Cervical disc shoulder pain
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Shoulder pain from a cervical herniated disc is one of the more common cervical spine conditions seen by rheumatologists.
In fact, making the distinction between shoulder pain from a shoulder abnormality versus shoulder pain being referred from the neck is often difficult.
Pain from herniated disc in the cervical spine usually develops in people in the 30 - 50 year old age group. Although a herniated disc in the neck may originate from some sort of trauma or injury to the cervical spine, the symptoms, including shoulder and arm pain, commonly start simultaneously.
The shoulder and arm pain from a cervical herniated disc results because the herniated disc material “pinches” a cervical nerve, causing pain to radiate down the arm. Along with the shoulder and arm pain, numbness and tingling can be present in the arm and down into the fingertips. Muscle weakness may also be present due to a cervical herniated disc.
The two most common levels in the cervical spine to herniate are the C5 - C6 level (cervical vertebra 5 and cervical vertebra 6) and the C6 -C7 level. The next most common is the C4 - C5 level. Rarely,does the C7 - T1 level herniate.
The nerve that is affected by the cervical disc herniation is the nerve exiting the spine at that level, so at the C5-C6 level it is the C6 nerve root that is affected.
A cervical herniated disc will typically cause pain distribution and neurological deficits:
• C4 - C5 (C5 nerve root) - weakness in the deltoid muscle in the upper arm. Can cause shoulder pain.
• C5 - C6 (C6 nerve root) - weakness in the biceps (muscles in the front of the upper arms) and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand.
• C6 - C7 (C7 nerve root) - weakness in the triceps (muscles in the back of the upper arm) and the finger extensor muscles. Numbness and tingling along with pain can radiate into the middle finger. This is also one of the most common levels for a cervical disc herniation
• C7 - T1 (C8 nerve root) - Can cause weakness of grip. Numbness and tingling and pain can radiate down the arm to the small finger side of the hand.
While the above describes typical pain patterns associated with cervical disc herniation, these pain patterns may vary. Some people have nerve roots that don’t follow the classic pattern, and their shoulder and arm pain and other symptoms will be different.
Because the space available for the nerves to exit is relatively tight, even a small cervical disc herniation can impinge upon the nerve and cause significant pain.
Usually, the arm pain from a cervical herniated disc can be controlled with medication, and conservative (non-surgical) treatments help resolve the condition.
The arm pain generally improves before the weakness and numbness resolves.
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