Neck pain with lateral movement

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

Numerous causes of neck pain exist and neck pain is one of the most common complaints seen in a rheumatology office.

Here are some of the more common causes…

Cervical spondylosis (osteoarthritis) is due to a combination of disk degeneration and osteophyte (bone spur) formation in the facet joints, which are located at the back of each vertebra. The end result is diffuse pain that may radiate from the neck to the shoulders, occipital area, or the interscapular muscles. Physical examination may reveal tenderness and pain at the limit of motion with extension and lateral flexion.

X-ray findings are significant only if they correlate with the patient's clinical signs and symptoms. Plain x-rays of the cervical spine typically demonstrate narrowing between the vertebrae and facet joint arthritis. MRI reveals degenerative cervical disk disease in more than 50% of patients 40 years of age or older. Scans serve to locate nerve impingement.

Most patients have a relapsing course with recurrent flares of acute neck pain. Effective therapy requires a balance between stability and maintenance of motion. Range-of-motion exercises maximize neck flexibility; cervical collars decrease pain by restricting neck movement. Non-steroidal anti-inflammatory drugs (NSAIDS) and local injections may help to relieve pain.

In patients with arm pain, the underlying cause often is pressure from a herniated disk or bone spur and secondary inflammation of the nerve roots. Herniation can result from sudden exertion, as in heavy lifting. Neck pain is minimal or absent, and the injury causes pain that spreads from the shoulder to the forearm and hand and is severe enough to limit arm use.

Physical examination will detect increased radicular pain with any maneuver that narrows the intervertebral foramen and places tension on the affected nerve, such as compression, extension, or lateral flexion of the cervical spine (Spurling's sign).

Neurologic examination will reveal sensory abnormalities, reflex differences, or muscle weakness correlated with the affected spinal nerve root and degree of impingement.

MRI is the best technique to locate disk herniation and nerve root impingement; electromyography and nerve conduction tests will document nerve dysfunction and differentiate peripheral entrapment syndromes (e.g., carpal tunnel syndrome) from spinal nerve impingement.

Therapy includes rest, cervical collars, NSAIDs, and traction. Those with resistant pain may also obtain relief from epidural corticosteroid injections. Low-dose oral corticosteroids (10 mg to 15 mg/day) may be considered for patients who refuse epidural injections. Corticosteroids should be used for a limited period; dosage is tapered slowly once radicular symptoms have resolved. Many patients' arm symptoms resolve within three months.

When there is progressive neurologic worsening or intractable pain, surgical decompression should be considered. Some studies suggest that patients who undergo such surgery do better than those who do not.

Stingers. These happen in the neck when nerves (brachial plexus) that run from the back of the neck into the arm are stretched or pinched. This occurs from a forced lateral movement, or twisting of the neck and head. There is an acute pain or sensation of a shock from the shoulder down into the arm and fingers. There may be a numbness or weakness in the arm. Usually this acute pain lasts only a few minutes and resolves completely.

These injuries are common in football and other contact sports. When the top of the shoulder and neck is pushed one way and the arm is forced another, the nerve gets stretched. Stingers can occur in car accidents and other traumatic events, or by simply moving the head and neck too quickly.

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