Neck Pain / Pinched Nerve

Several times daily an individual will come into the office with a left arm tingling, or pain or tingling in the left chest.   Often the patient will be concerned about the heart. This discomfort  is most often due to a " pinched nerve" in the cervical spine where a disc is bulging onto the nerve root.  This can cause acute severe pain, or a chronic low grade intermittent gnawing pain, worse in the cold weather. The discomfort can be at the base of the neck, radiating up into the scalp, down the shoulder to the arm and fingers, into the top of the chest, the pectorals, into the angle of the shoulderblade, or under the arm and into the lower pectoral muscles.  Some women with this pain become concerned about breast cancer, which incidentally rarely causes pain, especially in the first few years.

Treatment consists of recognizing the causes of neck trauma.  The discs are like jelly donuts, and years of wear and tear erode the disc capsule posteriorly, causing a backward oozing of the disc jelly onto the nerve.

This is worsened by poor posture, carrying heavy bags over the shoulder, sleeping with the neck in a crooked position, and crooking the neck while using the phone.

Effective therapy includes proper desk ergonomics,  maybe a phone headset, a neck pillow that cradles the neck while one sleeps on one's back, not carrying an assymetrical shoulder bag,  and neck exercises to build up the neck muscles.  Isometric neck exercise consists of putting the hands behind the head, while maintaining excellent neck posture, and exerting a sustained force on the head, while pushing back with the neck.  If done properly for a minute, three times daily, a stronger neck will result in 6 weeks.

Upon evaluation, we give anti-inflammatories, sometimes codiene, or other narcotic pain medication, sometimes a muscle relaxant.  We rarely recommend an MRI, a neurologist,  or surgery.  Sam Lippin, the physical therapist in the office, is very helpful both in acute situations, and in devisng a program for longterm relief and prevention of recurrence.. He aqccepts Oxford, United Health Care, and a few other plans.

If the pain isn't getting better over a 4 week period, we then start considering an MRI, and/or surgery.  It should be appreciated that an MRI doesn't always correlate well with what' s seen on the MRI, and the managed care companies, often like to delay the MRI.