Many different pathologies and processes may cause neck pain and arm pain. The list includes the following :
This list is not exhaustive.
Cervical disc herniation is often without any symptoms and may not cause any problems. However. When compression affects a nerve root or multiple roots, the pathology is called cervical radiculopathy. Compression of the spinal cord can cause weakness; poor control of arms and/or legs; loss of ability to use hands appropriately, e.g., inability to use cutlery, close buttons when dressing, or tie shoelaces; poor balance; frequent falls; urinary incontinence and abnormal reflexes. This pathological process is called cervical myelopathy. Sometimes these two pathologies can coexist.
Cervical disc herniation can cause compression of the spinal cord and nerve root. This process can lead to sensory changes, such as pain, numbness, loss of sensation, and tingling. It can also cause weakness and loss of muscle bulk, or atrophy, in specific muscles or muscle groups.
Cervical myelopathy requires medical attention at the earliest convenience. It may need surgery.
Cervical radiculopathy in acute presentation tends to get better without surgery in more than 9 out of 10 cases. The period of recovery varies. During this period, it is necessary to have adequate pain control and avoid activities that would make pain and discomfort worse; this may require some adjustments at home and in the work-place. Surgery is an option for those cases that fail to improve with conservative management and those that get worse and develop a neurological deficit.
Cervical disc herniation can affect one or multiple levels.
Compression of the cervical spinal cord can cause cervical myelopathy. Many possible pathological processes result in compression of the spinal cord in the neck:
Cervical myelopathy is frequently related to neck pain. Sometimes, it can be associated with the compression of nerve roots in the neck. This is known as cervical radiculopathy and manifests as pain, loss of sensation and weakness in the distribution of that particular nerve.
When cervical myelopathy and radiculopathy are present together, this condition is called cervical myeloradiculopathy.
Cervical myelopathy may manifest in the following ways:
In the number of cases with cervical myelopathy, it may be necessary to perform a surgical intervention and decompress the spinal cord. The operation aims to stop the progression of the disorder. Any improvement in function and symptoms should be considered as a bonus. In some cases, the decompression must be accompanied with a fusion procedure to prevent any instability, thus preventing further injury and damage to the spinal cord.
The operation can be done from the back or the front of the neck. The procedure of choice depends on the individual patient and her or his presentation. Common surgical procedures include:
Less commonly, it may be necessary to remove the whole cervical vertebra. The name of this procedure is corpectomy.
Treatment options, surgical and nonsurgical, must be discussed with a spinal specialist.
Cervical radiculopathy manifests as pain, change (loss) of sensation and weakness in one or both arms. It frequently goes hand in hand with neck pain, and sometimes it is challenging to distinguish between the two.
The distribution of pain, sensory change, numbness and muscle weakness depends on the nerve roots involved. Symptoms may be mild in some cases and can settle spontaneously with some simple painkillers and exercise. However, in some other cases, pain, loss of sensation, and weakness can be severe. In those cases, surgical intervention may be necessary.
In some cases, this narrowing of the spinal canal may lead to compression on the spinal cord - it appears "pinched ". This condition is called cervical myelopathy. It can coexist with cervical radiculopathy.
The underlying pathological process can be described as a degenerative spinal disease affecting the neck. Structures involved in the degenerative process include discs, facet joints and ligaments. Physiological neck spinal curvature is frequently lost, and the spinal canal may become narrow.
Surgery for cervical radiculopathy aims to decompress the nerve roots. If there is associated compression of the spinal cord, then this may need to be decompressed as well. Surgical interventions include foraminotomy, laminectomy, arthroplasty procedures, and if there is neck instability, cervical fusion procedures. These procedures vary in their technical aspects, possible results, benefits and risks. It is essential to discuss these procedures with a spinal specialist if you are taking any of these operations.
In some cases, pain in the distribution of the particular nerve root can be treated with injections. These injections often contain a cocktail of local anaesthetics and steroids. Sometimes, the injection can work very well. However, the effect usually does not last long. Fortunately, the injection therapy can be repeated.
It is essential to be aware that shoulder pathology can present with neck pain as well. Shoulder problems require the attention of an orthopaedic surgeon and shoulder specialist.
Equally, loss of sensation, pain and weakness can be the result of compression on one of the peripheral nerves. The most commonly affected is the median nerve. If compressed at the wrist, the condition is called carpal tunnel syndrome. This may be treated by decompressing the nerve at the wrist level. Compression of the ulnar nerve is less frequent. This nerve is mostly compressed at the level of the elbow. This is called cubital tunnel syndrome. All possible treatment options, including surgical decompression, must be discussed with a specialist.