In this blog I will continue my discussion about neck and arm pain.
I will discuss radiculopathy, facet syndrome and myofascial pain.
In future posts I will discuss other causes for neck and arm pain.
Neck and Arm pain/radiculopathy
The nerves to the arms arise from the spinal cord in the neck. The spinal cord is protected in a canal formed by the vertebrae. The skull sits on top of the first vertebrae. Between the skull and the 1st vertebrae exists the 1st cervical nerve root. The 2nd roots exit between vertebra 1 and 2. This pattern continues between each vertebra until the 7th vertebra (C7) which sits on the 1st Thoracic vertebra (T1). The nerve root between C7 and T1 is named the C8 nerve root. Note that there is no C8 vertebra.
Thereafter the nerve roots are named for the vertebra above the root. Example, the 1st thoracic root exists the spine below T1.
I will discuss radiculopathy, facet syndrome and myofascial pain.
In future posts I will discuss other causes for neck and arm pain.
Neck and Arm pain/radiculopathy
The nerves to the arms arise from the spinal cord in the neck. The spinal cord is protected in a canal formed by the vertebrae. The skull sits on top of the first vertebrae. Between the skull and the 1st vertebrae exists the 1st cervical nerve root. The 2nd roots exit between vertebra 1 and 2. This pattern continues between each vertebra until the 7th vertebra (C7) which sits on the 1st Thoracic vertebra (T1). The nerve root between C7 and T1 is named the C8 nerve root. Note that there is no C8 vertebra.
Thereafter the nerve roots are named for the vertebra above the root. Example, the 1st thoracic root exists the spine below T1.
Radiculopathy (Latin radicula + English -o- + -pathy) means anything irritates or injures the nerve root. Examples are a disc herniation into the spinal canal (formed by the vertebral body, pedicle, lamina and spinous process where the spinal cord “lives” ((see the picture above)) or into the neural foramen where the root exits the spine to go to the shoulder. Other causes of a radiculopathy can be a spinal stenosis, where the canal is narrowed generally due to a combination of factors. Irritation of the nerve root can cause pain and/or weakness in the neck, shoulder and down the arm to the hand.
Treatments of a radiculopathy are: 1. Exercise, 2. Therapy, which may include traction, 3. Acupuncture, 4. Manipulation, 5. Anti-inflammatory medication (Ibuprofen and Naprosyn as well as Celecoxib and Aspirin are examples), Steroids, either oral or injected around the root through an epidural approach. In general, an epidural is more effective than a pill because the steroid is placed where the nerve is compressed and swollen.
Neck and Arm Pain/Cervical Facet Syndrome:
Different from radiculopathy is irritation of the facet or joint between two vertebrae. In this case the nerve root is not irritated, but either the joint or the nerve twig that supplies the joint is irritated or inflamed. This process affects sensory nerves, not motor. It does not cause weakness, although because of pain you may feel weak.
The pain can be in the neck, shoulder and arm. It usually does not cause pain into the hand.
Treatments may differ from those offered for treating the nerve root. It does not usually involve an epidural steroid injection but may involve a facet (steroid) block. In this case the doctor may try to inject the facet or the branch nerve that supplies sensation to the facet (called a medial branch block). In some cases, the doctor may offer to “burn” the medial branch nerve to the facet joint with a procedure called Radiofrequency Ablation (RFA). This can be done because there is no weakness caused by the block. The facet block may provide pain reduction for days to three months. The RFA may provide pain reduction for up to two years. However, most insurances require a good result from a facet block before approving an RFA procedure.
All other treatments used for radiculopathy are used for facet syndrome beside an epidural injection.
Neck and Arm Pain/Myofascial Pain Syndrome:
Another major cause for neck, shoulder and arm pain is muscle generated pain, i.e. trigger points.
In this instance, it is believed that there was an injury to the muscle, and probably a tear that was microscopic, meaning you can’t see it with existing technology. In the healing process a scar of the tissue develops that is not as flexible as the tissue previously was. Because of this inflexibility, with muscle contraction or stretching, pain is caused in the muscle and frequently has pain in a defined referral pattern.
Treatments are stretching, massage, acupuncture, trigger point injections (that are followed immediately by stretching). Anti-inflammatories are used but are typically less effective since inflammation is not always present.
Summary:
While this is not an exhaustive list of causes or treatments for neck and arm pain, it is the most common. It is also very common that all these causes exist at the same time, thus making evaluation and treatment much more difficult.
- DKP
Treatments of a radiculopathy are: 1. Exercise, 2. Therapy, which may include traction, 3. Acupuncture, 4. Manipulation, 5. Anti-inflammatory medication (Ibuprofen and Naprosyn as well as Celecoxib and Aspirin are examples), Steroids, either oral or injected around the root through an epidural approach. In general, an epidural is more effective than a pill because the steroid is placed where the nerve is compressed and swollen.
Neck and Arm Pain/Cervical Facet Syndrome:
Different from radiculopathy is irritation of the facet or joint between two vertebrae. In this case the nerve root is not irritated, but either the joint or the nerve twig that supplies the joint is irritated or inflamed. This process affects sensory nerves, not motor. It does not cause weakness, although because of pain you may feel weak.
The pain can be in the neck, shoulder and arm. It usually does not cause pain into the hand.
Treatments may differ from those offered for treating the nerve root. It does not usually involve an epidural steroid injection but may involve a facet (steroid) block. In this case the doctor may try to inject the facet or the branch nerve that supplies sensation to the facet (called a medial branch block). In some cases, the doctor may offer to “burn” the medial branch nerve to the facet joint with a procedure called Radiofrequency Ablation (RFA). This can be done because there is no weakness caused by the block. The facet block may provide pain reduction for days to three months. The RFA may provide pain reduction for up to two years. However, most insurances require a good result from a facet block before approving an RFA procedure.
All other treatments used for radiculopathy are used for facet syndrome beside an epidural injection.
Neck and Arm Pain/Myofascial Pain Syndrome:
Another major cause for neck, shoulder and arm pain is muscle generated pain, i.e. trigger points.
In this instance, it is believed that there was an injury to the muscle, and probably a tear that was microscopic, meaning you can’t see it with existing technology. In the healing process a scar of the tissue develops that is not as flexible as the tissue previously was. Because of this inflexibility, with muscle contraction or stretching, pain is caused in the muscle and frequently has pain in a defined referral pattern.
Treatments are stretching, massage, acupuncture, trigger point injections (that are followed immediately by stretching). Anti-inflammatories are used but are typically less effective since inflammation is not always present.
Summary:
While this is not an exhaustive list of causes or treatments for neck and arm pain, it is the most common. It is also very common that all these causes exist at the same time, thus making evaluation and treatment much more difficult.
- DKP
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