherapy team if the pain fails to settle, for heat

treatment and motion exercises.

3 Unfortunately, symptoms may continue for months, and may be exacerbated

by further minor injuries.