Workings Of The Human Neck-Part Four

                                                                                         

The arm pain from nerve root compression in the neck is often described as unbearably severe and can make a patient feel they would like the arm to be cut off. People with nerve root compression present with a haggard expression from not having slept, a loss of sense of humour and a physical nursing of the arm in a particular position. The pain in the arm can be in a variety of positions depending on which nerve root is affected, with the pain described as surging down the arm in severe waves, or as intensely sharp in nature. Any movement of the arm or neck which applies tension to the nerve is rewarded by a severe increase in the pain.

It is very hard for the patient to find a comfortable position for their arm and they may cradle it across the body or hold the hand on top of the head. Prescribing strong painkillers and anti-inflammatories is important as the joints and nerve need to settle and the pain mechanisms are difficult to reduce once they have been set up by severe incoming pain symptoms. Mechanical treatment needs to be careful as the irritability of the pain is very high, with careful pressure against the facet joint helping to relieve the local circulatory stasis and facilitate joint movement.

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.

As the severe pain begins to settle the treatments can be stepped up with the careful watching for intervention interfering with the natural history of the pain and flaring it again. Sleeping can be improved by wearing a soft collar to limit the positions attained by the neck joints at night. Helpful mechanical inputs to the neural pain systems can be provided by performing regular gentle range of motion neck exercises. Painkillers are best maintained for somewhat longer than thought necessary as pain control is so important to the disability associated with this syndrome and patients need to cope with increased activity.

The arm pain should start resolving within six weeks and if it does not then a referral to an orthopaedic spinal surgeon might be indicated. While nerve root pains almost always settle on their own the period of severe pain can be too long in some cases to just wait until it resolves. The surgeon will want to know the history of previous neck pain and the reason, if known, for this episode, where the pain is and the worsening and easing factors. Examining this kind of patient physically is restricted by their pain levels but movements, sensation, reflexes and muscle power are typically assessed.

One nerve root is the most likely affected structure and this means that all the symptoms will be related to the functions which this nerve has. Reflex loss, loss of feeling, weakness of muscle groups and the distribution of the pain in the arm should all fit in terms of being attributable to the compression of this one nerve. If more than one root is affected the patient should be referred for a medical opinion.

A magnetic resonance imaging scan is typically ordered once the surgeon feels a nerve root lesion is the likely diagnosis, in order to indicate the nature of the compression. If a disc protrusion consistent with the examination findings is found on the MRI scan then a cervical discectomy is an option although this is more commonly performed in the lumbar spine. Management after operation is straightforward and patients should return to normal. Maintenance of physical fitness over the long term and a speedy return to normal activities is the best management of this problem and may protect against complications.

About the author:
Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in London visit his website.

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