Cervical protruding disc shoulder blade 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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Vertebrae are bones that are stacked upon each other to form the spinal column.
The vertebrae are connected to each other by ligaments. The facet joints located at the rear of the vertebrae allow motion. Each vertebra has four facet joints, one pair that connects to the vertebra above and one pair that connects to the vertebra below.
Ligaments are strong fibrous bands that bind the vertebrae together, stabilize the spine, and protect the disks.
The spinal nerves are numbered according to the vertebrae above which it exits the spinal canal. The eight cervical spinal nerves are named C1 through C8.
The vertebrae are separated by discs, which are designed similar to a jelly doughnut. The outer ring, called the annulus, has criss-crossing fibrous bands. These bands attach between the bodies of each vertebra and contain the gel-filled center called the nucleus. At each disc level, a pair of spinal nerves exit from the spinal cord and branch out. The spinal cord, which runs down a central canal through the middle of the vertebrae, and the spinal nerves act as a transmitter allowing messages, or impulses, to travel back and forth between the brain and and rest of the body.
A herniated cervical disc is different from a bulging disc or protrusion. It occurs when the gel-like center of the disc ruptures out through a tear in the disc wall (annulus). The gel material causes pressure on the nerve root as well as a chemical irritation.
A herniated cervical disc causes pain that radiates down the arm and possibly into the hand. In addition, there may be pain on or near the shoulder blade, and neck pain when turning the head or bending the neck. Cervical disc pain due to either herniation or protrusion may be the most common cause of pain radiating into the shoulder blade region. Sometimes the pain is felt between the shoulder blades.
And sometimes the pain is accompanied by numbness and tingling in the arm. Muscle weakness in the biceps, triceps, and grip may occur.
Discs can bulge and herniate because of injury or can occur spontaneously. With age, discs dry out and become harder. The tough fibrous outer wall of the disc may weaken and the gel-like nucleus in the center bulges. This material may bulge or rupture through a tear in the disc wall, causing pain when it touches a nerve. Genetics, smoking, and a number of occupational and recreational activities lead to early disc degeneration.
A magnetic resonance imaging (MRI) scan is the diagnostic imaging procedure of choice.
EMG, often done with a NCV study, measures nerve and muscle response to electrical stimulation. Small needles, or electrodes, are placed in the muscles, and the results are recorded on a special machine. This test can show nerve damage, both old and new.
Conservative non-surgical treatment is the first step to recovery and may include medication, rest, massage, physical therapy, home exercises, ice/heat, and pain management. More than 95% of people with arm pain due to a herniated disc improve in about six weeks and return to normal activity.
When symptoms progress or do not resolve with conservative treatment, surgery may be required. Factors such as patient age, how long the problem has persisted, other medical problems, previous neck operations, and expected outcome are considered in planning surgery.
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