Neck Pain

Overview

While neck pain (in the cervical spine) is less common than lower back pain (in the lumbar spine), millions of people experience neck pain and/or related arm pain at some point in their life.The vast majority of episodes of neck pain will get better with time and can be addressed with non-surgical treatments. However, there are a few symptoms that are possible indications of a serious medical condition and patients with these symptoms should seek medical attention immediately.

  • Progressive neurological deficit (weakness in the arms or loss of feeling and coordination in the arms or legs) could indicate nerve damage.
  • If sustained or increasing pain is accompanied by lack of appetite, unplanned weight loss, nausea and vomiting, or fever/chills/shakes, there could be a spinal tumor or infection.

While many episodes of neck pain have no identifiable anatomical cause, certain types of neck pain and arm pain can be linked to a general cause (such as muscle strain) or a diagnosable condition (such as cervical herniated disc or cervical stenosis).

This article provides a brief introduction to the most common conditions that cause neck pain and/or arm pain, including the primary symptoms and links to more information.

Acute Neck Pain

Acute Neck Pain

Most episodes of acute neck pain are due to a muscle strain or other soft tissue sprain (ligaments, tendons). This type of injury can be caused by a sudden force (such as whiplash resulting from a car accident), or from straining the neck (such as a stiff neck from sleeping in the wrong position, or a strain from carrying a heavy suitcase).

Most minor injuries to the ligaments, tendons and muscles in the neck usually heal with time (a couple of days or weeks) because these soft tissues have a good blood supply to bring the necessary nutrients and proteins for healing to take place. Nonsurgical care, such as ice and/or heat, medications, physical therapy, and/or chiropractic or osteopathic manipulations can help alleviate the painful condition while it is healing.

For patients with neck pain that lasts longer than two weeks to three months, or with predominantly arm pain, numbness or tingling, there is often a specific anatomic abnormality causing the symptoms.

Neck Pain that Radiates Down the Arm

Neck Pain that Radiates Down the Arm

Pain that radiates down the arm, and possibly into the hands and fingers, is frequently caused by a cervical herniated disc or foraminal stenosis pinching a nerve in the neck. The pain may be accompanied by numbness or tingling in the arms and/or hands. The symptoms may start suddenly or develop over time.

The approach to treatment for a cervical disc herniation is guided by how long the pain lasts, pain intensity and the degree to which the cervical nerve and/or spinal cord are affected. Most commonly, the symptoms are temporary and can be treated successfully with nonsurgical care (such as medication, physical therapy, manipulations). If the pain does not respond within 6 to 12 weeks of conservative treatments, then surgery may be recommended.

Neck Pain that is Related to Certain Activities or Positions

Neck Pain that is Related to Certain Activities or Positions

Neck pain that develops slowly (often over a number of years) and tends to occur during or after certain activities or neck positions is frequently caused by cervical foraminal stenosis. Usually, impingement of one nerve root on one side of the spine causes most of the symptoms.

This type of spinal stenosis is caused by wear or aging related changes in the joints of the neck (facet joints) or at the margins of the discs. These changes may be diagnosed by either an MRI or a CT scan with a myelogram. As with a herniated disc, the mainstay of treatment for stenosis is medical care (medicine, therapy, exercise, injections, etc.). If the pain is severe or prolonged, or the functional impairment is sufficient, surgery may be recommended to open up the disc space and give the nerve root more room.

Arm Pain with Lack of Coordination

Arm Pain with Lack of Coordination

Pain that radiates down the arm, along with symptoms such as lack of coordination in the arms and legs, difficulty with fine motor skills, and occasional intermittent shooting pains, is commonly caused by cervical spinal stenosis with myelopathy.

These symptoms, which are caused by either a cervical herniated disc or degenerative changes in the joints that can cause pressure on the spinal cord, generally develop slowly. Symptoms may not progress for years, and then the patient may notice progression of the coordination difficulties, only to be followed by another long period where there is no progression.

Conservative treatments may help relieve the chronic arm pain, but the definitive treatment option for the spinal cord compression (which causes the coordination difficulties) is surgery to decompress the spinal canal.

Neck Pain that Persists for More than a Few Months and May Fluctuate

Neck Pain that Persists for More than a Few Months and May Fluctuate

Neck pain that is often characterized by a low level of chronic pain that sometimes “flares” and gets worse, is made worse by certain positions or activities, and may be accompanied by arm pain, may indicate symptomatic cervical disc degeneration.

While cervical disc degeneration is virtually ubiquitous in humans, symptoms from this “gray hair of the spine” are less common and often short-lived. However, there may be an event, such as a twisting injury to the disc space, which precipitates the onset of symptoms and, in a subset of such people, may lead to chronic neck pain. Such symptoms are often proportional to the person’s level of activity; that is, the more the shoulders, arms and neck are used, the more they hurt.

Neck Pain that is Worse in the Morning and at the End of the Day

Neck Pain that is Worse in the Morning and at the End of the Day

Paradoxically, there are also patients who feel their worst when they first rise in the morning and at the end of the day. These people often feel best when they are moving their neck, and they often prefer warm, sunny days to cool, rainy or overcast days. Such symptoms parallel those experienced by patients with osteoarthritis of the weight-bearing joints (e.g., hips and knees). It is presumed that arthritic changes in the facet joints play a role in these people.

Degeneration in the cartilage of the facet joints can produce pain and tends to occur in older adults (over 60 years old). The facet joints are designed to move against smooth surfaces, but as the cartilage degenerates it develops a lot of friction and there is accompanied loss of motion. Often the chronic pain is worst first thing in the morning …Range of motion exercises, physical therapy, traction, and manipulations can all help preserve motion and lessen chronic pain.

In addition to the above conditions, there are a number of other less common cervical conditions. These cervical conditions can cause shoulder pain, wrist pain, elbow pain, or headaches. For a review of these conditions, see Miscellaneous Causes of Upper Extremity Pain.

John Heller, MD. “Types of Neck Pain.” Spine-Health.com. (2001): n. page. Web.
http://www.spine-health.com/conditions/neck-pain/types-neck-pain.