Neck trauma ranges from minor soft-tissue sprain to life-threatening vascular or airway injury. Clinical findings vary by mechanism (blunt vs. penetrating) and the structures involved, but the following features are characteristic.
- Local pain and tenderness
Pain is almost universal, usually originating in the nuchal muscles or paraspinal region; palpation reveals focal tenderness and voluntary guarding. In whiplash-associated disorders, discomfort often begins hours after the impact and is accompanied by stiffness. - Restricted motion
Patients instinctively hold the head in a neutral or slightly flexed position; active rotation or extension increases pain and may be limited by muscle spasm. - Neurological deficits
Radiculopathy produces unilateral arm pain, numbness or weakness in a dermatomal/myotomal pattern. Spinal cord involvement (grades III–IV) causes long-tract signs: bilateral weakness, altered reflexes, sensory level or, in severe cases, quadriplegia . - Headache and facial symptoms
Cervicogenic headache is common (70 % of chronic cases), typically occipital, provoked by neck movement, and linked to upper cervical facet or occipital nerve irritation. Dizziness, blurred vision, tinnitus and facial numbness may accompany vestibular or sympathetic dysfunction . - Vascular “hard signs” (penetrating injury)
Rapidly expanding or pulsatile haematoma, active uncontrollable bleeding, diminished carotid or vertebral pulse, bruit/thrill, or ipsilateral neurological deficit suggest major vessel injury and mandate immediate intervention . - Airway-digestive red flags
Hoarseness, dysphonia, stridor, dyspnoea, haemoptysis, subcutaneous air or significant haematemesis indicate laryngo-tracheal or pharyngo-oesophageal disruption and may evolve into airway obstruction or mediastinitis . - Soft signs requiring observation
Minor haemoptysis/haematemesis, dysphagia, non-expanding haematoma or mediastinal air can herald occult injury; serial examination and imaging are obligatory because symptoms may be delayed .
Because normal radiographs do not exclude vascular or oesophageal lesions, a high index of suspicion and liberal use of CT-angiography or endoscopy is essential when any of the above indicators are present.
| Symptom / Sign | Implication |
|---|---|
| Neck pain & stiffness | Muscle/ligament sprain, facet irritation |
| Limited motion | Muscle spasm, mechanical block |
| Unilateral arm pain/numbness | Cervical radiculopathy |
| Bilateral weakness/sensory level | Spinal cord injury |
| Occipital headache | Cervicogenic headache |
| Dizziness, tinnitus, visual blur | Vestibular or sympathetic dysfunction |
| Expanding haematoma, bruit, pulse loss | Major vascular injury |
| Hoarseness, stridor, subcutaneous air | Airway/oesophageal injury |