Content courtesy of spine-health.com
The arm pain from a cervical herniated disc results because the herniated disc material “pinches” or presses on a cervical nerve, causing pain to radiate along the nerve pathway down the arm. Along with the arm pain, numbness and tingling can be present down the arm and into the fingertips. Muscle weakness may also be present due to a cervical herniated disc.
The two most common levels in the cervical spine to herniate are the C5 – C6 level (cervical 5 and cervical 6) and the C6 -C7 level. The next most common is the C4 – C5 level, and rarely the C7 – T1 level may herniate.
The nerve that is affected by the cervical disc herniation is the one exiting the spine at that level, so at the C5-C6 level it is the C6 nerve root that is affected.
Symptoms of a Cervical Herniated Disc
A cervical herniated disc will typically cause pain patterns and neurological deficits as follows:
- C4 – C5 (C5 nerve root) – Can cause weakness in the deltoid muscle in the upper arm. Does not usually cause numbness or tingling. Can cause shoulder pain.
- C5 – C6 (C6 nerve root) – Can cause weakness in the biceps (muscles in the front of the upper arms) and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is one of the most common levels for a cervical disc herniation to occur.
- C6 – C7 (C7 nerve root) – Can cause weakness in the triceps (muscles in the back of the upper arm and extending to the forearm) and the finger extensor muscles. Numbness and tingling along with pain can radiate down the triceps and into the middle finger. This is also one of the most common levels for a cervical disc herniation
- C7 – T1 (C8 nerve root) – Can cause weakness with hand grip. Numbness and tingling and pain can radiate down the arm to the little finger side of hand.
It is important to note that the above list comprises typical pain patterns associated with a cervical disc herniation, but they are not absolute. Some people are simply wired up differently than others, and therefore their arm pain and other symptoms will be different.
The pain pattern from a cervical herniated disc is referred to as a cervical radiculopathy.
Since there is not a lot of disc material between the vertebral bodies in the cervical spine, the discs are usually not very large. However, the space available for the nerves is also not that great, which means that even a small cervical disc herniation may impinge on the nerve and cause significant pain. The arm pain is usually most severe as the nerve first becomes pinched.
Diagnostic Tests for a Cervical Herniated Disc
After the initial exam, special diagnostic imaging tests may be required to better diagnose a cervical herniated disc.
MRI Scan to Identify a Cervical Herniated Disc
The single best test to diagnose a herniated disc is a MRI (Magnetic Resonance Imaging) scan. A MRI scan can image any nerve root pinching caused by a herniated cervical disc.
CT Scan with Myelogram to Identify a Cervical Herniated Disc
An MRI is the best first test, although occasionally a CT scan with a myelogram may also be ordered, as it is more sensitive and can diagnose even subtle cases of nerve root pinching.
Although a CT scan with myelogram is more sensitive it is also a slightly invasive test, as the myelogram dye must be injected into the spinal canal as part of the procedure. Because of the injection, a CT scan with myelogram is not usually the first test ordered.
Plain CT scans (without myelogram) are for the most part not useful for the diagnosis of a herniated cervical disc.
In This Article:
EMG to Identify Other Conditions Causing Pain
Occasionally, an EMG (Electromyography) may also be requested. An EMG is an electrical test that is done by stimulating specific nerves and inserting needles into various muscles in the arms or legs that may be affected from a pinched nerve. If the muscles have lost their normal innervation, there will be spontaneous electrical activity.
An EMG can also help rule out other nerve entrapment syndromes that can give one arm pain, such as carpal tunnel syndrome, brachial plexitis, ulnar nerve entrapment, thoracic outlet syndrome, among other conditions.
Cervical Herniated Disc Treatments
Most disc herniations will heal themselves with a gradual resolution of neck pain and arm pain (radiculopathy) over time. Therefore, most cervical disc herniations can be managed with non-operative treatment. Improvement in the symptoms from a cervical disc herniation should occur over 6 to 12 weeks but may take longer. The goal of non-operative treatment is pain and relief and restoration of normal function. The following treatments (alone or in combination) are most typically prescribed.
All treatments for a cervical herniated disc are essentially designed to help resolve the arm pain, and usually the weakness and numbness/tingling will resolve with time.
Once the arm pain does start to improve it is unlikely to return, although it may take longer for the weakness and numbness/tingling to improve. If the arm pain gets better it is acceptable to continue with conservative treatment, as there really is no literature that supports the theory that surgery for cervical disc herniation helps the nerve root heal quicker.
- Physical Therapy and Exercise. In the initial period a physical therapist may use modalities, such as heat/ice or ultrasound, to help reduce muscle spasm. Muscle massage can help relieve muscle tension and pain. McKenzie Exercises, a specific type of self administered exercise therapy can be used to help reduce the neck and arm pain.
- Cervical traction. Traction on the head can help reduce pressure over the nerve root. It does not work for everyone but is easy to do, and if effective the patient can use a home traction device for pain from a cervical herniated disc.
- Chiropractic manipulation. Gentle manipulation can help reduce the joint dysfunction that may be an added component of the pain. High velocity manipulations should be avoided as they can make the pain worse, or worsen any neurological damage.
- Activity modification. Some types of activities may tend to exacerbate the herniated disc pain and it is reasonable to avoid these activities to keep from irritating the nerve root. Such activities may include heavy lifting (over 50 pounds), activities that can cause increased vibration and compression to the cervical spine (boating, snowmobile riding, running, etc.), and overhead activities that require prolonged neck extension and/or rotation.
- Bracing. In some instances a cervical collar or brace may be recommended to help provide some rest for the cervical spine.
- Medications. Anti-inflammatory medications such as Ibuprofen, muscle relaxers like Robaxin and narcotic pain killers might be used on a temporary basis to help reduce the pain and discomfort from a cervical herniated disc. These medications are typically prescribed in the first few weeks after a disc herniation when the pain tends to be at it’s worst. For patients with severe pain from a herniated disc, oral steroids (such as Predisone or a Medrol Dose Pak) may give even better pain relief. However, these medications can only be used for a short period of time (one week). Certain “nerve pills” like Lyrica and Neurontin (Gabapentin) may help reduce the nerve-type pain (neuropathic pain) and help restore normal sleep patterns.
- Injections. Epidural Steroid Injections or Selective Nerve Root Blocks can help reduce inflammation in cases of severe pain from a cervical herniated disc. These injections are typically performed by a pain management specialist under x-ray guidance to place the needle in the appropriate position. Injections can be very effective if accompanied by a comprehensive rehabilitation program that may involve a number of the above conservative treatments.
If the symptoms related to a cervical disc herniation fail to improve after 6 to 12 weeks then it is reasonable to consider surgical intervention.