July 6, 2018
Neck pain with radiation down the right or left arm is known as Cervical Radiculopathy or what people consider a “pinched nerve”. This can result in pain in the neck travelling down the shoulder, shoulder blade, arms, and hands resulting in pain, weakness, as well as numbness and/or tingling depending on how severe and location of the which is being “pinched”. This condition can be a result of traumatic incident (motor vehicle accident) or degenerative conditions (normal wear and tear) and is usually the result of compression or irritation of the spinal nerve root.
Cervical Spine Radiculopathy may be a result of a herniated disc, degenerative disc, or arthritis of the facet joint of the neck (spondylosis). Symptoms can be worsened with certain movements like turning of the neck or neck extension. Sometimes the symptoms are made better with stretching the shoulder and placing the hand above the head. Generally cervical radiculopathy will get better with time and most do not need surgery or any type of treatment at all although symptoms may re-occur in the future.
In patients, whose pain lasts for several weeks or there is progressive pain or weakness, a consultation with a spine specialist is necessary to find the root of the problem. A good history and physical examination will allow the physician to ascertain the problem and determine the next step in the treatment process. Often times, there is an overlap of shoulder conditions with cervical spine conditions that a physical exam can differentiate.
For those patients, that do no have significant weakness or debilitating pain, generally a short trial of medication along with physical therapy can help alleviate the pain. Medications such as anti-inflammatories, oral corticosteroids, and narcotics may be used in the short term. Physical therapy may also be useful including stretching and strengthening of the neck as well as traction and other modalities. A short trial of chiropractic care may be beneficial as well.
If the symptoms, do not improve with the conservative measure, the pain is debilitating, or there is weakness, an MRI of the cervical spine can be performed to further diagnose the problems. The MRI is useful to look at the soft tissues around the spine including the nerves, the joint surfaces, and the disc. X-rays are necessary to help determine the position of the resting spine, determine the size of the discs, and note whether there is a deformity or instability of the spine. These tests will help determine the necessary non-conservative measures. In those patients that can not get an MRI, a CT scan with dye (myelogram) is the best test to determine stenosis (tightness around the nerve) and a herniated disc. An EMG (electromyography) with nerve conduction studies can help look for nerve damage due to pressure on the spinal nerve roots or any other pathology such as a pinched nerve in the elbow (cubital tunnel syndrome) or wrist (carpal tunnel syndrome).
If conservative measures fail, an Epidural Steroid Injection (ESI) may be beneficial to decrease the inflammation around the nerve to decrease the nerve pain down the arm. The common misconception is that the epidural injection will “take away” the herniated disc or “melt” the arthritis. The ESI does not change the MRI but helps decrease swelling around the nerve to hopefully lessen the pain down the arm. Studies have shown that an ESI along with physical therapy has a 60-70% chance of good to excellent results in taking care of cervical radiculopathy. Epidurals usually do not help with weakness. The recommendation is to not have more than three epidural injections in a 6-12 month period and they do not have to be done in a series of 3.
If the conservative options fail, surgery may be indicated. The type of surgery is dependent on multiple factors including, the type of problem that you have (arthritis verses a herniated disc), a history of previous surgery, and other medical conditions. This may include an Anterior (Front) Cervical Discectomy and Fusion, a Posterior (Back) Decompression and Fusion, or Disc Replacement.