There are two conditions that can cause the exact same distribution of pain in the neck and arm. These are the shoulder or the spine. When it is the shoulder pain is much worse with movements of the arm and range of motion is decreased. The shoulder joint can be stressed on a physical exam to determine if this reproduces the pain.

Spinal stenosis is narrowing of the spinal cord and is a very common source of neck and arm pain. It is the most common condition we treat. Each of the nerves that exit the cervical spine has known complete distributions. C4 and C5 can cause pain in the upper arm and not below the elbow, C6 to the thumb, C7 to the middle fingers, and C8 to the little finger. Pain at the shoulder blade or scapula is also common. It is not unusual to not have this full distribution. A spinal source can be tested for a physical exam and an MRI can confirm as well. This is also known as slipped disc, herniated disc, or pinched nerve.

Whatever structural degeneration of stenosis that is seen on MRI has likely been there with little or no symptoms, and when the pain began or got worse something happened that caused the other problem of inflammation to begin. Then the narrowing that was already there and the inflammation which is new together cause the pain. The pain is dramatically better, usually completely better by getting rid of the inflammation and that is done with shots under X-ray guidance. Most patients come back after the initial treatment and the pain is no longer constant, becomes intermittent and at least half gone. The improvement is because the inflammation is less, but when the episodes of inflammation are well established and been present for over a month it takes two injections to resolve all the inflammation. With that initial response the second injection is the same as the first. If the response is less than that we do the other type of injection.

There are two types of injections for spinal stenosis. Epidural steroids are the same as epidurals for women in labor, but rather than using numbing for delivery we use steroids for inflammation, but the procedure is the same and is even easier with using X-ray. This is a common treatment if we know the pain is from a nerve, but we don’t know which nerve. With epidural steroids the medication is placed centrally where the nerves originate, and the medication can help at multiple levels and both sides.

The other type of injection is a nerve root injection, and the medication is placed where the nerves exit the spinal cord. Sometimes we know which nerve to treat based on the precise location of pain or from MRI results. There is also electrodiagnostic testing that can be obtained. When nerves are the source of pain the nerves that are causing the pain also go to certain muscles in the arm and cause cellular changes that can be detected with tiny electrodes. During the testing selected muscles are tested and when we see which muscle has these changes, then we know which nerve is causing the pain and there is a target for selective nerve root injections.

So it takes two injections, the second one may be different than the first one and there are two tests that can be obtained, an MRI or electrodiagnostics which is called an electromyelogram (EMG).  These are very effective and complete relief is common, even though the structural stenosis will be ongoing. Then prevention becomes the most important education.

Neck and Arm Pain: Understanding the Causes and Advanced Treatment Options

Understanding Neck and Arm Pain

Neck and Arm Pain is a common condition that can significantly interfere with daily activities, sleep, and quality of life. Many patients are surprised to learn that pain traveling from the neck into the arm can originate from two very different sources: the shoulder or the cervical spine. Determining the true cause is essential for effective Pain Management and long-term relief.

When the shoulder is the source of Neck and Arm Pain, symptoms are typically worse with arm movement, lifting, or reaching overhead. Patients often notice reduced range of motion and weakness. During a physical exam, the shoulder joint can be stressed in specific ways to see if these movements reproduce the pain, helping distinguish shoulder-related issues from spinal causes.

However, when the spine is responsible, the pain pattern and treatment approach are very different.