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Neck And Shoulder Pain Radiating Down The Arm

Neck And Shoulder Pain Radiating Down The Arm

Neck problems can be debilitating. The mean prevalence of neck pain is 23.1%, with women being more prone to falling prey to it than men. Individuals belonging to the higher income group have a greater chance of developing painful symptoms. According to surveys, neck pain accounts for up to 40% of leave from work.

There is a high prevalence of disorders because your neck and shoulders support your body’s CPU, i.e., the brain, and help you keep upright. The spinal cord in the neck region, also known as the cervical spine, carries the weight of your head and protects it from trauma/injury. Pathologies of the cervical spine and spinal nerve roots can lead to severe pain and discomfort.

If you are experiencing radiating neck and arm pain, there is a good chance that you are suffering from cervical radiculopathy.

Cervical Radiculopathy

The condition of persistent pain in the cervical spine is called cervical radiculopathy. The malady causes widespread pain and disability. In most cases, cervical radiculopathy starts at 40 years of age. As the name suggests, the pain experienced by patients is due to compression of the nerve roots (radiculopathy) of the spinal cord.

Neuropathic pain is usually radiating and not confined to the affected region only. In this disease, symptoms are felt along the pathway of the involved nerve root. Thus, it is also known as “pinched nerve” disorder.

According to a 2020 systematic review, there is a higher prevalence of the radiculopathy in women than in men. The overall prevalence of the disease was found to be 1.14% in males and 1.31% in females.

Cervical Spine Anatomy

Your neck comprises multiple hard and soft tissues supporting the head. The spine is made up of vertebrae, and there are seven vertebrae in the cervical spinal column (named C1-C7). The vertebrae have specialized structures inside them called intervertebral disks. The role of an intervertebral disk is to provide a cushioning effect and adds to the flexibility of the spine. Compression of the nerve root can occur at different levels of the spinal canal.

Signs And Symptoms

The disorder can present with the following symptoms:

Neck Pain

A pinched nerve in the neck region primarily causes pain in the neck. A vast majority of patients present with pain and neck disability due to pinched nerves. According to a study, participants reported disability due to pain in the neck. The specific point of ache depends on the affected nerve in the neck.

Patients describe the discomfort as a sharp pain in the neck, which may is generally associated with other nerve symptoms as well.

Arm Pain

The pinching of the nerve roots leads to radiating pain. Some people experience arm pain as a consequence of compressed nerve. Movement of the neck muscles triggers sharp, radiating pain in the neck and shoulder radiating down the arm.

Many patients find the arm pain due to radiculopathy to be more of a concern than the neck discomfort. It was revealed in a study that patients suffering from arm pain had a higher rate of disability than neck ache.

Clinical studies have revealed middle-aged patients with persistent severe pain in the neck and shoulder radiating to the arm, forearm and hand.

Unilateral neck and arm pain is an evident feature of neck radiculopathy. The aches significantly reduce the quality of life of patients.

Numbness And Tingling

In addition to the pain, patients also experience symptoms of pinched nerve roots. The symptoms range from burning and tingling sensations to paraesthesias. In a study, 35% of patients suffered from burning and tingling, while 60% complained of sharp and shooting pain. Some patients also complain of their upper body (neck, head and shoulder region) going numb. Numbness (paraesthesia) is common in radiculopathies.

Muscle Weakness

When the nerves that innervate the neck muscles get compressed for a long, it can lead to weakness of the muscles. If the compressed nerve supplies motor input to the muscles and the body’s soft tissues, weakness can ensue. Studies reveal that cervical radiculopathy can cause appreciable muscle weakness, and nerve decompression is an effective treatment. Some individuals also report altered reflexes due to nerve impingement. Impaired tendon reflexes are also noted, along with weakness.

Reduced Range Of Motion

The pain in the neck and shoulder region limit neck motion. The reduced mobility of the neck joint can interfere with your daily activities, work performance and lead to poor quality of life.

Causes And Risk Factors

There are different underlying causes for compression of nerves. The radiating pain condition arises due to nerve compression, which can result from disc slips or spine pathologies. The most common causes of pain are discussed below:

Spinal Cord Compression

Herniated Disk

The most common cause of neck and arm pain in the younger generation is disc herniation. Young patients develop symptoms of radiculopathy in the third and fourth decades of life. Studies reveal that the most frequent cause of pain in the neck and shoulder radiating down the arm is disc trauma and consequent herniation.

The intervertebral disk is composed of an inner soft, jelly-like material surrounded by a hard structure. Trauma to the disk can push out the soft structure causing a herniated disk.

Sports injuries, a sudden injury or direct trauma to the cervical spine can lead to a bulging or herniated disk. A herniated disk bulges outwards and pinches on the nearby spinal nerves. The pinched nerve root then presents as radiculopathy.

Other factors that can contribute to a herniated disc include poor posture, ageing, sudden injury and overuse of the neck.

Spinal Cord Degeneration (Spondylosis)

Adults entering the fifth and sixth decade of life can also fall prey to neck ache due to different underlying causes. In older adults, radiating pain is the outcome of spinal disc degeneration. Patients suffering from osteoarthritis develop bony projections called bone spurs. These developed bone spurs or osteophytes compress the nearby nerves, causing pain.

Arthritic bone spurs contribute significantly to persistent nerve irritation and cause chronic pain. The hard tissue anomaly is the outcome of cartilage degeneration in the neck vertebrae. CT scans revealed that bone spurs are at multiple levels of the spinal column.

Cervical Spinal Stenosis

With increasing age, the cervical vertebrae disintegrate, leading to closer movement of the bones. The collapse of the vertebrae shrinks the spinal canal and the associated structures.

Neuronal foraminal stenosis causes nerve compression at the foramen level leading to radiculopathy. The formation of bony projections almost always accompanies the collapse of the disk. When the bone spurs form at the spinal canal’s (foramen) opening, it is called foraminal stenosis.

Diagnosis

Medical History And Physical Examination

Diagnosis depends on the patient’s complete medical history and physical exam. Due to similar symptoms with other conditions, it is important to rule out other differential diagnoses. Unilateral pain radiating to the left arm with chest pain can be a presentation of a heart attack. Therefore, accurate and quick diagnosis is important.

Your healthcare provider will do certain neck movement tests to test radiculopathy. The clinical tests for radiculopathy include:

  • Cervical flexion rotation test
  • Spurlings test
  • Upper limb tension
  • Distraction test

If the physical examination (clinical test) is positive, there is a high probability (90%) of cervical radiculopathy.

Radiographic Imaging

Radiographic imaging for diagnosing includes spine X-rays and MRI scans, and Computerized tomography (CT) scans. X-rays help appreciate hard tissue anomalies like stenosis, osteophytes, disc slips, etc.

Magnetic resonance imaging (MRI) scans highlight soft tissue abnormalities better than X-rays. An MRI scan provides a clearer picture of slipped discs.

Electrophysiologic Testing

Electrodiagnostic medicine uses nerve conduction studies to diagnose radiculopathies. Electromyography (EMG) is performed to test muscle and nerve function.

How Do You Treat Pain In Neck And Shoulder Radiating Down Arm?

There are multiple ways to treat cervical radiculopathy. The main aim of all treatment modalities is to provide pain relief. In general, cervical radiculopathy responds well to non-surgical treatment. Nonsurgical treatment includes the following modalities:

Nonsurgical Treatment

Immobilization

A simple and important step in managing cervical radiculopathy is the immobilization of the neck. You can wear a soft cervical collar to support and immobilize the neck. A soft collar with a padded ring wraps around the neck and prevents abnormal movements, keeping you from further injuring the already sensitive nerve root.

According to a study, conservative treatment, i.e., rest plus collar for three to six weeks paired with physical therapy, significantly reduces neck and arm pain in the early stages of cervical radiculopathy.

Anti-Inflammatory Medication And Steroids

Medications like Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain but do not cure the underlying condition. Your doctor may advise oral corticosteroids to reduce inflammation.

Physical Therapy

Physiotherapy is a highly prevalent and effective treatment modality for cervical radiculopathy. Physical therapy tops the list of most effective conservative therapies for cervical radiculopathy.

While steroid injections temporarily relieve pressure, the physical therapist touch decreases pain and promotes internal healing of the body.

Manual Therapy And Strengthening Exercises

A physical therapist also teaches you exercises to strengthen neck muscles. Studies show that manual therapy paired with strengthening exercises sognificantly reduce pain and disability.

Another study claimed that manual physical therapy works best with cervical traction and certain neck movements (strengthening exercises). 91% of cases reported that pain decreases with the combination of modalities.

Injections

Steroid injections are frequently given to radiculopathy patients for instant pain relief. To relieve pain, your healthcare provider might suggest you a cervical epidural injection. This selective nerve injection helps reduce local inflammation and thus, reduces the pinching of the nerves.

Surgery

Advanced patients require evaluation for surgical intervention. In most cases, surgical procedures are reserved for extreme cases. There are several surgical procedures in which symptoms persist after conservative therapies.

The main procedure is a decompression surgery to relieve pressure off the pinched cervical nerves. The most commonly performed procedures include anterior cervical diskotomy and fusion (ACDF), artificial disk replacement (ADR) anf posterior cervical linoforaminotomy.

According to one study, surgery may provide pain relief (faster than physiotherapy and immobilization) in advanced radiculopathy patients.

The surgeon begins by giving anepidural injection to anesthesise the region followed by removal of hard or soft or hard and soft tissue of the culprit disk.

According to a 2023 study, surgical intervention for cervical radiculopathy is an effective treatment but requires care and expertise of the surgeon for quicker results.

 

FAQs

  1. How do you treat neck and shoulder pain radiating down the arm?

    Pain radiating down the neck and shoulder is mostly caused by a pinched nerve in the cervical region. Cervical radiculopathy is best treated with conservative management. Taking rest, immobilizing the neck with a collar and getting physical therapy works for most of the patients. You can get local steroid injections along with oral medications to get instant relief. A disc decompression surgery is performed for severe, non-responding cases.

  2. When should I be concerned about neck and arm pain?

    You should be concerned about your neck and arm pain if the discomfort persists for more than a couple of weeks. The red flags for neck and arm pain include nerve symptoms including radiating pain, burning and tingling sensation with parasthesias. These symptoms indicate nerve impingement and can lead to debilitating muscle weakness if not treated.

  3. Can neck and shoulder pain be something serious?

    Neck and shoulder ache from cervical radiculopathy is serious but not life-threatening. However, it may be a serious issue if you feel pain radiating from the back of your chest to your left arm or left neck. Heart attack also presents as pain radiating to the arm/shoulder and neck. You should get checked asap if feeling radiating pain on the left side.

  4. What are red flags for neck problems?

    Red flags for neck problems include:

    Pain radiating down the neck to the arm and shoulder

    Burning and tingling sensations

    Parasthesias

    Weakness of muscles

  5. Should I go to the hospital for neck and shoulder pain?

    Yes, neck and shoulder pain due to cervical radiculopathy can be debilitating. Timely treatment can save you from disease and disability. If the radiating pain is experienced on the left side of the body, you must immediately get checked for a myocardial infarction.

  6. How do I know if my neck pain is severe?

    If the discomfort persists for more than a week and reduces your range of motion, it means the pain is severe. A lot of patients with severe neck pain are unable to perform basic movements of the neck leading to a reduction in the quality of life.

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