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Neck and Arm Pain - Is it a Herniated Disk?

 

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 disk “pinching” or irritating 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 their condition. Sometimes X-rays indicate years of degenerative changes even though: “It never bothered me before."

 ---- Neck and Arm Pain (large)


The classic herniated or bulging disc pain presentation includes neck pain that radiates into the arm in a specific area, called a dermatome; as each nerve affects different parts of the arm and hand.
Describing the exact location of the arm complaint, such as, "I have neck pain which is causing numbness and pain in my arm and hand worse at my ring and pinky fingers," tells me the cause of the problem.  In this example, the person has a pinched C8 nerve at the base of the neck.

Examination findings usually include limitations in cervical (neck) ranges of motion, usually in the direction that increases the “pinch” on the nerve. Another way to determine where the nerve is pinched is through orthopedic tests that can recreate 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 tests can tell me if the pain is being caused by stuck ribs or muscle spasms. Still other tests include reflexes and muscle strength in the arm.

When a nerve is pinched, the reflexes may be sluggish or absent and certain muscles in the arm may be 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 is very helpful when applied 3x/day for 15 minutes, at 8-12 pounds.  Seventy-eight percent of 81 patients reported a significant improvement in symptoms, which is very effective (I can perform traction here and get you a device to use at home).

Other forms of care that can be highly effective include spinal manipulation, spinal mobilization, certain exercises, physical therapy modalities, and certain medications.  A variety of supplements can help to reduce inflammation as well.  If you have neck pain with arm pain that persists for more than 2 days or is getting worse it makes sense to have it evaluated by your chiropractor or MD.