“Neck pain is the fourth leading cause of disability, with an annual prevalence rate exceeding 30%” (1). 

Neck pain, while unfortunately very common, can be quite the debilitating condition. Losing the ability to turn your head during simple and necessary daily activities, such as driving, adversely impacts one’s quality of life. Getting through episodes of neck pain quickly is vital to getting back to living your best life.

What can this feel like?

Cervical radiculopathy may present as pain, numbness, or tingling that travels from the neck into the shoulder and down the arm. 

There may be associated muscle weakness with this condition as well.

Depending on the level of nerve involvement in the neck, symptoms may be felt in different locations. For example, if the nerve root of cervical nerve #7 (located in the lower neck) is being compressed, pain will likely be felt traveling down to the middle finger. An assessment of symptom location can help clinicians determine where the issue is stemming from to guide treatment. 

Cervical nerve root #7 is also the most commonly affected nerve root, making up 45-60% of cervical radicular pain cases (1).

Why is this happening?

Just like sciatica in the low back and legs, we can get radiating symptoms in the neck and arms. A “pinched nerve,” or pressure on the nerve, frequently causes the associated neck and arm pain. A disc herniation or bone spur are the most common culprits of this nerve compression. Disc herniations can result from trauma to the neck and place physical pressure on the nerve. Bone spurs are caused by extra bone laid down in the spine by the body as a natural part of the aging process. These spurs similarly compress the nerve in certain body positions.

Another source of neck and arm pain include irritation or inflammation of nearby facet joints of the spine. Local trauma can aggravate these joints releasing inflammatory mediators that hang around for a few days and irritate the nearby nerve root. This is a chemical irritant, unlike a disc herniation and bone spurs that place physical pressure on the nerve.

What else could it be?

Your arm pain may not necessarily be coming from your neck as there are a myriad of conditions that may be causing it. Here is a list of other potential explanations for the pain in your arm:

Brachial plexus injury – This bundle of nerves is located between the neck and shoulder. An injury in which the arm or shoulder is forcefully pulled may damage this area.

Nerve Entrapment – This is a blanket term for a nerve that is being compressed at some point along its path. Common locations for the radial, median, and ulnar nerves to be compressed are in the elbow, forearm, and wrist.

Carpal tunnel – Results from compression of the median nerve at the wrist. This is a type of nerve entrapment. Occupations that require repetitive finger and hand movements are regularly affected by this (typing, factory work).

Double Crush Syndrome – It’s possible for your neck and arm pain to be coming from both the neck and the arm. Double crush is when a nerve is being compressed in the neck as well somewhere in the arm. With this condition, it’s important to address both areas of compression for symptom resolution. 

Treatment

Early treatment interventions can be beneficial in reducing the intensity and frequency of these episodes, with 90% of non-operative patients having good outcomes (1-2,8).

Conservative care is the best place to start: chiropractic, physical therapy, and anti-inflammatory medication are a few options. One study found chiropractic and McKenzie-type exercises to be superior treatment options to medication for acute neck pain (4).

Dr. Hartley demonstrates a couple of exercises we frequently give to patients to help reduce neck and arm pain:

 

 

While immobilization (often advised by urgent care and emergency rooms) of the neck may be used to reduce aggravation of symptoms, it doesn’t appear to be a successful long term treatment option (1,3).

More invasive treatment options are available if needed:

 Non-steroidal anti-inflammatory drugs (NSAIDs) can be an effective treatment option for acute neck pain that doesn’t respond to other conservative care treatments (1,5). NSAIDs have both anti-inflammatory and pain-relieving properties that target the chemical irritants affecting the nerve root.

Corticosteroid injections are another treatment option. If injections are needed, facet injections may be a safer and more effective option than transforaminal corticosteroid injections (6,8).

While the majority of neck and arm pain cases will respond to conservative treatment, there are always those cases that won’t. “When nonsurgical treatment fails to relieve symptoms or if a significant neurologic deficit exists, surgical decompression may be necessary. Surgical outcomes for relief of arm pain range from 80% to 90% with either anterior or posterior approaches” (7). Based on the cost and risk of complications, this should only be considered after failure to improve with conservative care.

Conclusion

If you’re dealing with nagging neck and arm pain, give us a call! There may be a simple solution to get you back out living your best life, and we are here to help!

 

References

1.     Cohen, S. P. (2015). Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clinic Proceedings, 90(2), 284–299. https://doi.org/10.1016/j.mayocp.2014.09.008
2.     Saal JS, Saal JA, Yurth EF. Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine (Phila Pa 1976) 1996;21:1877–83. doi: 10.1097/00007632-199608150-00008.
3.     Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: a review. HSS J. 2011;7:265–72. doi: 10.1007/s11420-011-9218-z
4.     Bronfort, G., Evans, R., Anderson, A. V., Svendsen, K. H., Bracha, Y., & Grimm, R. H. (2012). Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain. Annals of Internal Medicine, 156(1_Part_1), 1. https://doi.org/10.7326/0003-4819-156-1-201201030-00002
5.     Dreyer SJ, Boden SD. Nonoperative treatment of neck and arm pain. Spine (Phila Pa 1976) 1998;23:2746–54. doi: 10.1097/00007632-199812150-00016.
6.     Bureau, N. J., Moser, T., Dagher, J. H., Shedid, D., Li, M., Brassard, P., & Leduc, B. E. (2014). Transforaminal versus Intra-Articular Facet Corticosteroid Injections for the Treatment of Cervical Radiculopathy: A Randomized, Double-Blind, Controlled Study. American Journal of Neuroradiology, 35(8), 1467–1474. https://doi.org/10.3174/ajnr.a4026
7.     Rhee, J. M., Yoon, T., & Riew, K. D. (2007). Cervical Radiculopathy. Journal of the American Academy of Orthopaedic Surgeons, 15(8), 486–494. https://doi.org/10.5435/00124635-200708000-00005
8.     Iyer, S., & Kim, H. J. (2016). Cervical radiculopathy. Current Reviews in Musculoskeletal Medicine, 9(3), 272–280. https://doi.org/10.1007/s12178-016-9349-4