Pinch nerve in neck pain in arm treatment
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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A pinched nerve in the neck is one of the most common problems seen in a rheumatologists office. Often, the patient will provide a history indicating a prior whiplash injury or other trauma.
In older patients, the underlying cause is usually cervical spondylosis (osteoarthritis in the neck). A herniated or bulging disc may also be the culprit.
It is helpful to examine the anatomy of the neck to understand this problem.
The cervical spine (neck) is made up of seven vertebrae. C-1 (the topmost vertebra)interacts with the occiput of the skull above and with C-2 below. The C1-occipital interaction is considered a true joint.
The C1-occiput joint primarily allows flexion and extension, while the C1-C2 articulation primarily provides rotation. Vertebrae C-3 through C-7 as an interdependent group allow for varying degrees of flexion, extension, lateral bending, and rotation. Flexion centers on C-5 and C-6 and extension on C-6 and C-7, which is why degenerative changes.
Intervertebral disks are found from C2-3 and below. These act as cushions but are subject to injury and degeneration. Disk degeneration and herniation can lead to compression of the nerve root (radiculopathy) or spinal cord (myelopathy). The term “radiculopathy” refers to a pinched nerve.
Eight pairs of cervical spinal nerves exit through the intervertebral foramina.
The posterior aspect of the cervical vertebrae contain the facet joints, which are true synovial joints, while a bony lip off the side margin of the vertebrae form the uncovertebral joints.
Both types of joints are subject to degenerative changes that produce pain with neck extension combined with lateral bending and rotation.
The muscles of the neck are divided into four major compartments: anterior (flexion), posterior (extension), and the lateral groups (lateral bending).
The most common type of injury is muscle strain. Muscle strains usually resolve within a few days to a couple of weeks, ligament sprains may take up to a few months, and disk injuries or herniations with radiculopathy can take 3 to 6 months for full recovery.
Pain that increases with activity but improves with rest or a change in position, is commonly referred to as mechanical pain. Pain that persists or worsens despite rest and treatment, pain that persists around the clock, or pain that worsens at night should raise suspicion that another process such as malignancy might be present.
Localized pain generally points to muscle strains, ligament sprains, and facet or disk (degenerative) processes, although radiattion of pain to the scapula or upper trapezius area is common as well. Pain that radiates into the arms frequently stems from nerve involvement, although myofascial pain sometimes does this too.
It is not uncommon for pinched nerves in the neck to cause bizarre symptoms such as facial pain, ringing in the ears, headaches, and chest pain. A careful history and physical examination are critical.
Upper cervical nerve injuries can cause pain to tadiate into various regions depending on the innervation pattern of the nerve. Examples are: the head (C-1, C-2), the neck (C-3), and the upper trapezius region (C-4). The C-5 nerve transmits pain to the shoulder and lateral arm.
The C-6 nerve pattern is very similar but includes the radial forearm and thumb, and occasionally the index finger. The C-7 nerve refers pain to the posterior arm, dorsal forearm, and the index and middle fingers. The C-8 nerve classically radiates pain to the medial arm, ulnar forearm, and the ring and little fingers.
Other diagnostic considerations for referred pain include thoracic outlet syndrome and ulnar neuropathy, in which pain radiates to the medial arm, forearm, and ring and little fingers. This can appear like a C-8 radiculopathy. Thoracic outlet syndrome typically will involve more proximal pain as well, such as in the axilla or scapula.
Carpal tunnel syndrome characteristically causes painful tingling in the thumb and first two fingers, and sometimes pain up the arm as high as the neck, thereby mimicking a C-6 or C-7 radiculopathy.
Shoulder degenerative joint disease or acromioclavicular, subacromial, or rotator-cuff pathology may be confused with a C-5 radiculopathy.
In addition to careful clinical examination, diagnostic studies such as magnetic resonance imaging (MRI) and electromyography (MRI) are helpful.
The treatment depends on the severity of the problem. In patients where pain is the primary problem and there is little evidence of cord compression, then a conservative program consisting of anti-inflammatory drugs, physical therapy, soft cervical collar, neck support pillow, gentle traction, exercises, and steroid injections are usually sufficient.
Ligament injuries sometimes respond to prolotherapy.
In cases where significant muscle spasm exists, injections of Botox can alleviate pain.
Patients who develop significant limb weakness or evidence of cord compression need neurosurgical evaluation immediately.
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