FYI's (for your information) and
FAQ's (frequently asked questions)
about Neck and Arm Pain
Neck pain and arm pain definitions.
The word cervicalgia is Latin for neck pain. Neck pain sometimes occurs with arm pain. Radiculopathy is another name for arm pain. Radiculopathy is Latin word for a damaged nerve root. It also implies pain. The pain usually follows the distribution of the nerve. The distinction between neck pain and arm pain is important. Neck pain is usually due to a bad disc but "arm pain is usually caused by a pinched nerve." The two can occur together when the damaged disc compresses one of the nerves. Fixing the damaged disc with usually cure both problems.
The middle portions of the neck bear the most weight and move more than adjacent levels. Because of this they disc problems are seen first and most commonly at C4-C5, C5-C6, and C6-C7. After age 30 the center of the disc (the nucleus) begins to shrink and its capsule begins to weaken. The height of the disc decreases. this causes an increase in the loading of the other structures in the neck, especially the facet joints. This is degenerative disc disease (or “DDD”) or just "wear and tear". Although the x-ray changes are usually degenerative, the symptoms can be due to injury.
Disc problems are the leading cause of lower neck pain. As we age, the problem becomes more common. Almost everyone over 18 years old has some “wear and tear” in their discs. With every decade of aging, there is a 10% increase in the probability of having at least one damaged disc in the neck.
Magnetic resonance imaging (MRI) is most commonly used to diagnose disc disease but shows the bones only poorly. Plain x-rays show the alignment of the bones, and are used to check for fractures or after surgery. CT scans are better ways to visualize bones but do not show the nerves. CT scans with myelogram contrast injected in the back are probably the best study to see both the bones and nerves, but they do hurt a little.
Information on Preventing both Neck and Arm pain
If you control your weight, limit smoking, and do regular exercise you will decrease your chance of a neck injury. Proper lifting techniques and good postured are also helpful. Avoid prolonged work overhead and do not carry things on your head.
Information on the causes of Neck pain.
The cause is neck pain is often difficult to identify. Pain can come from muscles, ligaments, joint capsules, cartilage, blood vessels, tears in the outside (annulus) of the disc, damage to the center of the disc (nucleus), damage to the nerves, and damage to the bones. The pain can be severe from even minor damage. The soft tissues (everything other than bones, discs, and nerves) are probably the most common culprits. They are also the most difficult to treat.
Acute pain is defined as lasting less than six weeks . Chronic pain, on the other hand, is defined as lasting more than three months. Neck pain may be burning, stabbing, aching, sharp, dull, well-defined or vague. It may be mild or severe. It can be variable during the day. It is often worse after sleeping and is usually increased by strenuous activity.
Managing your own acute Neck pain.
For an acute (new) neck problem, the following can help you get better without the need for a doctor visit:
If the pain is too severe to stretch or work after a few days, see your doctor (Schedule an appointment).
You should consider over the counter medications such as ibuprofen, Motrin, Naprosyn and similar medications. You should follow the directions exactly. Pain may cause trouble sleeping. Benadryl, or its generic equivalents, are over the counter drugs which can help you sleep. It has few risks. A good night's sleep will help back pain. In addition, you can use herbs. See a complimentary provider (such as chiropractic, yoga, herbal medicine, and other non-traditional care).
The good news is that 50% of acute neck pain will resolve in two weeks or less. Over 80% go away in 6 weeks. The bad news is that 30% if those with acute neck will have a second episode within a few years. In other words, the symptoms are usually self limited but they often come back.
Signs of an Emergency for acute pain (called "Red Flags" by your doctor)
If you have one or more of the following, do not treat yourself. Go directly to your doctor or to an emergency room:
If you think that you have something worrisome, or if you pain seems unusual, go to the doctor. Your doctor will not complain. An extra visit will not hurt you, or even cost much money, but it may save your life. Your doctor will not be unhappy with you if you are just being careful.
What will your doctor do for your acute Neck pain?
Emergency treatment may be needed if you have a very large herniation, bowel or bladder problems, arm weakness, or pain so severe that medications are ineffective.
If properly treated, 80% to 90% of patients with disc herniations will improve with conservative care. Your doctor will likely make sure that you are doing the right exercises. He or she will probably write a physical therapy prescription. Physical therapists teach patients how to do the exercise right. Therapists also provide ultrasound, electric stimulation, hot and cold packs, and hands on or manual therapy. Chiropractic is much like physical therapy but chiropractors have more training in aggressive techniques.
Your doctor can give you medications that are stronger and more effective than those you can get without a prescription. Typically you will be treated with a combination of at least three drugs. The drugs you may get include:
IMPORTANT NOTE: Do not drive a car, operate equipment, do anything dangerous or sign documents when using pain killers, muscle relaxants, or sleeping medicines. Do not do so when starting new seizure or anti-depressant medications.
Your doctor may order tests. These may include x-rays (to make sure that there are no broken bones), CT scans or Bone scans (to further test the bones), MRI scans (to look at discs, nerves and some other soft tissues), or MRI scans with contrast (to check for scar tissue in those who have had surgery or whose plain MRI is not clear).
For acute pain, and depending on whether the above treatments work, and on what the scans show, you may need a shot, or even a surgery. Trigger point injections can help to relieve muscle spasm. Nerve blocks are very helpful for shooting arm pain from a pinched nerve. They take only a few minutes and have few risks. We used to do them in groups of three, but have learned that just one is enough for most patients. Facet blocks numb the small joints in the back. They are good for some types of back pain from arthritis. Discectomies are operations that "un-pinch" a nerve which is causing arm pain. In the neck, they are done from the front and involve replacing the removed disc with a small piece of bone. Discectomies will work for about 90% of patients who do not improve with conservative care. Discectomies work best for arm pain. They will not fix all neck pain. Discectomies can be done using microscopes, endoscopes and lasers. Using the correct technology will be up to your doctor and will depend on the shape and size of your disc herniation.
Discograms are not usually considered for neck pain unless unless it is present for more than 6 months.
Managing your own chronic Neck pain.
You should consider over the counter medications such as ibuprofen, Motrin, Naprosyn and similar medications. You should follow the directions exactly. Pain may cause trouble sleeping. Benadryl, or its generic equivalents, are over the counter drugs which can help you sleep. Benadryl is a strong drug with few risks. A good night's sleep will help back pain. In addition, you can use herbs, see a complimentary provider (such as chiropractic, yoga, herbal medicine, and other non-traditional care For chronic pain counseling is often very helpful..
Signs of an emergency or "Red Flags" for chronic pain.
The "red flags" are almost the same as those for acute pain and should get you to go directly to your doctor or the local emergency room:
If you think that your pain is unusual, go to the doctor. Your doctor will not complain
What will your doctor do for your chronic Neck pain?
Chronic pain is difficult to treat. Midline neck pain is usually due to
a broken bone, a bad facet joint, or a bad disc. Arm pain can be due to
spinal stenosis or a chronic disc herniation.
Multi-disciplinary pain clinics can be very helpful. They provide counseling, help in coping with pain, special expertise in adjusting medications or using the drugs in combination. The medications which can be used for pain are numerous and include many which are not narcotic or addictive. If all else fails, surgery may be needed.
If your chronic pain comes from a broken bone, a bad facet or a damaged disc a fusion is almost always needed. Adjacent bones are set in a way that they will heal. A mending plate with screws will hold the bones in place till they heal.
Facet blocks numb the small joints in the neck. They can tell if the pain is coming from a facet. If you have facet pain, facet rhizotomies can be done for more lasting relief. Fusions can be done to remove the painful facet entirely.
IDET procedures and other needle procedures do not work in the neck. There has been a great deal of research over the years, but the results have unfortunately show that these operations don't work and have a high risk of complications.
Artificial discs are brand new and are not FDA approved. The early results are poor and it seem unlikely that these will become one of our standard treatments.
Neck Problems From Scoliosis.
Scoliosis is divided into three categories: congenital, Idiopathic and neuromuscular. In some cases, treatment can involving only observation or bracing. If the problem is severe, surgery is needed. At Northern California Neurosurgery we do not do major scoliosis surgery. We recommend that you seek a referral through the North American Spine Society web site. In the East Bay area near San Francisco, we refer our patients with scoliosis to Robert Rovner, M.D., a scoliosis specialist. His phone number is 925-275-8080.
More Neck Pain FAQ's (Frequently Asked Questions).
Q. How can I avoid neck problems?A. I apologize that I have to give you this bad news. You may have to give up your favorite bad habits. Don't smoke or use too much alcohol. Studies have shown that both cause disc and bone damage. Keep your weight within ten pounds of your ideal. Exercise regularly. Walking two miles, three or four times a week is a good start. Doing exercises to strengthen abdominal muscles is better. Stretching in the morning and evening is helpful. Strength training of all muscles and doing aerobic exercise is best. A personal trainer, physical therapist can help you learn these exercises.
Q. What can women do to avoid neck problems?
A. All of the advice above (in the last question: exercise, weight loss, and avoidance of smoking and drinking) apply to women as well. Women also have special risks not shared by men. High heels should be avoided. Lifting heavy children is a great risk. It is hard to use good lifting techniques when picking up a squirming child. Kids will often grab you by the neck and hang on. This is particularly dangerous. Let the kids climb stairs with assistance. Use a good quality stroller with quality wheels. Get on the floor to play with the kids. Women are especially prone to osteoporosis. Take supplements and do exercise.
Q. What if the MRI Scan shows a herniated disc? What do I do then?
A. If you have a herniated disk, you should see a spine specialist. The doctor will first diagnose the cause of the problem. Unless there is severe pain or weakness, conservative care will usually be recommended. Exercise and pain medications are used first. Chiropractic or acupuncture may be helpful. If these do not help, a steroid shot may be advised. Surgery is usually the last resort.
Q. When is arm pain an emergency?
A. You should see a spine specialist immediately if you have any of the following: severe pain extending down your arm; if you have had a recent injury; if the pain lasts more than three to six weeks; if your neck pain becomes worse at night or wakes you up from sleep; if the pain is accompanied by a fever; or, if you have bladder or bowel problems. Night pain can be caused by some tumors. Weakness in the deltoid or triceps is an urgent problem. These two, served by the C5 and C7 roots, heal less easily than other nerves and muscles in the neck.
Q. Are there other causes of arm pain?
A. Not all arm pain is caused by a herniated disc. A pinched nerve in the arm itself can cause similar symptoms. Carpal tunnel syndromes (a pinched nerve at the wrist) or cubital tunnel syndromes (a pinched nerve at the elbow) can both simulate a ruptured disc. Both can cause neck pain. An EMG is used to tell the difference. Carpal tunnel syndromes and cubital tunnel syndromes may be treated with braces, activity changes, or surgery.
Q. What do I do if I have a spinal tumor?
A. Spinal tumors are uncommon. They are divided into several groups according to their source and their location.
Metastatic tumors: These are tumors that have spread from somewhere else in the body. Lung cancers, gastrointestinal tumors, breast tumors, kidney tumors, myelomas and other cancers can spread to the spine. These usually affect the vertebral bones. If the diagnosis is known, the treatments are usually non-surgical. Chemotherapy and radiation treatments are most commonly used. Surgery is only recommended if the spine is unstable.
Dural tumors: The most common dural tumors are "meningiomas." These are typically benign. They can usually be removed with a limited surgery and only a low risk of neurologic damage. Once removed these can recur. Radiation is sometimes used to decrease the risk of recurrence.
Nerve root tumors: Nerve root tumors may be solitary or part of a syndrome (like neurofibromatosis). When these are single, they can be removed with surgery. When multiple, your doctor will usually try to avoid surgery unless absolutely necessary.
Other tumors: There are a number of uncommon tumors that invade the spine. These can include some that spread from the brain and some that occur in the other structures of the spine.
Tumors are easily diagnosed by MRI with contrast. If you think you have a spinal tumor, you should see a neurosurgeon. Neurosurgeons specialize in spinal tumors.
Q. Can sports injuries affect my neck?
A. Yes. They are most common in the young athlete.
If a young athlete has a neck injury, the mechanism must be studied. A complete examination is also absolutely mandatory. Pain with motion is worrisome. Numbness and weakness indicate that there may be a nerve or spinal cord injury. For injuries where a fracture is possible, x-rays are mandatory.
Most neck injuries are sprains or strains. These are called burners and stingers. These can be treated with rest, instruction in proper body mechanics and over the counter analgesics. Appropriate exercises will speed recovery once the pain is gone.
Q. Do young people get disc herniations?
A. Yes. Although uncommon, we have seen children as young as 16 with ruptured cervical discs. Many recover with time and analgesics. Some, like adults, require surgery. When surgery is needed, the good news is that kids do much better than adults in healing.
Q. What can older people do about neck pain?
A. Avoid surgery at all costs. If you need an operation, pick the shortest and safest procedure. For example, cervical spinal stenosis is treated with decompression alone. This is a short procedure that is safer and less invasive than either laminoplasty or fusion. The time needed for the surgery greatly increases the risk in older people. Older people almost never need a fusion. The risk associated with fusion surgery are too great.
For more information on neck pain, see the North American Spine Society Web Site of the American Association of Neurological Surgeons Web Site.
For common sense books (which discuss mostly the back, but do review neck prolems) see Your Spine, The Back Book or Back Pain Remedies for Dummies. All can be ordered online. For Your Spine, see http://www.spine.org/spine_owners_manual.cfm. For The Back Book or for the "Dummies" series see www.amazon.com. Studies have shown that merely reading one of these books will decrease the chance that you will develop chronic neck pain.