Forearm pain neck

Pain in the forearm has many potential causes including arthritis, tendonitis, and bursitis. However, when it’s coupled with neck pain, the number of possibilities is decreased.

The most likely cause of forearm pain accompanied by neck pain is referred pain from cervical radiculopathy (pinched nerve in the neck).

The cervical spine consists of 7 vertebrae, each shaped like a building block, separated from one another by shock absorbing pads called intervertebral discs which allow the spine to move freely. Each disc consists of a "nucleus pulposus" in its center, surrounded and contained by the tough fibrous membrane called the "annulus fibrosis" which is attached circumferentially to the adjacent vertebral bodies. The cervical spinal column provides strong, flexible support of the head and protection of the spinal cord. It is in constant motion during the waking hours.

Attached to the back of each vertebral body, by two struts of bone called "pedicles", one on each side, is an arch of bone (lamina) that encloses a hollow space, much like a tube, that runs the length of the spine and contains the spinal cord and spinal nerves. At each vertebral level a pair of spinal nerves (right and left "nerve roots") exits from the spinal column through openings called foramina; these nerves supply sensation to the skin and power to the muscles of the arms and hands. The spinal cord itself carries the motor and sensory nerve pathways to the trunk and legs, including nerves that control bowel, bladder and sexual function. The spinal cord and nerve roots are enclosed in a tough membrane called the dura, inside of which is a membrane called the arachnoid, containing clear colorless spinal fluid which bathes the spinal cord and nerves.

Each vertebra is connected to the vertebrae above and below by several strong ligaments as well as by the discs. Small "unco-vertebral" joints are located at the sides of each vertebral body, one on the right and one on the left, by which each vertebral body articulates with is neighbors. Right and left "facet" joints also support the spinal column, and each vertebra also articulates with its neighbors at the facet joints; they are located behind the vertebral bodies and lateral to the laminae.

Large strong muscles run the length of the cervical spine, in front, beside and behind the vertebral column, maintaining and controlling head position and neck movement.

Progressive degenerative changes occur in the cervical spine of all adults. The nucleus portion of the discs gradually dry out and become thinner, allowing the adjacent vertebrae to become closer together. As a result, the annulus portion of the discs tend to "bulge". Because the vertebral bodies come to lie closer together, there is increased wear and tear on the joints of the vertebral column, especially the unco-vertebral joints, the facet joints and disc margins, resulting in the gradual formation of bony overgrowths at the disc margins, at the unco-vertebral joints and at the facet joints. This process is the normal aging process, and it begins in middle life. It is sometimes called "spondylosis", and is present to a greater or lesser degree in all adults. The vast majority of individuals with these aging changes, even though the changes are quite advanced, are free of pain or any other symptoms. Various aging or degenerative changes such as bulging, degenerated or protruding discs, bony spurs or overgrowths, and facet joint hypertrophy are seen in X-rays, CT scans or MR scans of the cervical spine in over half the adult population.

Pain nerve endings are located in the various ligaments and muscles in the neck, as well as in the facet and unco-vertebral joints and the outer layer of the disc (annulus fibrosis). When these structures are irritated, strained or inflamed, pain is felt in the back of the neck, and may spread toward the shoulders but not down the arms, and is commonly felt between the shoulder blades ("referred pain").

Neck pain, which is a very common symptom in the general population, is usually muscular or ligamentous in origin, and is usually self-limited although it can be persistent. The natural processes of healing of areas of inflammation result in improvement in almost all cases. In fact, the pain from serious neck injuries such as fractures, dislocations and most cervical spine surgery almost always resolves after a few weeks or at most a few months. There is usually little if any correlation between neck pain and the degenerative changes so commonly seen on x-rays and scans.

In the situation in which a cervical nerve root is severely irritated or compressed, there is severe sharp pain radiating all the way down the arm and into the forearm, aggravated by neck movement, with or without numbness and/or tingling in a portion of the hand, fingers or arm, with or without weakness of arm or hand muscles supplied by that nerve. There may also be pain around the shoulder blades. A nerve root may be irritated or compressed by: (a) bone spurs or osteophytes growing into the exit foramen or canal through which the nerve travels, or (b) bulging of the part of the disc that lies in front of the nerve (the most lateral portion of the disc, not the central portion), or (c ) rupture or herniation of a piece of disc (nucleus pulposis) through the outer portion of the disc (annulus) into the nerve canal, or (d) fracture and/or dislocation injury causing bone fragments to narrow and/or impinge on the nerve canal (rare). In (a) (b) and (c ), a constant repair process is at work, and most symptoms subside over a period of time, usually a few weeks, almost regardless of treatment. Only a small percentage of patients with nerve root pain fail to recover, and require surgery.

There are a number of conditions with shoulder, arm and neck pain, weakness of arm and/or hand muscles, and/or numbness of the arm or hand, that must be differentiated from cervical disc and nerve root problems.

"Neuralgic amyotophy" or "brachial plexitis" is a condition in which there is inflammation of the nerves in the brachial plexus in the neck, with severe neck and shoulder pain followed by paralysis of shoulder girdle and upper arm muscles, and spontaneous recovery over a period of months. There is no numbness or sensory change in the arm or hand. Pain occurs in the forearm on occasion.

Thoracic outlet syndrome (TOS) is an extremely rare condition in which the nerves in the neck above the collar bone (the brachial plexus), which are the continuation of the cervical nerve roots, are entrapped or squeezed by muscles, ligaments or abnormal bone, causing arm and hand discomfort.

Peripheral nerves in the arm or hand may be entrapped or inflamed, giving rise to forearm and hand pain and numbness. Examples are entrapped median nerve at the wrist (carpal tunnel syndrome), entrapped ulnar nerve at the elbow (cubital tunnel syndrome), and peripheral neuropathy of these nerves due to diabetes.

Tumors or infections affecting the spinal column, although rare, must also be considered in the differential diagnosis of a patient who complains of persisting neck or arm pain, weakness and/or numbness. The fact that a patient with these complaints may have had a neck injury does not rule out the existence of a spinal tumor or infection as the cause of the symptoms. Therefore, all patients with persisting neck and arm pain, with or without weakness or numbness, require a thorough clinical history, physical examination and appropriate imaging.

Shoulder joint pain. Pain from a degenerated or injured shoulder joint often mimics and may be mistaken for nerve root pain, as the pain often spreads well down the top of the arm. Shoulder joint pain may inhibit the patient's willingness to contract the arm or hand muscles strongly when these muscles are being tested for strength, thus leading to the wrong conclusion that there is true muscle weakness, possibly caused by impairment of a nerve root. Pain from a diseased or injured shoulder joint is easily distinguished from nerve root pain: shoulder joint pain is usually aggravated by elevating the arm, whereas the arm can be moved freely in the presence of a cervical nerve problem, but neck extension aggravates nerve root pain in the arm.

Another condition that is sometimes seen is soft tissue rheumatism. This occurs when the tendons and ligaments surrounding the structures in the neck, shoulder, elbow, and wrist become strained. Then it is possible to see muscle tightness, and localized pain. Typically, a patient will have signs and symptoms of muscle strain in the neck accompanied by shoulder pain complaints that represent rotator cuff tendinopathy. These patients often will have forearm pain due to epicondylitis. Sometime they will have carpal tunnel syndrome that causes pain referral into the hand but also proximally into the forearm or shoulder.



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