Pain that begins in the neck and radiates down the arm to the fingers can range from annoying to debilitating. Some people may experience hand, arm, or shoulder weakness. Others may notice numbness and tingling down the arm or loss of sensation. Pain in the shoulder blade may be aggravated by neck movements. If the pain does not resolve on its own after a few weeks of rest and over-the-counter medications, it may be time to see a doctor.
Causes of the pain
The diagnosis for pain that starts in the neck and radiates down the arm may be cervical radiculopathy. The pain is the result of compression and irritation of a nerve where it branches off the spinal cord. There may be several contributing factors. The condition may have been caused by a sudden injury to the neck that resulted in a cervical disc herniation. In older patients, arthritis or degenerative disc disease may be causing the problem. As people age, the spinal discs dry out and become stiff. They no longer act as shock absorbers in between the bones of the spine. The discs may lose height and collapse, or they may start to bulge. This results in the spinal vertebrae moving closer together as the discs degenerate. Bone spurs can develop as a result of these changes, causing pain and compression on the nerves by narrowing small openings on each side of the spine called the neuroforamen or just foramen. The narrowed foramen pinch the nerve root as it exits the spinal column. Many of these changes are normal occurrences as people age, but can cause symptoms if they become severe enough.
The doctor will perform a physical exam of the patient, looking for changes in reflexes, muscle weakness, and loss of sensation. Diagnostic tests may be ordered including x-rays, an MRI, or a CT with myelogram scan. These tests can show damage to the discs, bone spurs, alignment of the vertebrae in the neck, and narrowing of the foramen.
For some patients, their pain will improve without significant treatment. Other patients will experience pain relief for a period of time, but symptoms may eventually return. The physician may first recommend some non-surgical treatment options to see if the condition improves.
Physical therapy is one such option. This may consist of exercises that can strengthen the neck muscles and improve range of motion. Neck traction may help decrease symptoms by stretching the muscles and reducing pressure on the spinal nerves. After completion of formal physical therapy the patient would be trained to continue these exercises and treatments at
home. A soft cervical collar may be worn for a short period of time to allow the neck to rest and help reduce any inflammation, but extended use of these collars can weaken neck muscles and cause other issues.
Anti-inflammatory medications (NSAIDS) may provide pain relief. Corticosteroid medications can help reduce swelling. Narcotic pain relievers may be prescribed for a very short time. Epidural steroid injections can lessen pain and reduce swelling so that the symptoms are less painful during the time it takes for the affected nerve to heal.
Surgical intervention depends on many factors including the type and severity of the symptoms, as well as the location of the root nerve involved. Spinal cord compression can also require surgery, sometimes much sooner than if there is only a nerve root involved. Surgery may need to be considered if there is movement impairment, weakness or debilitating pain that has not responded well to nonsurgical treatments. Surgery may also be recommended if the neck is structurally unstable.
There are three surgical procedures commonly used to treat cervical radiculopathy:
Anterior Cervical Discectomy and Fusion (ACDF) is removal of a herniated or degenerative disc in the neck. The disc is removed, and a graft or spacer/cage is inserted to properly realign the spinal bones (vertebrae) above and below the disc and allow them to heal together (fusion).
Posterior Cervical Laminoforaminotomy is a decompression surgery used to relieve pressure on the spinal cord and nerve by removing bone to widen the spinal canal and foramen. This creates more space for the spinal cord and nerves. This can be done alone if a fusion is not required to stabilize the spine. In that case the patient will maintain a greater range of motion
of the neck. In other situations, posterior cervical decompression surgery requires a fusion to be performed with it due to the severe degeneration, or instability that would cause problems to recover quickly after surgery.
Artificial Disc Replacement
Some patients may meet the criteria to benefit from artificial disc replacement. Disc replacement is usually best for people who have a disc herniation as their main problem causing nerve compression. There should be minimal bone spurring and relatively normal alignment for this to be a consideration as surgical treatment. Patients with degeneration affecting more than two discs or segmental spinal instability are generally not candidates for disc replacement.
The neurosurgeons at Atlanta Brain and Spine Care are experienced in diagnosing and treating neck pain that radiates down the arm. Appropriate treatment will be determined after a thorough examination of the patient’s history, symptoms and physical examination.
Nonsurgical treatments are usually tried first, unless the problem is so severe that there is a concern of further nerve injury if surgical treatment is delayed. Regardless of which treatment option is recommended, during your office visit your Atlanta Brain and Spine neurosurgeon will explain their treatment recommendations and why they were made.