Understanding Anatomy and Treatment of Neck Problems 
When you have pain in your hand your first instinct is to look and see what’s wrong with your hand. However, when pinched nerves are involved, locating the sources of your pain is not so easy and simple. Nerves can and do correctly report the location of an injury. For example, when you hurt your hand, your brain tells you your hand hurts. It could be a splinter, accidentally hitting your hand, whatever. Nerves can also give an incorrect location report when a nerve is pinched. That’s why when you have a disk injury in your cervical spine (neck) that pinches the nerve leading out to the hand it sends a message your hand hurts, even though the problem is in your neck about 2 1/2 feet from your hand. This is the concept of referred pain. When dealing with pain in the arm, shoulders and hands there is a set pattern that usually emerges. The most common disk injures occur at the C5-C6 level, which tends to pinch the C6 spinal nerve causing some tingling and numbness out to the thumb and index finger. The second most common is at C6-C7 which produces symptoms out into the long finger and the third most common is at C4-C5 which causes pain into the shoulder (see illustration A, Cervical Radiculopathy). Shoulder pain is actually complex to diagnose because there are so many mechanical problems that arise in the shoulder itself. These are problems such as rotator cuff syndrome, impingement syndromes (rubbing of arm bone and spine of the shoulder blade) that lead to shoulder pain. However, some pain in the shoulder, arm and hand are due to disk problems or bone spurs in the cervical spine. Although the hand can experience tingling and numbness from neck problems, patients can have pinched nerves at the elbow, muscles in the forearm, or at the wrist such as carpal tunnel.. The hand can also be numb or tingly from something called Thoracic Outlet Syndrome. Most studies suggest this involves the long, ring and small finger. These can be affected by a problem with the C7-T1 disk but a disk problem or bone spur at this level is not very common. Thoracic Outlet (see illustration B, Thoracic Outlet Pinch Sites) usually is caused by liget neck muscles called the scalenes, pressure by the collar bone itself or by a small, deep chest muscle called the Pectoralis Minor. Treatment may take many different approaches. Surgery is always an option but according to most authors, is needed in only two to three percent of the cases reviewed. Most problems can be worked out with a combination of treatments in about three months. If your pain or numbness keeps getting worse no matter what, after three months you may wish to try a surgical consult For the vast majority surgery is not required, what then to do? Bed Rest vs. Activity and Exercise Patients do better, recover more quickly, and have more lasting benefit if they try directed activity such as stretching and strengthening. Bed rest has clearly been shown to have a poor outcome, activity is better for you. Loading and Lubricating Using the joints of the body “loads them” and produces more joint fluid and lubrication. Controlled and directed therapy exercises can help make your joints healthier in the spine. Traction A simple type of mechanical measure is spinal traction which benefits many patients with disk or joint problems in the spine. The set-up involves a support or harness. This gently pulls the head to relieve pressure in the neck arms, shoulders and hands. Sometimes insurance companies will pay for home devices whose design and use have really improved. Individualized Therapy Programs These involve a variety of modalities such as ultrasound, electrical stimulation, traction, stretching, and strengthening that is designed to reduce pain and restore health. You should receive a thorough evaluation and an individualized treatment plan. It is very helpful to have testing such as x-rays, MRI or nerve testing to help direct treatment in therapy. We do painless never testing at our facility. Medications There are a large variety of medications for pain but they fit into a few main categories: 1.) Nonsteroidal Anti-Inflammatory Drugs (Aleve, Aspirin, Motrin, Celebrex, Vioxx, Etc.) 2.) Locally Acting Medications for Pain (Steroids, Muscle Relaxants, Pain Anesthetic Patches) 3.) Narcotic Pain Medications-Schedule III narcotics, lower addiction probability (Darvocet, Darvon, Vicoprofin, Tylenol #3, Loricet) Schedule II, medium addiction potential (Percocet, Percodan) Schedule #II, higher addition probability (Demerol, Dilaudid, Duragesic, Oxycontin) TIPS TO KEEP YOUR SPINE HEALTHY Try exercise or sports Try good back or neck support when driving. Keep your hands on the lower part of the steering wheel and keep your seat closer. Keep keyboard spacer bar at sitting elbow height. Get up and stretch regularly. When lifting or carrying, keep weight close to center of gravity (belly button). Stretch and tone the spinal muscles. See us for a good program. Keep good posture. Don’t slouch. If you are tired, find a seat that offers good support. Common sense. Don’t over do it. If your pain persists, call your doctor and/or give us a call for a free consult. We can make suggestions on how to get help for your problem. |
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