Neck pain is very common and patients frequently seek medical attention for this problem. It is very important to understand the difference between neck pain and arm pain. Patients with cervical problems generally present in the following 3 ways:
- Patients who have neck pain only. This neck pain is generalized, does not favor one side or the other. It does not radiate down to the shoulder or arm. Most often this is caused by a strain or sprain of the muscles and ligaments in the neck. Other causes of neck pain include fractures of the spine due to trauma, tumors and infection
- Patients who have arm pain only. Pain that travels down the arm is called radicular pain. When caused by a pinched nerve in the neck, this condition is referred to as cervical radiculopathy. Depending on which nerve in the neck is pinched, the pain may radiate to the shoulder only, or all the way to the forearm and hand. Some patients have frank pain, others have numbness and tingling down the arm
- Patients who have neck pain AND arm pain. This is the most common presentation of cervical radiculopathy. Generally patients have pain on one side of the neck that radiates down that same arm
The initial treatment of all the above conditions is similar. Physical therapy aimed at strengthening the neck muscles can be very helpful in relieving neck pain and radicular arm pain. Sometimes traction is used in therapy, particularly if patient has arm pain as a result of pinched nerves. The duration of treatment is generally 4-6 weeks. Over the counter anti-inflammatory medications are also helpful in relieving symptoms.
If physical therapy is not successful, then an MRI of the cervical spine is ordered. MRI is excellent for diagnosing pinched nerves in the neck and can precisely help the physician determine which nerve is pinched. Depending on the findings of the MRI, epidural steroid injections may be recommended to relieve symptoms.
If you have already had physical therapy and/or injections and the pain has not subsided, your surgeon can help determine whether surgery would be beneficial. A key point to remember is that surgery is generally recommended for patients who have radicular arm pain. Patients who have neck pain only, without any radiating pain down the arm, are generally not good candidates for surgery. However, it is important to localize your pain precisely. Some patients have pain along one side of the neck, which does not radiate to the arm. Sometimes a pinched nerve in the neck can cause one-sided (called “unilateral”) neck pain without arm pain. If the MRI shows a pinched nerve that correlates with this pain, surgery can be beneficial.