2009-06-03 / Medical Info

That neck and arm pain might be a herniated disc

Dr. Joseph Cilea

Patients who present with neck pain along with arm numbness, pain, and/or weakness often ask, "What's causing this pain down my arm?"The condition is often caused from a bulging or herniated disc pinching a nerve in the neck.The cause of this complaint can include both trauma as well as non-traumatic events. In fact, sometimes the patient has no idea what started the condition because no specific event can be tied to the onset.

The classic presentation includes neck pain that radiates into the arm in a specific area, as each nerve affects different parts of the arm and hand. Describing the exact location of the arm complaint such as "I have numbness in the arm and hand that makes my fourth and pinky fingers feel half asleep" tells us that you have a pinched C8 nerve. This nerve can also be pinched at the elbow and make the same two fingers numb.The difference between the two different conditions is when the nerve is pinched in the neck, the pain is located from the neck down the entire arm and into digits four and five of the hand.When the nerve is pinched at the elbow, the pain/numbness is located from the elbow down to the fourth and fifth digits, but no neck or upper arm pain exists.

Examination findings usually include limitations in certain cervical (neck) ranges of motion (ROMs) — usually in the direction that increases the pinch on the nerve.Another common finding is the arm is often held over the head because there is more stretching on the nerve when the arm is hanging down and pain in the neck and arm increases. Hence, raising the arm over the head reduces the neck/arm pain.To determine where the nerve is pinched, there are a number of different compression tests that can re-create or increase the symptoms. Some compression tests include placing downward pressure on the head with the head pointing straight ahead, bent or rotated to each side. Other compression tests are performed by pressing in areas where the nerve travels, such as in the lower front aspect of the neck, in the front of the shoulder where the arm connects to the chest/trunk, at the elbow and at the wrist. If there is a pinched nerve, numbness, tingling and/or pain will be reproduced when pressure is applied to these regions. Other tests include testing reflexes and muscle strength in the arm.When a nerve is pinched, the reflexes will be sluggish or absent, and certain movements in the arm are weak when compared to the opposite side.Another very practical test is called the cervical (neck) distraction test where a traction force is applied to the neck.When neck and/or arm pain is reduced, this means there is a pinched nerve.This test is particularly useful because when pain is reduced, the test supports the need for a treatment approach called cervical traction. It has been reported that the use of cervical traction when applied three times a day for 15 minutes each, at 8-12 pounds, 78 percent of 81 patients reported a significant improvement in symptoms, which is very effective. Other forms of care that can be highly effective include spinal manipulation, spinal mobilization, certain exercises, physical therapy modalities and certain medications.

If you, a friend or a loved one are struggling with a herniated disc in the neck with associated arm complaints, seek medical attention to have your condition properly assessed.

Dr. Joseph Cilea is owner of AdvancedWellness in Marlboro. He is available for consultation at 732-431- 2155.To receive more information on procedures his office offers, visit www.NJAdvancedWellness.com.

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