Pinch nerve in neck pain in arm treatment
The cervical spine (neck) is made up of seven vertebrae. C-1 articulates with the occiput of the skull above and with C-2 below. Intervertebral disks are found from C2-3 and below and are subjected to significant deformation during flexion and extension. Disk degeneration may be painful in its own right, while 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 bilaterally through the intervertebral foramina. Each spinal nerve is named for the vertebra above which it exits; for example, the C-6 nerve exits above the C-6 vertebra. Therefore, a herniated disk or significant foraminal narrowing at the C5-6 level will most commonly involve the C-6 nerve. The exception is the C-8 spinal nerve, which exits between the C-7 and T-1 vertebrae. The posterior aspect of the cervical vertebral articulation contains the facet joints, which are true synovial joints, while a bony lip off the lateral margin of the upper vertebral body forms the uncovertebral joint with the vertebra below. Both joints are subject to degenerative changes that may produce pain with cervical extension combined with lateral bending and rotation. Hypertrophy of these joints may affect the surrounding anatomic structures, including the spinal cord, nerve roots, and exiting spinal nerves, as well as the vertebral artery and the sympathetic rami. 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 couple of months, and disk injuries or herniations with radiculopathy can take 3 to 6 months for full recovery. Pain that increases with activity or within a few hours after activity, but settles down 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 raises suspicion for a metabolic or neoplastic condition or for psychosocial factors that prolong recovery. It is important to determine whether the pain is localized or radiating; therefore, knowledge of the anatomic region is essential. 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 are relatively rare and refer dysesthetic (painful numbness and tingling) pain to 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, and occasionally the radial forearm. Other differential diagnostic considerations for referred pain include thoracic outlet syndrome and ulnar neuropathy, in which pain refers to the medial arm, forearm, and ring and little fingers, similar to a C-8 radiculopathy. Thoracic outlet syndrome typically will involve more proximal pain as well, such as in the axilla or scapula. 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, and steroid injections are usually sufficient. Patients who develop significant limb weakness or evidence of cord compression need neurosurgical evaluation immediately.
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