Neck pain with arm pain

Neck pain may be associated with severe pain radiating down the arm as far as the hand which is known as radicular pain.

Many people will suffer with neck pain at some point in their adult life. A small percentage will experience pressure on the nerve root adjacent to the disc. This nerve root pressure results in the severe pain radiating down the arm. 90% will resolve without specialist input and more than 70% report improvements in their symptoms within 4 weeks.

The most common symptoms are pain and stiffness in the neck which radiates to the shoulder and often down one or both arms. There may be sensory symptoms such pins and needles, tingling or numbness in the arms or hands and in rare cases individuals develop some weakness to particular muscle groups in the upper limb.

Commonly, symptoms tend to be aggravated with sitting postures, especially with prolonged work at a computer and in the morning after sleeping. Symptoms are often relieved with simple exercises, postural or ergonomic modifications and maintaining general levels of activity.

Nerve root pain coming from the neck can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination.

The main feature on examination is often a reduced range of movement and the reproduction of shoulder and arm symptoms when extending the neck. Sensation, power and reflexes will also be assessed.

X-rays are not required. Scans are not routinely required but may be requested if injections or surgery are being considered.

Non-surgical management

In the majority of cases, neck and nerve root pain can be managed effectively by non-invasive measures as described below. The most effective are exercises, ergonomic modifications and in those who are sedentary, maintaining general activity levels.

Exercises. Exercises can relieve stiffness in the spine and maintain flexibility at the shoulders:

10 second holds to each side, 2x per day

3×10 repetitions 3-4x per week

20 slow movements up & down, 2x per day

 

20 slow movements up & down, 2x per day

Modifying ergonomics.

Modifications could include raising your seat height, changing the backrest angle, lumbar wedges as well as ensuring there is an appropriate overall set up if working with display screen equipment. Everyone is different so try out slightly different combinations which may work best for you:

Medication

It is reasonable to try over the counter painkillers initially. Unfortunately, standard painkillers are not very effective in relieving radicular pain from nerve root compression. Your clinician will advise on medication that may help your symptoms. This may include muscle relaxants and anti-neuralgic medications.

Injection therapy

For individuals who continue to suffer symptoms significantly affect their quality of life and who have undergone scans confirming the presence of nerve root irritation an injection around the nerve root may be offered.

Surgical management

Decompression surgery for the affected nerve root can be offered for patients who:

  • Have trialled at least a 12-week course of non-surgical management without success
  • Have scans confirming the presence of nerve root compression
  • Have consistent, disabling pain in the arm (not the neck itself) which significantly limits their quality of life

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