One of the most common symptoms presenting to our orthopedic spine surgeons at DSSC is neck and arm pain. Some causes for these symptoms are discussed below:
There are several common causes of symptoms occurring in the neck and arm at the same time. These symptoms may vary from pain, numbness, tingling and weakness, which might occur in any combination. When considering neck pain with arm symptoms occurring at the same time, it is useful to consider three categories of potential causes:
1. Radicular Pain Referral (Cervical Radiculopathy): Neck pain with radicular pain in the shoulder, arm and/or hand is often the result of compression of a spinal nerve in the neck. Spinal nerves leave the cervical spine (neck) to enter the arm as nerves. Thus, when a nerve is compressed in the neck, it can cause radiating pain into various regions of the shoulder and/or arm. The pattern and distribution of these symptoms can often be deciphered and isolated to a particular nerve in the neck by physical examination by a trained spine surgeon.
2. Vertebrogenic Pain Referral: This type of pain referral (and associated symptom pattern) is a little vaguer than the radicular type. Vertebrogenic symptoms are caused by compromise of structures of the spine such as the disc, joints and bony structures of the spine. This type of pain refers into the upper back, shoulders and arm in a similar way that a heart attack refers into a limb. This type of symptom pattern can sometime closely resemble radicular pain but can be differentiated by a good physical examination, correlation with imaging (e.g. MRI and X-ray) and sometimes by other tests like electrodiagnostic testing (EMG/NCV).
Myogenic/Soft Tissue: This type of pain is often harder to diagnose. Soft Tissue pain syndromes, while quite common, are underappreciated by conventional medicine. This type of pain is caused by tiny clusters of adhesions (scar tissue) that accumulates in and around the soft tissues (muscles, ligaments, tendons) of the spine and adjacent structures. This causes pain and restriction with movement of the neck and/or arm. A particular type of tissue called fascia is often to blame. While often debilitating, this pain is often easier to treat and rarely if ever requires surgery.
One of the common causes of severe, radiating, neck and arm pain is a herniated, cervical disc. In cases where the patient is suffering from a herniated disc, they will often report a fairly long history of mild-moderate neck pain that suddenly enters the arm (as the disc herniates and makes contact with one or more nerves in the neck.) This condition is discussed in this video:
Treatment for Neck, Shoulder and Arm Pain
By the descriptions above, it is easy to see that neck and arm pain is not a clear-cut entity. The first step in treating neck and arm pain is to identify what is causing the symptoms. This can be achieved by evaluation by a trained orthopedic spine specialist. This evaluation will involve a thorough history, which will try to identify patterns that might provide clues as to the source of the neck, shoulder or arm pain. This will be followed by a physical examination, which will aim to identify patterns of sensory loss, weakness or reflex changes that might implicate a particular nerve or group of nerves in the neck. A spine surgeon will also perform special orthopedic tests in an effort to reproduce or provoke your symptoms by special maneuvers – this will give further evidence as to the source your pain. This examination may be enhanced by an evaluation of X-rays, MRIs or other tests like nerve tests.
Once this information is studied by your spine surgeon, he will recommend a best course of action to resolve your neck and shoulder pain. This might involve something as conservative as pain medication, physical therapy or chiropractic to more advanced options such as spinal injections. The decision to recommend spine surgery will be reserved for cases where the cause of the pain represents a danger to the patient or if the condition is unlikely to respond to conservative options.
Desert Spine and Scoliosis Center (Mesa, AZ) offers quality orthopedic spine care and spine surgery for patients living in the metro Phoenix area, including areas such as Tempe, Gilbert, Chandler and Casa Grande.