Soft Tissue Injury of the Neck

ExitCare ImageA soft tissue injury of the neck may be either blunt or penetrating. A blunt injury does not break the skin. A penetrating injury breaks the skin, creating an open wound. Blunt injuries may happen in several ways. Most involve some type of direct blow to the neck. This can cause serious injury to the windpipe, voice box, cervical spine, or esophagus. In some cases, the injury to the soft tissue can also result in a break (fracture) of the cervical spine.

Soft tissue injuries of the neck require immediate medical care. Sometimes, you may not notice the signs of injury right away. You may feel fine at first, but the swelling may eventually close off your airway. This could result in a significant or life-threatening injury. This is rare, but it is important to keep in mind with any injury to the neck.

CAUSES

Causes of blunt injury may include:

  • "Clothesline" injuries. This happens when someone is moving at high speed and runs into a clothesline, outstretched arm, or similar object. This results in a direct injury to the front of the neck. If the airway is blocked, it can cause suffocation due to lack of oxygen (asphyxiation) or even instant death.

  • High-energy trauma. This includes injuries from motor vehicle crashes, falling from a great height, or heavy objects falling onto the neck.

  • Sports-related injuries. Injury to the windpipe and voice box can result from being struck by another player or being struck by an object, such as a baseball, hockey stick, or an outstretched arm.

  • Strangulation. This type of injury may cause skin trauma, hoarseness of voice, or broken cartilage in the voice box or windpipe. It may also cause a serious airway problem.

SYMPTOMS

  • Bruising.

  • Pain and tenderness in the neck.

  • Swelling of the neck and face.

  • Hoarseness of voice.

  • Pain or difficulty with swallowing.

  • Drooling or inability to swallow.

  • Trouble breathing. This may become worse when lying flat.

  • Coughing up blood.

  • High-pitched, harsh, vibratory noise due to partial obstruction of the windpipe (stridor).

  • Swelling of the upper arms.

  • Windpipe that appears to be pushed off to one side.

  • Air in the tissues under the skin of the neck or chest (subcutaneous emphysema). This usually indicates a problem with the normal airway and is a medical emergency.

DIAGNOSIS

  • If possible, your caregiver may ask about the details of how the injury occurred. A detailed exam can help to identify specific areas of the neck that are injured.

  • Your caregiver may ask for tests to rule out injury of the voice box, airway, or esophagus. This may include X-rays, ultrasounds, CT scans, or MRI scans, depending on the severity of your injury.

TREATMENT

If you have an injury to your windpipe or voice box, immediate medical care is required. In almost all cases, hospitalization is necessary. For injuries that do not appear to require surgery, it is helpful to have medical observation for 24 hours. You may be asked to do one or more of the following:

  • Rest your voice.

  • Bed rest.

  • Limit your diet, depending on the extent of the injury. Follow your caregiver's dietary guidelines. Often, only fluids and soft foods are recommended.

  • Keep your head raised.

  • Breathe humidified air.

  • Take medicines to control infection, reduce swelling, and reduce normal stomach acid. You may also need pain medicine, depending on your injury.

For injuries that appear to require surgery, you will need to stay in the hospital. The exact type of procedure needed will depend on your exact injury or injuries.

HOME CARE INSTRUCTIONS

  • If the skin was broken, keep the wound area clean and dry. Wear your bandage (dressing) and care for your wound as instructed.

  • Follow your caregiver's advice about your diet.

  • Follow your caregiver's advice about use of your voice.

  • Take medicines as directed.

  • Keep your head and neck at least partially raised (elevated) while recovering. This should also be done while sleeping.

SEEK MEDICAL CARE IF:

  • Your voice becomes weaker.

  • Your swelling or bruising is not improving as expected. Typically, this takes several days to improve.

  • You feel that you are having problems with medicines prescribed.

  • You have drainage from the injury site. This may be a sign that your wound is not healing properly or is infected.

  • You develop increasing pain or difficulty while swallowing.

  • You develop an oral temperature of 102° F (38.9° C) or higher.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You cough up blood.

  • You develop sudden trouble breathing.

  • You cannot tolerate your oral medicines, or you are unable to swallow.

  • You develop drooling.

  • You have new or worsening vomiting.

  • You develop sudden, new swelling of the neck or face.

  • You have an oral temperature above 102° F (38.9° C), not controlled by medicine.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.