Neck and Radiating Arm Pain

Neck and Radiating Arm Pain

Cervical Spondylosis

·        Spondylosis is the most common disorder of the cervical spine. Universal in patients over the age of 40 but seldom causes symptoms 

·        Intervertebral discs degenerate and flatten (ie not synovial Þ not OA) 

·        Bony spurs appear at the anterior and posterior margins of the vertebral bodies. Posteriorly, these may encroach upon the intervertebral foramina, causing pressure on the nerve roots

·        Clinical features:

o   Neck pain and stiffness, usually gradual onset and worse on getting up

o   Pain may radiate widely, to occiput, scapular muscles and down one or both arms

o   May be paraesthesia, weakness and clumsiness

o   Weakness of the legs or bladder disturbance suggest cervical cord compression 

o   The appearance is normal. Tenderness occurs in the posterior neck muscles and scapular region, all movements are limited and painful

·        Differential Diagnosis:

o   Thoracic Outlet Syndrome: pain in the ulnar forearms and hand

o   Carpal Tunnel Syndrome: pain and paraesthesia are worse at night. Nerve conduction is slowed across the wrist

o   Rotator cuff lesions: pain is like one of a prolapsed cervical disc, but shoulder movements are abnormal and there are no neurological signs

o  Cervical tumours: Symptoms are not intermittent and x-ray may be abnormal

·        X-ray: Cervical disc spaces are narrowed. Corners of vertebrae have osteophytes. Oblique views may show encroachment of the intervertebral foramina

·        Treatment:

o  Heat and massage are soothing

o  Neck collar is the most effective treatment during painful attacks

o  Physiotherapy

o  Operation is seldom indicated but if necessary then anterior fusion is appropriate

Prolapsed Cervical Disc

·        May be precipitated by local strain or injury, esp. sudden flexion and rotation

·        May be a predisposition abnormality of the disc with increased nuclear tension

·        Prolapsed disc may press on:

o  Posterior longitudinal ligament, causing pain and stiffness

o  Nerve roots, causing pain and paraesthesia in one or both arms

·        Usually occurs above or below the 6^th cervical vertebra, nerve roots are C6 and C7

·        Presentation:

o  Usually acute in onset and more severe than those of neck strain

o  Pain may be referred into the scapula, shoulder or hand and there may be associated paraesthesia

·        Differential: 

o  Cervical spine infections, pain is unrelenting and local spasm severe, x-ray show erosion of the vertebral end-plates

o  Cervical tumours, neurological signs are progressive and x-rays show bone destruction

·        X-rays may show slight narrowing of the disc space.  Disc itself is best seen on MRI

·        Treatment:

o  Rest: in a collar to prevent unguarded movement

o  Reduce: traction may enlarge the disc space

o  Remove: if symptoms are severe enough the disc may be removed