Vertebrae shoulder and arm 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.
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There are seven vertebrae (bones) in the cervical (neck) part of the spine. These vertebrae form a bony protective tunnel around the spinal cord.
A soft disc separates each vertebra, providing cushioning. At the level of each vertebra, a nerve root exits through an opening and joins with other nerve roots to form peripheral nerves that travel down the neck, shoulders, and arms.
When a nerve root leaves the cervical spine, it travels down into the arm. Along the way, each nerve supplies sensation and electrical signals to muscles to enable movement of the arm or hand. When a nerve is irritated or pinched - by either a bone spur or part of the intervertebral disc - it causes nerve dysfunction. This manifests as weakness in the muscles, numbness in the skin, or pain. This condition is called cervical radiculopathy.
Bending the neck forward and backward, and twisting left and right, places pressure on the vertebrae and disc. The disc responds to the pressure by acting as a shock absorber. Bending the neck forward compresses the disc between the vertebrae. This increased pressure on the disc may cause the disc to bulge back toward the spinal canal and nerve roots.
Injury to the disc may occur when too much pressure is placed on the disc. One of the most painful injuries is a herniated disc. In this injury, the nucleus pulposus, the inner part of the disc, ruptures through the tough outer circle of the disc. When this happens, the nucleus pulposus presses against the nerves. Pressure on the nerve root from a herniated disc can cause pain, numbness, and weakness along the nerve. There is also evidence that the chemicals released from the ruptured disc may irritate the nerve root.
In middle-aged and older individuals, the degenerative disc disease can cause bone spurs to form around the nerve roots. This usually occurs inside the foramen - the opening in the cervical spine where the nerve root leaves the spine to travel into the arm. If these bone spurs get large enough, they may rub on the nerve root and irritate it. This causes the same symptoms as a herniated disc.
Common symptoms include:
• Pain in your neck
• Pain in your shoulder, arm, or hand
• Reduced range of motion in your neck
• Numbness, weakness, and slower reflexes in your arms, hands,legs, or feet
• Problems walking including a "spastic gait"
• Muscle weakness in your legs
Finding the cause of neck pain begins with a complete history and physical examination. Diagnostic tests are next. Regular X-rays may be the first step.
Important clues are:
• When did the pain first begin?
• Have you increased your activity level?
• Have you had an injury, or surgery, to your neck at any time?
• Does the pain go down into your arms or legs?
• What causes your neck to hurt more or less?
• Have you had any problems with your bowels or bladder?
A physical exam is important. This includes:
• How well you can bend your neck and roll your head in all directions
• How well you can twist your neck
• If there is tenderness around the neck
• If there are muscle spasms around the neck and shoulders
Tests that examine the nerves that leave the spine are also important. These include:
• Testing for numbness in the arms and hands
• Testing the reflexes
• Testing the strength of the muscles in the arms, hands, and legs
• Testing for signs of nerve irritation
X-rays show the bones of the cervical spine. Also, narrowing of the disc space between each vertebra and bone spurs show up on X-rays. The X-rays will be useful in showing how much degeneration and arthritis are affecting the neck.
The MRI is the most commonly used test to evaluate the spine because it can show abnormalities of the soft tissues around the spine.
The CAT scan is sometimes ordered when bony lesions are suspected as having a major role in the pain syndrome. It is also ordered if a patient can't have an MRI (ie., they have a pacemaker).
An EMG tests the speed at which the nerve roots send electrical messages to the brain. The test is done by inserting tiny needle electrodes into the muscles. The EMG measures the electrical signals in the muscles. The EMG can show if a nerve is being pinched after it branches from the spine
There are many possible causes of neck pain. Some of these causes are not related to degeneration of the spine. Blood tests to look for infection or arthritis may be necessary. Problems originating in areas other than the spine may also cause neck pain. If your doctor feels that you may have a throat problem or a thyroid problem, other tests may be ordered to make sure the problem is not coming from these areas.
Treatment is always based on the individual and his or her symptoms. Treatment for neck pain falls into two broad categories: conservative treatment (non-surgical) and surgical treatment.
Medications are commonly used to control pain, inflammation, muscle spasm, and sleep disturbance.
A cervical collar is often used to provide support and limit motion while an injured neck is healing. Cervical collars can be soft (made of foam) or hard (made of metal or plastic). Because these collars can restrict the movement of your head, you may need help with eating and other activities. The skin under the collar needs to be checked every day to prevent blisters or sores.
A cervical pillow is sometimes recommended for people who have problems with neck pain at night. The cervical pillow is designed to hold the neck in the best position to prevent excess stress on the cervical spine during sleep.
Your doctor may have a physical therapist work on an exercise program developed just for you. The physical therapist will teach you ways to prevent further injury to your neck.
If other treatments do not relieve your back pain, you may be given an epidural steroid injection (ESI), or a cervical nerve block. An ESI places a small amount of cortisone into the bony spinal canal. This may ease the pain caused by irritated nerve roots. The ESI is not always successful. This injection is often used when other conservative measures do not work, or in an effort to postpone surgery.
Surgery is only necessary in a small percentage of patients.
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