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The Neck

Nerve root lesions in the neck are responsible for causing such extreme arm and shoulder pain that some patients wish they could cut off their arm. Typical presentation with this syndrome involves looking very tired from sleep loss, limited interaction and loss of sense of humour and the keeping of the arm in a guarded position. The exact nerve root implicated will determine which areas of the arm are most badly affected. The pain can surge through the arm in agonising waves and also appear incredibly sharp. Any stretching, or tension, forces applied to the nerve by movements of the neck or arm is followed by a worsening of the pain severity.

As a comfortable position for the arm can be extremely limited in nature patients typically hold their arm in whatever posture eases the pain most, either holding on to the top of the head or carefully held across the abdomen. Taking anti-inflammatory and strong painkilling drugs is vital to settle inflammation as soon as possible and prevent the set up of high levels of activity in the pain pathways. This syndrome always has high irritability so it is very easy to stir things up with treatment, making mechanical therapy a very carefully judged process with gently manual inputs to affected joints helping movement and circulation.

Nerve root lesions need therapeutic care as intervention is much more likely to aggravate this highly irritable condition than add anything to the natural resolving process. However, treatments such as neck traction, collar wearing, keeping the joint in the least painful position and mobilisation techniques can be useful to speed up or start the process. As the pathological process begins to ease the patient is relieved to sleep better, start neck motion and go back gradually to performing activities of daily living.

Once the pain is settling the focus can change to some extent but still needs to be kept on how easy it would be to re-aggravate the pain back towards its previous levels. A collar may still be useful at night to minimise the excursion of the neck joints during sleep and gentle mobilising movements taught in small ranges for the neck to put some mechanical input in to affect the pain systems. Analgesic support should be kept up for longer than the  person feels they need to as control of the pain is important and they need some cover as they begin to do normal things again with the neck.

Resolution of this kind of severe arm pain is very likely with time, but sometimes the time is too great to allow the patient to go on suffering for so long so a referral for consideration of operation by a spinal surgeon may be appropriate. The examination will require a history of the neck and arm pain and whether previous episodes have occurred, what brought it on, the areas of the arm affected and the easing and aggravating factors. It is wise to limit the physical examination to easy ranges of joint movement, reflex testing, sensory testing and an assessment of muscle power to avoid aggravating the pain.

Since it is very likely that a single nerve root will be responsible for the pain it is also likely that a particular arm area will be painful and that particular muscle weakness, sensory loss and reflex changes will be present. These will reflect the changes which have occurred in the parts of the arm function which are controlled by the compromised nerve root. More than one nerve root affected is a red flag for medical referral.


After the examination the surgeon will have a clear idea of which nerve root is the likely culprit and will order an MRI scan to image the segment of the neck responsible. If a large disc protrusion is evident on the scan then a surgical removal of the disc prolapse is possible although this is less commonly performed than in the lumbar spine. After the recovery period it is useful for patients to keep themselves fit and try to return to as normal activity as possible in order to forestall any chances of developing consequences from the syndrome.

Further information: whiplash injury claim

 

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