A stiff neck refers to a tightness or rigidity in the muscles supporting the neck. Nuchal rigidity refers to a stiffness that prevents bending of the neck and limits movement of the neck. Neck stiffness can be simply a mild discomfort and slight problem in moving the neck. Or it can be severe pain and the inability to move or bend the neck at all. What is going on in the body? The muscles and bones of the neck have to support the weight of the head and every turn the head makes. Neck stiffness can occur by itself or with neck pain. Neck pain may come from any structure of the neck. This includes the vertebrae and muscles of the upper back, the blood vessels of the neck, and lymph nodes in the neck. Any type of injury or illness can result in a stiff neck. A person with a stiff neck may move the neck more slowly and carefully. This can lead to painful muscles spasms. Neck stiffness can also lead to strained ligaments and pain that travels from the neck into the back and arms. What are the causes and risks of the condition? The cause of neck stiffness can vary greatly. Some of the causes of neck stiffness include: 7 sleeping on a pillow the wrong way 7 a sudden turn of the neck 7 stress, which can cause the neck muscles to tighten and become stiff 7 injury, such as a whiplash as a result of a car accident 7 cervical arthritis, an inflammatory condition affecting the upper spine and possibly other parts of the body 7 encephalitis, a serious inflammation affecting the brain. 7 meningitis, a viral or bacterial infection affecting the membranes surrounding the spinal cord and brain. 7 subarachnoid hemorrhage, or bleeding into the space surrounding the brain 7 ankylosing spondylitis, an inflammation and inability to move some of the upper vertebrae, often caused by arthritis 7 neck sprain, which may be accompanied by pain, slight swelling, and restricted range of motion 7 rheumatoid arthritis 7 torticollis, a deformity of the neck caused by a shortening of the neck muscles. This condition causes the head to tilt to the affected side with the chin pointing to the other side. Neck stiffness is not a diagnosis; it is a symptom, a form of neck pain. Up to 50% of people may experience neck pain at some time. Trauma and overuse are common factors in young adults. Muscle spasm usually lasts only 1-4 days; torticollis (unilateral neck muscle spasms causing a twisting of the head) should prompt a work up for a serious underlying problem. Many nonspecific infections may produce an “achy” neck; neck rigidity, however, suggests meningitis and is a medical emergency. History When did the pain begin? Ask about trauma and occupation (i.e., overhead work). Be aware that injuries, including whiplash, may not result in pain until 24 hours later. Where else is the pain felt? Pain on motion of the shoulder suggests the problem is in the shoulder, not the neck. Decreased sensation in the hands indicates nerve compression. Physical Exam Provided there is no acute trauma, put the patient’s neck through passive and then active range of motion. Pain on motion of the neck helps localize the problem. Referred pain is suggested by an absence of tenderness on palpation. Soft tissue infections, osteomyelitis, metastatic disease, tendinitis, and neuritis may manifest as point tenderness. Spasm may be felt on palpating the posterior neck muscles; unilateral spasm produces torticollis. A neurological exam may be indicated (reflexes, strength, sensation). Increased lower extremity reflexes, or a positive Babinski sign, suggest cord compression. A patient with meningitis is febrile but awake, and has true meningismus (nuchal rigidity); the neck is as stiff as a board. An altered mental status suggests (meningo) encephalitis.
