Arm Pain/Numbness (Cervical Radiculopathy)

Neck Pain & Arm Pain :: Cervical Radiculopathy :: Cervical Stenosis and Myelopathy :: Cervical Disc Herniation

Cervical Radiculopathy is a condition caused by compression of a spinal nerve that leads to arm pain, numbness, tingling or weakness. It most commonly occurs as a result of arthritis in the neck or a cervical disc hernation. Arthritis in the neck leads to development of bone spurs and enlargement of the joints, and these structures in turn begin to pinch off nerves that go down the arm.

Symptoms

Most common complaint in patients with cervical radiculopathy is one-sided neck pain that radiates to one arm. Some patients have pain between the shoulder blades in the shoulder region. Each nerve provides sensation to a different region of the arm. For example, the C5 nerve provides sensation to the shoulder and upper arm, while the C6 nerve provides sensation to the forearm, thumb and index fingers. So the location of the pain or numbness in the arm varies depending on which nerve is compressed in the neck. Some patients feel frank pain in the arm, others feel numbness or tingling or burning pain. Occasionally patients have pain on one side of the neck that goes into the trapezius area, but no further pain down the arm.

Some patients have weakness in one or more muscle groups. For example, if the C7 nerve is being severely pinched, the patient may have weakness with straightening his or her elbow (triceps muscle is weak). When weakness is present, this usually means the compression on the nerve is more severe and that there may be some nerve damage.

Other conditions that may mimic cervical radiculopathy include shoulder problems (rotator cuff tear or inflammation) and nerve problems in the elbow or wrist (such as carpal tunnel syndrome). Your orthopedic surgeon will determine whether your symptoms are coming from your neck or your shoulder/elbow/wrist by performing a physical examination and by ordering some tests.

Diagnosis

The best test to diagnose a pinched nerve in your neck is an MRI. If you cannot get an MRI (for example if you have a pacemaker), the alternative test is a CT myelogram.

Treatment

The good news is that most patients with cervical radiculopathy improve without surgery. The prognosis is generally good, and most patients improve over the course of a few weeks. Typical treatment consists of anti-inflammatory medications (ibuprofen, naproxen or a short period of oral steroids) and physical therapy. Physical therapy consists of exercises for the neck and traction to relieve some of the pressure off the nerves. Patients who benefit from traction can get a home traction unit so they can apply traction to their neck at home. If medications and physical therapy are not effective in relieving the pain, epidural steroid injections are a reasonable next step. Response to injections is variable, with some patients having significant pain relief while others have little to no relief after the injection.

A common question is when surgery is needed. Remember that the only time surgery is absolutely necessary is if the weakness in your arm is getting worse, and you are dropping objects and cannot use your arm/hand. This means the pressure on the nerve is so severe that it is causing nerve damage. In this situation, surgery is strongly recommended to relieve the pressure off the nerve and gives the best chance of recovery.

In the absence of worsening weakness in your arm, YOU determine when surgery is needed, not your surgeon. Your decision depends on the level of your pain. Some patients have numbness and discomfort that is tolerable and does not limit their activities. If this is the case, surgery is not necessary. Other patients have severe persistent pain that is affecting their quality of life, and cannot do things they enjoy. If these patients have tried conservative treatment options (see above) and have not improved, then surgery is a good option. In the end, the decision for surgery is based on the severity of symptoms and the patient’s ability to tolerate these symptoms. For example, say a patient has arm pain and tingling only when he is playing tennis. If tennis is an important part of this person’s life, and he cannot play without pain, then surgery is a good option. But if this person is perfectly happy not playing tennis, and has no pain with any other activities, then proceeding with surgery does not make much sense. The decision for surgery is a personal one. Your surgeon can talk to you about success rates with surgery and potential complications, but in the end only you know how much pain you are in and whether you can or cannot live with this pain.

Surgery for cervical radiculopathy is generally very successful, especially if the symptoms are primarily in the arm or hand. It is important to correlate the MRI findings with your symptoms – if the two correlate, then relieving the pressure off the nerve(s) usually leads to pain relief. Of course no surgery is 100% effective, but for this condition, success rates are very high, and over 90-95% of patients have a good result.

There are two main surgical options for this problem. The most common surgery involves what is called an anterior approach, in which the incision is in the front of the neck. This procedure is called anterior cervical discectomy and fusion, or “ACDF” for short. It is one of the most commonly performed spine surgeries. For more information about this surgery, Click here.

Another option is to make an incision in the back of the neck and perform what is called a “posterior laminoforaminotomy”. The decision to perform one surgery versus the other depends on a number of factors, such as the location of the pinched nerve, the number of cervical levels involved, patient age and findings on physical examination. Each surgery has its own advantages, and your surgeon can determine the best option in your particular situation.