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.
Common features 
Any of the following may occur immediately or appear hours to days following injury:
- Neck pain, stiffness, and tenderness
- Reduced neck range of motion
- Palpable shoulder and neck muscle tension
- Occipital headaches
- Upper back, shoulder, and upper limb pain and/or paresthesia
- Dizziness, fatigue, insomnia, visual disturbances, tinnitus, difficulty concentrating
Red flags 
- Neck pain after major trauma
- hematoma , e.g., paravertebral
- Features of vascular injury, e.g., arterial bruit or symptoms of cerebral ischemia
- Neurological features, e.g., hypesthesia or Horner syndrome
The absence of neurologic deficits does not rule out clinically significant cervical spine injury.
- Neck sprain and whiplash injury are clinical diagnoses.
Determine the need for CT to rule out clinically significant C-spine injury using a validated tool, e.g.:
- Consider additional imaging to assess for fractures, dislocation, ligament damage, and/or neurovascular injury.
- Consult spine surgery urgently for any evidence of vertebral fractures or cervical facet dislocation.
Following acute trauma, maintain C-spine precautions until the initial assessment is complete.
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 
- 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