Pain in Neck and Shoulder Radiating Down Arm
Pain in the neck and shoulder radiating down the arm to the fingers can be anything from a minor inconvenience to a life-altering inconvenience. Hand, arm, and shoulder weakness can occur in some people. Others may experience tingling or numbness in the arm. Neck movements can exacerbate shoulder blade pain. A doctor may be needed if the pain does not go away after a few weeks of rest and over-the-counter medications.
CAUSES OF THE PAIN
Cervical radiculopathy may be the cause of pain in the neck that radiates down the arm. Compression and irritation of a nerve at the spinal cord’s branching point cause the pain. There could be a number of factors at play. A sudden injury to the neck may have resulted in a cervical disc herniation, which caused the condition. There is a chance that arthritis or degenerative disc disease is to blame in older patients. The spinal discs stiffen and dry out with age. Their function as shock absorbers has been largely eliminated. If the discs begin to bulge, they may begin to lose their height. As the discs degenerate, the spinal vertebrae become closer together. Bone spurs can form as a result of these changes, narrowing small openings on each side of the spine known as the neuroforamen or just foramen, which can cause pain and compression on the nerves. As it leaves the spinal column, the nerve root is pinched by the narrowed foramen. When these changes become severe enough, they can cause symptoms that would otherwise not be present.
DIAGNOSIS
During a physical exam, the doctor will look for changes in reflexes, muscle weakness, and loss of sensation in the patient. X-rays, an MRI, or a CT with a myelogram scan may be ordered as diagnostic tests. Foramen narrowing and damage to the discs can be seen in these tests, as well as abnormal vertebral alignment in the neck.
NON-SURGICAL TREATMENT
Some people’s pain can be alleviated without the need for extensive treatment. For some patients, the pain subsides for a short period of time but then returns. To begin with, the doctor may suggest some non-surgical treatment options to see if the condition can be improved.
One option is physical therapy. Exercises to strengthen and expand the range of motion in the neck may be included. By stretching and relieving pressure on the spinal nerves, neck traction may help alleviate symptoms in some people. Following formal physical therapy, the patient would be taught how to carry out these exercises and treatments at home. Short-term use of soft cervical collars may be beneficial in relieving neck pain and inflammation, but long-term use of these collars can weaken neck muscles and cause other problems.
Analgesics, such as NSAIDs, may help alleviate pain. Swelling can be reduced with the use of corticosteroid medications. The use of narcotic pain relievers is usually limited to a few days. As the affected nerve heals, epidural steroid injections can lessen pain and reduce swelling so that the symptoms are less painful.
SURGICAL TREATMENT
Numerous factors influence surgical intervention, including the symptoms and their severity as well as the specific root nerve in question. Surgery may also be required if the spinal cord is compressed, and this may happen much sooner than if only a nerve root is affected. If there is movement impairment, weakness, or debilitating pain that has not been alleviated by nonsurgical treatments, surgery may be necessary. If the neck is in danger of collapsing, surgery may be necessary.
Cervical radiculopathy can be treated surgically in three ways:
Treatment for a herniated or degenerative disc in the cervical region is accomplished through an operation known as an Anterior Cervical Discectomy and Fusion (ACDF). Implants are used to correct vertebral misalignment and promote healing by replacing the disc with an artificial graft or spacer/cage (fusion).
The Posterior Cervical Laminoforaminotomy procedure removes bone from the spinal canal and foramen to widen the canal and relieve pressure on the spinal cord and nerves. This gives the spinal cord and nerves more room. If a fusion is not necessary, this procedure can be performed on its own. As a result, the patient’s neck will be able to move more freely. In other cases, posterior cervical decompression surgery necessitates a fusion because the degeneration or instability is so severe that the patient would have difficulty recovering quickly from the procedure.
ARTIFICIAL DISC REPLACEMENT
Disc replacement surgery may be an option for some patients. When disc herniation is the primary cause of nerve compression, a disc replacement may be the best option. For this to be a viable surgical option, there must be minimal bone spurring and relatively normal alignment. Disc replacement is generally not an option for patients who have degeneration affecting more than two discs or who have segmental spinal instability.
In the case of arm-tingling neck pain, the neurosurgeons at Atlanta Brain and Spine Care are well-versed in the diagnosis and treatment options available. After a thorough review of the patient’s medical history, symptoms, and physical examination, a treatment plan will be developed.
Unless the problem is so severe that further nerve injury is feared if surgical treatment is delayed, nonsurgical treatments are usually tried first. Your Atlanta Brain and Spine neurosurgeon will explain their treatment recommendations and why they were made during your office visit.
