I’ve heard this phrase a lot of times in the past 20 years: “I’ve got a pinched nerve in my neck”. It’s a fairly common conclusion for many people who have a sore neck and pain that refers down into their arm. The reality may or may not involve a pinched nerve, so let’s take a look at what this type of pain may be and what might need to happen if it is a pinched nerve.
So the first thing to do is work out the diagnosis. This involves:
1. Taking a thorough history (many times the history is just about enough to identify a pinched nerve);
2. A thorough physical examination in which both the diagnosis is proven (and alternative possibilities known as differential diagnoses are dis-proven);
3. The physical examination should also identify the risk (or causative) factors since this is what will need treatment.
4. In some but not all cases further investigation may be warranted (such as Xrays or imaging like MRI or CT).
Then the diagnosis and underlying causes should be explained to you in easy to understand language and a plan established as to how your pain will best be managed and over what time frame. It’s important to remember that many types of neck problems refer pain into the arm and mimic a pinched nerve, ranging from less serious issues such as muscle (trigger point) referred pain, referred pain from joints or other structures in your neck, ribs or upper back (as opposed to nerve referred pain). Even the diaphragm and organs can refer pain into the neck and upper limb and mimic nerve pain, so a professional evaluation is warranted if you have these symptoms. The image below illustrates just the nerves and vessels in the neck and upper quadrant - it's complex and difficult to self diagnose.
So back to pinched nerves. A pinched nerve is, by definition, one that is being compressed. This is usually due to either soft tissue compression from a disc bulge in the neck, or more common hard bony compression from a bone spur that has formed in the neck as part of a degenerative (“wear and tear”) process over a significant period of time. Another good reason to act on mild neck pain before it becomes a more major problem!
If the nerve is compressed it may result in a broad range of symptoms like pain that may remain in the neck or radiate into the arm. It’s classically described as running down the arm in a line (“dermatomal distribution”) but more commonly the pain is not so clearly in a line that’s easy to identify. Often it’s patchy, with some pain in the shoulder area, sometimes a patch of pain in the elbow or hand. You might get tingling or numbness, often in one or more fingers. Weakness can occur in more severe cases, causing clumsiness in manipulating objects or weakness doing things like opening jars. The pain can be severe at night causing you to wake and need to get up, maybe take pain killers or walk around for a bit to get back to sleep. The pain comes from both mechanical squashing of the nerve and a chemical effect of the disc material causing the nerve to be inflamed.
It is more common to have an inflamed or irritated nerve root as it exits the neck. In this case there might not be true compression causing paralysis of the muscles supplied by the nerve, but the referred pain and tingling is essentially the same as per the more serious compression.
How do we deal with a true pinched nerve (known as "cervical radiculopathy"; cervical meaning neck and radiculopathy meaning nerve referred pain)? Well the good news is that the vast majority of people recover with conservative care, being Physiotherapy and rest. Very few require surgery, which is reserved primarily for patients who have weakness that progressively worsens despite rest and Physiotherapy. Sometimes a corticosteroid injection is a useful adjunct to treatment (this is the potent anti-inflammatory that can help reduce pain and the inflammation about the nerve).
But for the most part treatment will involve you actively unloading the neck via learning good posture, ergonomics at work (eg desk set-up), and developing appropriate strength and flexibility to maintain a good posture, and to use the muscles to unload the discs. Manual therapy treatment can be helpful depending on what else is contributing to your pain, but certainly is helpful in gently getting your neck moving again. Exactly the combination of strategies used really depends on your unique circumstances.