Arm Pain (Cervical Radiculopathy)
What is Cervical Radiculopathy?
“Radiculopathy” refers to pain from a single spinal nerve. Pain that travels down the arm may often be from a problem in the neck or cervical spine. These problems are often confused for problems in the shoulder, elbow or hand. Many patients are misdiagnosed with shoulder problems, problems with nerves that cross the elbow, or carpal tunnel syndrome. Some even undergo surgery in a misguided attempt to fix these wrong diagnoses.
Radiculopathy arises from a damaged or irritated nerve. Damage or irritation may be caused by degenerative conditions of the spine or after trauma.
- Herniated Disc: Because the amount of space in the cervical spinal canal is limited, even a small herniation in a cervical disc may cause severe symptoms in one or both arms.
- Degenerative Disc Disease: As the discs of the spine wear out, bone spurs develop in the front and back of the spinal column. When degenerative disc disease or arthritis develops, in the spine, the joints become larger with bone spurs. These bone spurs can press on the spinal cord or on the nerves that travel out of the spine and into the arms.
- Trauma: Trauma to the neck can result in arm pain as the nerves become stretched (also known as a “stinger” or “burner”). This is usually temporary, but trauma to the spine may result in nerve damage.
Radiculopathy often presents with pain in the neck, and may be made worse with certain neck movements. Problems in the cervical spine may also lead to weakness, clumsiness, or numbness. It can also make nerve problems in the arms worse. Such conditions like “cubital tunnel syndrome” or “carpal tunnel syndrome” are made worse by cervical radiculopathy (called “double crush syndrome”).
The diagnosis of cervical radiculopathy is made after a careful examination by a professional examiner. It involves differentiating problems that come from the cervical spine from those that arise from other joints or nerves in the arms.
- History: Your medical provider should ask what makes your pain worse or better. It is important to note what neck or shoulder motions make your pain worse. It is also important to try and locate where the pain travels into the arm. For example, pain that travels into the shoulder area is different from pain in the thumb, and different from pain in the ring and small fingers.
- Physical Examination: A physical examination is perhaps the most important part of diagnosing cervical radiculopathy. Your provider may try to reproduce your pain with certain movements, without damaging nerves any further. Your strength, sensation, and reflexes will be tested.
- X-rays: X-rays are the first step for imaging. Even if other images have been taken, x-rays provide unique information that is not available from other studies. They will also be taken at future visits to see if the fracture is becoming worse.
- MRI: An MRI scanner uses a magnetic field and radio waves that are not harmful to visualize the body in 3D. In most circumstances, it is the best way to see the soft tissues of the body, including nerves, intervertebral discs, and other parts of the spine other than the bones.
- CT: A CT scan uses many x-rays to produce a 3D image of the body. It is often the best way to visualize the spinal bones or bone spurs.
- Injections: Spinal injections may be used to help diagnose the cause of your symptoms. In addition to providing relief, they also provide useful information for your provider to pinpoint the cause of symptoms. If you have an injection, it is important to document how the injection affected your symptoms.
Radiculopathy may cause severe pain that significantly reduces quality of life for some people. Treatment options vary based on the severity of symptoms and the degree of damage to the affected spinal nerves.
- Medications: Some medications, such as gabapentin (Neurontin®) or pregabalin (Lyirca®) may treat the pain caused by radiculopathy. It is important to increase and decrease the dosage of these medications slowly and under the guidance of a physician, because they may cause seizures if not taken properly.
- Injections: Spinal injections may be used to treat radiculopathy. Using a combination of local anesthetic, this may help to decrease the inflammation in the affected nerve root. Spinal injections may provide temporary or lasting relief, depending on the technique and underlying reason for radiculopathy. For more information, see Nonsurgical Treatments.
- Surgery: For those patients who do not improve with spinal injections and nonsurgical methods, an operation may be recommended. Since there are many potential causes of radiculopathy, there are several ways to treat it with an operation. It is important to have a discussion with your surgeon about how best to treat it. Often, a minimally invasive procedure can relieve symptoms with a short recovery and only a few restrictions. Surgical options may include ACDF, Cervical Disc Replacement, Cervical Laminoplasty or Posterior Cervical Fusion.