The neck supports the weight of the head, joins the head to the torso, carries the sensory and motor information from the brain to the rest of the body and contains major blood vessels, vital organs and glands.

In order to provide the flexibility of movement necessary to use the eyes, ears, nose and mouth to maximum effect, the neck is very slender and this means that all of the essential components it contains are confined to a narrow area with little protection, making them extremely vulnerable to injury.

Obstruction of the airways and bleeding represent the greatest risk to life.

The most common causes of neck injury are:-

• Road Traffic Accidents
• Sports Injuries
• Work Accidents
• Falls
• Assaults

A fracture may be caused by over-flexion, over-extension, excessive rotation or compression and can occur in any of the 7 cervical vertebrae. The prognosis is generally worse the higher up the neck the injury occurs and in some instances may cause paraplegia or death.

The pain of a slipped disc can be severe and may be aggravated by neck movement. If the prolapse presses on a root nerve, it can produce pain in the shoulder and down the arm. Other symptoms may be pins and needles in the hands and fingers, and muscle spasm in the neck is not uncommon.

This is one of the most common causes of neck pain but can also cause shoulder and arm pain. This injury is most often caused by involvement in a road traffic accident but is sometimes seen as a result of a sporting accident, accident at work , fall or a violent assault. If the force that causes the whiplash is severe enough damage can occur to the discs in the neck, the nerves of the spinal cord, blood vessels and even the vertebrae themselves.

This is a reduction in the flexibility of the neck and may be an indication of other problems such as a slipped disc or a fracture as well as an inherited disorder of the neck muscles. Following trauma, muscle spasm in the neck tends to be part of the bodies protective mechanism to prevent more damage being caused by further neck movement.

There are few other areas of the body where so many vital structures are located in such a narrow and unprotected region therefore any wound to the neck following an accident represents a cause for concern.

Structures at risk from wounds include:-

• Musculoskeletal – Vertebrae, neck muscles, tendons and ligaments, clavicles, first and second ribs, hyoid bone
• Neural – spinal cord, phrenic nerve, brachial plexus, recurrent laryngeal nerve, cranial nerves and stellate ganglion
• Vascular – carotid arteries (common, internal and external), vertebral arteries and the vertebral, brachiocephalic and jugular veins
• Internal Organs – thoracic duct, oesophagus and pharynx, larynx and trachea
• Glandular – thyroid, parathyroid, submandibular and parotid glands

Penetrating neck wounds can be classed as intentional or non-intentional and the injuries as having been caused by stabbing instruments such as knives, cutting instruments, puncturing and impaling objects, or by shooting instruments such as projectiles and missiles (bullets, shot, pellets etc.) A wound to the neck is only considered to be a penetrating wound if the injury pierces the sheet of muscle (platysma) that extends from the lower jaw to collar bone.

Penetrating neck injuries are most commonly seen as a result of violence but may also occur as a result of road traffic accidents, sports accidents, accidents within the home and industrial or work accidents.

Where a wound has not penetrated the platysma muscle of the neck it is called a blunt trauma.

The layers of skin, fascia (connective tissue) and platysma (muscle) that surround and interweave between the muscles, bones, organs, nerves, blood vessels and other structures offer some protection and may limit any damage to the blood vessels thus reducing the likelihood of the victim bleeding out. However, because the fascia and platysma are firm they may confine any swelling and expanding haematoma causing it to impede the airways and affect breathing.

Blunt trauma occurs as a result of vehicle accidents, during sports, strangulation, violent assault or excessive manipulation i.e. during chiropractic or physiotherapy treatment.