Neck pain with arm symptoms: cervical radiculopathy and myelopathy.
Neck pain on its own is common and usually settles. Neck pain with pain, tingling, or weakness in the arm — or with clumsy hands and unsteady walking — means a nerve or the spinal cord is involved, and that is worth a proper look.
Two different problems
Cervical radiculopathy is a pinched nerve root in the neck. It causes pain that shoots from the neck into the shoulder blade, arm, or hand, often with tingling in particular fingers and sometimes weakness in one muscle group. Cervical myelopathy is compression of the spinal cord itself. Its signs are subtler and easy to dismiss: dropping things, trouble with buttons or handwriting, numb hands, a stiff or unsteady gait, and occasionally bladder urgency. Radiculopathy usually settles with time. Myelopathy generally does not, and delay can cost function that is not recovered.
Causes
A herniated disc is the usual cause of radiculopathy in younger adults. In older adults, bone spurs and thickened ligaments from arthritis narrow the openings the nerves pass through, and can narrow the canal around the cord — cervical stenosis. Some people are born with a narrower canal and develop symptoms earlier. Less commonly, tumors, infection, or injury are responsible; neck pain with fever or a recent infection should be seen promptly.
Diagnosis
The exam maps which nerve root is involved through the pattern of pain, sensation, reflexes, and strength, and checks for the signs of cord compression. MRI shows the discs, nerves, and spinal cord directly and is the key test when arm symptoms persist or any myelopathy sign is present. Nerve conduction studies are occasionally used to separate a neck problem from one at the elbow or wrist.
Non-surgical care
Most cervical radiculopathy improves within weeks to a few months. Physical therapy, a short course of anti-inflammatory medication, activity modification, and sometimes a cervical epidural injection carry most people through. Myelopathy is different: it generally does not improve on its own. The decision is about timing, weighed against how severe the symptoms are and how fast they are progressing.
Surgical options
When arm pain or weakness does not settle, or when the spinal cord is being compressed, the goal of surgery is to take the pressure off. Depending on the level and anatomy that may be an anterior cervical discectomy and fusion, a total disc replacement that preserves motion in carefully selected patients, or a posterior decompression. Dr. Mushlin matches the approach to the individual anatomy and uses the least invasive technique that can do the job safely.
Where to be seen
Dr. Mushlin sees patients at the Stony Brook Spine Institute offices in Riverhead, Lake Grove, and Commack, across Suffolk County. Hand clumsiness or unsteady walking should be mentioned when booking so the visit is not delayed.
Ready to have it looked at? Request an appointment or call 631-444-1213.
How do I know if my neck pain is serious?
Neck pain alone rarely is. Pain shooting into the arm with weakness, numb or clumsy hands, trouble walking steadily, or any bladder change are the signs that a nerve or the spinal cord is involved and should be evaluated soon.
Can a pinched nerve in the neck heal on its own?
Usually, yes. Most cervical radiculopathy improves over several weeks to a few months with therapy and medication. Persistent pain, progressive weakness, or signs of cord compression are the reasons to consider surgery.
What is the recovery from neck surgery?
It depends on the operation. After an anterior procedure many patients go home the same day or the next morning, return to light activity within a couple of weeks, and to full activity over six to twelve weeks — longer for more extensive operations.
Does Dr. Mushlin see neck patients on Long Island?
Yes — at the Stony Brook Spine Institute offices in Riverhead, Lake Grove, and Commack.