Neck And Arm Pain

Learn how a same day surgery can provide lasting relief from neck and arm pain

Causes of Neck and Arm Pain

• Spinal cord compression. This condition can result in numbness and tingling in the arms and sometimes in the legs along with arm or leg weakness or stiffness. There can also be associated arm pain if one of the nerves is being compressed as it leaves the spinal canal. Spinal cord compression is a potentially serious condition that if left untreated could result in permanent weakness or paralysis of the arms and legs.
• Common causes of spinal cord compression include
• Herniated cervical disc
• Bone spurs in the neck which extend into the center of the spinal canal
• Bone formation in the ligament directly in front of the spinal cord (OPLL)
• Spinal cord tumors
• Nerve tumors
• Spinal fractures
• Slippage of 1 vertebra over the other
• Spine deformity
• Fluid within the spinal cord
• Infection extending into the spinal canal
• Nerve inflammation. Some conditions can cause the nerve to become irritated and swollen, resulting in neck pain and arm pain.
• Causes of nerve inflammation include
• Spine or nerve infection
• Trauma with stretching of the nerve resulting in nerve injury
• Conditions involving the immune system
• Diabetes
• Shoulder conditions are another cause of neck and arm pain. There is usually pain in the shoulder which can travels down the upper part of the arm. There is often decreased arm motion with difficulty reaching the arms above the head because of stiffness and pain. Neck and arm pain can cause shoulder problems as a side effect. Shoulder problems alone can be responsible for neck and arm pain. Common shoulder conditions include-
• “Frozen shoulder” – shoulder doesn’t move because of inflammation within the shoulder joint
• Shoulder impingement syndrome-bones nearby the shoulder preventing motion
• Rotator cuff injury-torn tendons that perform the support for the shoulder
• Bursitis-inflammation of the sac surrounding the shoulder joint
• Pinched nerves in the arms. This is mentioned above as pinched nerves outside of the spine. Common areas along the path of nerves leaving the spine and traveling into the arms which can cause neck and arm pain are listed below.
• Nerves being pinched as they leave the neck and enter the upper portion of the arm is called thoracic outlet syndrome. This can cause pain and numbness in the arms and hand. This often requires other testing of blood vessels and nerves in the arms to identify this problem.
• A nerve can be pinched in the elbow which causes neck and arm pain often with numbness in the hand and weakness of the grip. This is called cubital tunnel syndrome.
• A nerve pinched in the wrist is called carpal tunnel syndrome. A ligament is pinching the nerve as it enters the hand which causes numbness and tingling in the hand, mostly thumb and index finger, with burning numbness extending backwards into the arm and sometimes neck. This condition can be worse at night and confused with a pinched nerve in the neck.

Treatment of neck and arm pain

• Fortunately, there are a wide variety of treatment options for neck and arm pain. Before any treatment can be considered, we must first determine the cause. Evaluation includes ordering tests such as x-rays, MRI, and CT scans and performing a detailed examination of the patient so that a correct diagnosis and assessment of the condition can be made.
• 
  
• Once the cause of the problem is identified, a treatment plan is custom tailored for each individual. Before considering any surgical treatment, conservative treatment with can include physical therapy, steroid injections, acupuncture, chiropractic care and adjustment of lifestyle activities, are recommended. In patients with spinal cord compression with weakness, often conservative therapy is not recommended and instead surgery is performed to relieve the compression on the spinal cord.
• 
  
• Spinal cord tumors can be removed surgically or followed depending on the type of problems that are being caused by the tumor. In most cases, weakness should be treated with surgery to remove the spinal tumor.
• Fluid collections within the spinal cord (syringomyelia) may also require surgical treatment if they are causing weakness or numbness. The cause of the fluid collection would need to be identified first before treatment decisions are made. Many of these fluid collections are caused by neck trauma and don’t require any surgical treatment. Other causes include compression of the upper spinal cord (Arnold-Chiari malformation) and may require surgery by a neurosurgeon.
• Shoulder conditions described above are usually treated by an orthopedic or physical medicine specialist who may prescribe physical therapy, steroid injections, or surgery.
• Pinched nerves outside of the cervical spine may require specific nerve testing to identify the location of the nerve compression. These problems are usually managed by an orthopedic surgeon.
• Nerve inflammation caused by either diabetes or problems with the immune system does not usually require surgery and once this determination has been made the patient will be referred to the appropriate specialist. There are inflammatory conditions of the nerves which are caused by the patient’s own immune system attacking the nerves. Special nerve tests and sometimes spinal fluid examination is needed to identify the cause.
• Cervical spine deformity-often this is combined with other problems involving the neck including herniated disks, bone spurs, trauma, and arthritic conditions. Treatment of this problem depends on the severity and the results of imaging studies which are used to determine the anatomy of the deformity. Usually a significant deformity will also involve compression of the spinal cord and/or nerve roots. Some of the surgical procedures noted below either alone or in combination can be used to treat deformity causing symptoms such as pain, weakness, or difficulty swallowing and breathing.
• If conservative treatment fails and the person continues to have neck and arm pain with or without weakness, several surgical options are available. Several surgical treatments are same-day surgery (outpatient) and do not require a hospital stay. Cervical spine surgery is usually about 80-90% successful in treating neck and arm pain caused by pinched nerves in the neck. During surgery monitoring is used to check the status of nerves going into the arms, to the vocal cords (voice-box) and sometimes the spinal cord. Monitoring is used to increase the safety of the surgical procedure. During surgery, a microscope is used to allow the surgeon to visualize the area undergoing surgery which allows for smaller incisions and decreased risk.
• Anterior discectomy and fusion (ACDF)-a minimally invasive surgery which involves making an incision in the front of the neck usually on the right side. The esophagus (swallowing tube) and trachea/larynx (voice-box) is moved to the left and the spacer (disc) between the spine bones (vertebrae) is removed. This allows removal of bone spurs and disc to relieve the pinched nerves. A spacer made of plastic filled with ground up bone from the bone bank is placed into the disc space and a titanium plate is placed in front of the cage and secured to the vertebra using titanium screws. This procedure is often performed as same-day surgery. Following surgery, a soft neck brace is placed, and the patient is observed in the recovery room for about 4 hours before being released home. This surgery will relieve neck and arm pain gradually during the healing process. During recovery the patient wears a soft collar for about 4 weeks then undergoes physical therapy and by approximately 3 months may return to normal activity. Because this procedure involves fusing vertebrae together, there is a 10-15% risk that the disc above or below the surgery could wear out in the future and require another corrective surgery.
• Cervical disc replacement (disc arthroplasty)-involves similar surgery as an ACDF. After the disc and bone spurs are removed to relieve the pressure on the nerves, an artificial disc is placed into the disc space. This procedure was also performed as same-day surgery with the same amount of time in the recovery room. A soft neck brace is usually worn for about 2 weeks following surgery. Physical therapy is started after about 2 weeks and by approximately 6 weeks the patient may return to normal activity. The overall recovery time is less for disc replacement compared with ACDF. Because a fusion is not performed, the risks of levels above or below wearing out in the future is about 5%.
• Posterior micro-foraminotomy- this surgery involves making a ½ inch incision in the back of the neck and placing special retractor directly over the bone covering the nerve. Using a microscope, a small hole is made in the bone(foraminotomy), which creates more space for the nerve so that it can move away from the bone spur or disc which is compressing the nerve and causing arm pain. The disc compressing the nerve can also be removed if necessary. This surgery can also be performed on a same day basis. Because fusion is not performed, there is no risk of the levels wearing out above or below this location. The patient is observed the same length of time in the recovery room and then released home. Usually, no neck bracing is necessary. Activities are usually restricted for about 4-6 weeks to allow time for healing. Physical therapy may also be requested to help with the healing process. The degeneration of the disc at this same level continues over time and nerve compression caused by bone spurs or disc material can return. Repeat surgery for recurrent neck and arm pain can be performed using the same technique or other techniques such as ACDF or artificial disc replacement.
• Spinal cord compression in the neck (cervical spine)-if a patient has progressive weakness from spinal cord compression in the cervical spine, usually conservative treatment is not recommended and more aggressive therapies such as surgery is necessary. In this situation the goal of treatment is to hopefully reverse the progressive weakness which is our ready occurred or at least prevent the weakness from getting worse. There is often numbness and tingling in the arms and legs along with some neck pain and there may be stiffness in the legs with difficulty walking, difficulty controlling bowel and bladder function, and a progressive overall decline of physical activity. In order to treat this condition imaging studies such as MRI, CT, and x-rays are needed to determine which type of surgery would be the most effective in removing pressure away from the spinal cord.
• Anterior discectomy and fusion (ACDF)-can be often performed at multiple levels to remove disc and bone spurs from the spinal cord. This technique can also be used to help correct a spine deformity which is contributing to the spinal cord compression.
• Anterior corpectomy and fusion-involves the removal of one or 2 vertebrae causing spinal cord compression. The procedure uses the same approach as an ACDF, through an incision made in the front of the neck on the right. The vertebra and the disks above and below are removed and replaced with an expandable titanium cage filled with ground up bone. A titanium plate is then placed in front of the cage and the plate secured to the vertebrae above and below using bone screws.
• Laminoplasty-this is a procedure performed from the back of the neck using an incision in the center. The neck bones which formed the roof over the spinal cord are partially cut and rotated to increase the space for the spinal cord. Small titanium miniature plates and screws were used to hold the rotated bones in correct position. This procedure is usually performed to relieve spinal cord pressure caused by bone spurs and joint calcified ligaments, in front of the spinal cord. This surgery requires a 5-6-day hospital stay. Usually a hard neck brace (cervical collar) is worn for about 4 weeks following surgery.
• Cervical laminectomy-this procedure also involves an incision made in the back of the neck. The space for the spinal cord is increased by removing the entire roof of bone (lamina) behind the spinal cord. Often screws and rods are placed on either side of the spine to preserve the proper shape of the spine. Bone from the removed lamina is also placed alongside the screws and rods to allow for a fusion. Though this procedure is usually performed to relieve bone spurs and calcified ligaments compressing front of the spinal cord, it can also be used as an approach to remove spinal cord tumors and spinal infections. This surgery requires a 5-6-day hospital stay. A hard neck brace (cervical collar) is usually worn if a fusion is performed for about 6 weeks.