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.

Click here: Second Opinion Arthritis Treatment Kit



Vertebrae are the individual bones that interlock with each other to form the spinal column.

The vertebrae are connected and held to each other by ligaments to form joints. The facet joints of the spine allow back motion. Each vertebra has four facet joints, one pair that connects to the vertebra above (superior facets) and one pair that connects to the vertebra below (inferior facets).

Ligaments are strong fibrous bands that bind bones together. The ligaments of the spine hold the vertebral bones together, stabilize the spine, and protect the disks. The three major ligaments of the spine are the ligamentum flavum, anterior longitudinal ligament (ALL), and posterior longitudinal ligament (PLL). The ALL and PLL are continuous bands run from the top to the bottom of the spinal column along the vertebral bodies. They prevent excessive movement of the vertebral bones. The ligamentum flavum attaches between the lamina of each vertebra.

The spinal nerves are numbered according to the vertebrae above which it exits the spinal canal. The 8 cervical spinal nerves are named C1 through C8.

The cervical (neck) section of your spine supports the weight of your head (approximately 10 pounds) and allows you to bend your head forward and backward, from side to side, and rotate 180 degrees. There are 7 cervical vertebrae numbered C1-C7. The vertebrae are separated by cushiony discs, which are designed similar to a radial car tire. The outer ring, called the annulus, has criss-crossing fibrous bands, much like a tire tread. These bands attach between the bodies of each vertebra and contain the gel-filled center called the nucleus, much like a tire tube. The criss-crossing fibers of the annulus pull the vertebrae together against the elastic resistance of the gel-filled nucleus. The nucleus acts like a ball bearing when you move - allowing the vertebra to roll over the incompressible gel. At each disc level, a pair of spinal nerves exit from the spinal cord and branch out to your body. Your spinal cord, which runs through the middle of the vertebrae, and the spinal nerves act as a "telephone," allowing messages, or impulses, to travel back and forth between your brain and body to relay sensation and control movement.

A herniated cervical disc, sometimes called a ruptured disc, is different from a bulging disc or protrusion. It occurs when the gel-like center of your disc actually ruptures out through a tear in the tough disc wall (annulus). The gel material is irritating to your spinal nerves, causing a chemical irritation. The pain you feel is a result of spinal nerve inflammation and swelling caused by the pressure of the herniated disc.

If you have a herniated cervical disc, you probably feel pain that radiates down your arm and possibly into your hand. You may also feel pain on or near your shoulder blade, and neck pain when turning your head or bending your neck. Sometimes you may have muscle spasms (meaning the muscles tighten uncontrollably).

Sometimes the pain is accompanied by numbness and tingling in your arm. You may also have muscle weakness in your biceps, triceps, and handgrip.

You may have first noticed pain when you woke up, without any traumatic event that might have caused injury. Some patients find relief by holding their arm in an elevated position behind their head because this position relieves pressure on the nerve.

Discs can bulge and herniate because of injury and improper lifting or can occur spontaneously. Aging plays an important role. As you get older, your discs dry out and become harder. The tough fibrous outer wall of the disc may weaken, and it may no longer be able to contain the gel-like nucleus in the center. This material may bulge or rupture out 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.

Herniated discs are most common in people in their 30s and 40s, although middle aged and older people are slightly more at risk if they're involved in strenuous physical activity. Only about 8% of herniated discs occur in the neck portion of the spine.

When you first experience pain, consult your family doctor. Your doctor will take a complete medical history to understand your symptoms, any prior injuries or conditions, and determine whether any lifestyle habits are causing the pain. Next a physical exam is performed to determine the source of the pain and test for any muscle weakness or numbness.

Your doctor may order one or more of the following imaging studies:

X-ray tests use X-rays to view the bony vertebrae in your spine and can tell your doctor if any of them are too close together or whether you have arthritic changes, bone spurs, or fractures. It's not possible to diagnose a herniated disc with this test alone.

Magnetic Resonance Imaging (MRI) scan is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of your spine. Unlike an X-ray, nerves and discs are clearly visible. It allows your doctor to view your spine 3-dimensionally in slices, as if it were sliced layer-by-layer like a loaf of bread with a picture taken of each slice. The pictures can be taken from the side or from the top as a cross-section. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. An MRI can tell your doctor which disc is damaged and if there is any nerve compression. It can also detect bony overgrowth, spinal cord tumors, or abscesses. Myelogram is a specialized X-ray where dye is injected into the spinal canal through a spinal tap. An X-ray fluoroscope then records the images formed by the dye. Myelograms can show a nerve being pinched by a herniated disc, bony overgrowth, spinal cord tumors, and spinal abscesses.

Regular X-rays of the spine only give a clear picture of bones. The dye used in a myelogram shows up white on the X-ray, allowing the physician to view the spinal cord and canal in detail. This test may be followed by a CT scan.

Computed Tomography (CT) scan is a safe, noninvasive test that uses an X-ray beam and a computer to make 2 dimensional images of your spine. Similar to an MRI, it allows your doctor to view your spine in slices, as if it were sliced layer-by-layer with a picture taken of each slice. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. This test is especially useful for confirming which disc is damaged.

Electromyography (EMG) & Nerve Conduction Velocity (NCV): EMG, often done with a NCV study, measures your nerve and muscle response to electrical stimulation. Small needles, or electrodes, are placed in your muscles, and the results are recorded on a special machine. Because a herniated disc causes pressure on the nerve root, the nerve cannot supply feeling and movement to the muscle in a normal manner. 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, hydrotherapy, chiropractic care, and pain management. Over 95% of people with arm pain due to a herniated disc improve in about six weeks and return to normal activity. If you don't respond to conservative treatment or your symptoms get worse, your doctor may recommend surgery.

Self care: Using correct posture and keeping your spine in alignment are the most important things you can do for your back. You may need to make adjustments to your daily standing, sitting, and sleeping habits and learn proper ways to lift and bend. Your workspace may need to be rearranged to keep your neck from being under stress.

Physical therapy: The goal of physical therapy is to help you return to full activity as soon as possible. Exercise is very helpful for the pain of a herniated disc, and it can help you heal faster. Physical therapists can instruct you on proper lifting and walking techniques, and they'll work with you to strengthen and stretch your neck, shoulder, and arm muscles. They'll also encourage you to increase the flexibility of your spine and arms. Activity modification, rest, pain medication, muscle relaxants, and application of ice may be helpful in the acute stages. Although your physical therapist may show you strengthening exercises, it's your responsibility to follow them.

Your doctor may prescribe pain relievers, nonsteroidal anti-inflammatory medications (NSAIDs), and steroids. Sometimes muscle relaxers are prescribed for muscle spasms.

• Nonsteroidal anti-inflammatory drugs (NSAIDs
• Analgesics, such as acetaminophen (Tylenol) can relieve pain but don't have the anti-inflammatory effects of NSAIDs. Long-term use of analgesics and NSAIDs may cause stomach ulcers as well as kidney and liver problems.
• Steroids can be used to reduce the swelling and inflammation of the nerves. They are taken orally (as a Medrol dose pack) in a tapering dosage over a five-day period. It has the advantage of providing almost immediate pain relief within a 24-hour period.
• Steroid injections into the area of your herniated disc may be prescribed if your pain is severe. This procedure involves an injection of steroids and an analgesic-numbing agent into the epidural space of the spine to reduce the swelling and inflammation of the nerves. About 50% of patients will notice relief after an epidural injection, although the results tend to be temporary. This procedure is usually done in a series of three, at 2-week intervals, to obtain the best results in the shortest time. If the injection is helpful, it can be done up to three times a year.


Some patients want to try holistic therapies such as acupuncture, acupressure, nutritional supplements, and biofeedback. The effectiveness of these treatments for a herniated disc may aid you in learning coping mechanisms for managing pain as well as improving your overall health. For resources in your area visit:

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.

The most common approach to cervical disc surgery is anterior (front of the neck). Less commonly, a posterior (from the back) approach may be performed if you require decompression for additional conditions such as stenosis or removal of bone spurs.

• Anterior cervical discectomy removes the part of the ruptured disc that is pressing on the nerve. This procedure is performed through a small incision in the front of your neck. After removing the disc, the disc space may be fused.
• Posterior microdiscectomy removes the part of the ruptured disc that is pressing on the nerve. This procedure is performed through a small incision in the back of your neck. A portion of the bone overlying the spinal cord is removed (called a laminectomy) to expose the spinal nerve and disc space. The spaces through which the nerve roots exit your spine are usually enlarged to prevent future pinching (called a foraminotomy).
• Fusion describes the joining together of bone. A fusion is performed by placing a bone graft (from patient or donor) between the vertebrae where the disc was removed. Additional support with metal plates and screws provides stability during fusion and possibly a better fusion rate.
• Disc replacement is still considered an experimental treatment in which an artificial disc replaces the original disc and annulus.

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