Neck and Arm Pain: What You Need to Know
By: Brian Hoeflinger, MD
January 12, 2025 | #29
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Disclaimer: Opinions are my own. Not medical advice.
Medical Trivia of the Week
What is the name of the structure that cushions the vertebrae and can herniate to compress a nerve? (the correct answer is at the end of this email)
- A) Ligamentum flavum
- B) Spinal cord
- C) Facet Joint
- D) Intervertebral disc
Symptoms of a Pinched Nerve in Your Neck
Have you ever experienced an episode of neck pain that is associated with pain radiating into your arm? If so, you may have been experiencing discomfort from a pinched nerve in your neck. The official term for pain radiating into your arm from a pinched nerve in your neck in called “radiculopathy”.
The classic presentation of a pinched nerve in your neck is pain or discomfort originating in your neck and shoulder blade region which then courses down your arm ending in numbness or tingling in the hand. In my practice, I find the discomfort located along the inside aspect of the shoulder blade to be one of the most reliable and consistent complaints of a pinched nerve in the neck. Once a person experiences these type of symptoms, he or she will often seek treatment through their primary physician, and in many cases, be referred to a surgical specialist like myself.
Diagnosing Radiculopathy
When I see a patient in my office for suspected radiculopathy the first thing that I need to do is to obtain a good history. Important questions I ask include:
- When did the pain start?
- Was there any trauma to your neck associated with the initial onset of pain and is the pain worsened with movement?
- Where does the pain start and where does it go?
- How bad is the pain on a scale of 1-10 each day?
- Have you had similar pain before?
- Have you had any treatment and is the pain getting better or worse?
Next, I perform a thorough exam. I specifically check for tenderness or pain over the neck and shoulders. I examine the hands to look for loss of muscle mass or twitching of the hand muscles. I feel the pulse to make sure it is not a problem with blood flow. I then perform a good neurological exam to test muscle strength and sensation and look for any abnormal reflexes. By performing this exam, I can gather more information to correlate to the patients presenting symptoms and determine if there may be another condition causing the patients pain other than a pinched nerve.
At this point, imaging studies need to be obtained. These test may include:
- X-rays
- CT scans of the neck
- MRI scans of the neck
- Nerve study of the arm to assess nerve function
If I am suspicious for any other problem, I may order imaging of the shoulder or a blood flow test of the arm.
New Podcast Episode - Neck and Arm Pain: Neurosurgeon Explains
Explore further what it means to have a pinched nerve in your neck in this week’s podcast:
YouTube, Spotify, Apple Podcasts, Everywhere else
Potential Treatment Options
Based on all of the information I have reviewed, I can then determine what I feel would be the next appropriate step in your treatment plan. This may include medications, physical therapy, pain management, referral to another specialist like a neurologist or orthopedist, and lastly surgery on your neck. Each person’s presentation, exam, and imaging findings are different and thus your specific treatment will be very individualized to you.
If you do require surgery to treat a pinched nerve it:
- May be done from the front or back of your neck
- May or may not require a fusion
- May require one level or multiple levels to be performed
These are all specifics that your surgeon will discuss with you if surgery is an option.
This newsletter is meant to give you a brief overview of having a pinched nerve in your neck, including symptoms you may experience, testing you may undergo, and how your condition may be treated. There are other conditions that can mimic that of a pinched nerve in your neck so ultimately you should see your primary care physician for an initial evaluation if you are experiencing the type of symptoms discussed in this newsletter.
Impactful Quote of the Week
"Challenges are what make life interesting, and overcoming them is what makes life meaningful."
- Joshua J. Marine
All my best,
Brian Hoeflinger
P.S. - if you enjoyed this newsletter, you may enjoy my book that details my life as neurosurgeon and the loss of my oldest son, Brian (see below a synopsis).
My Book
Life and Death . . . Two words with such opposite meaning and which inflict such contradictory emotions and yet are so closely intertwined in our lives. As parents, we bring meaning and life into this world through our children. Our lives become defined as a result. We learn the joy, hardship, and responsibility of shaping an innocent life. But a day will come when that life will be taken. For some, death will come too soon. This is the story of my son, Brian Nicholas Hoeflinger, who died unexpectedly at age 18.
https://doctorhoeflinger.com/products/the-night-he-died-the-harsh-reality-of-teenage-drinking
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Medical Trivia Answer:
The correct answer is D) Intervertebral disc
