Neck pain and pain down the arm

(Cervical Rediculopathy)

Dr. Narendra pinto

MBBS, MS(SL), FRCS(Eng) ,FRCS(Ed)
Senior Consultant Orthopaedic and Trauma Surgeon
Rediculopathy
• Rediculopathy is not a specific condition, but rather
a description of a problem in which one or more
nerves are affected and do not work properly.
• This can results in redicular pain, weakness ,
numbness or difficulty controlling specific muscles
Cervical spondylosis
• Degenerative condition of the cervical spine with
narrowing of the intervertebral discs and
osteophytes formation of the adjacent vertebral
bodies
• Osteoarthritis develops in the synovial
intervertebral joints
• Common in middle-aged and elderly
• May cause pressure on the nerve roots or the cord
itself
Symptoms and signs
• Painful, tender cervical spine with reduced neck movements
• Pain may radiate over the occiput and to the shoulders
• Involvement of nerve roots pain radiates into the arm and
hand
• Stiff neck, limited movements of neck.
• Diminished reflexes in the arm
• Dermatomal sensory loss
• Signs of lower motor neuron weakness
• Rarely bladder involvement from cord compression
• Rarely spasticity of legs
Investigations

• AP and Lateral radiographs of cervical spine

-Narrowing of disc space
-Lipping of vertebrae
-Osteophytes
-Sclerosis of posterolateral joints with
encroachment on foramina

• MRI if neurological symptoms +

Differential diagnosis • Reassurance and
• Thoracic outlet symptomatic treatment
syndrome in mild cases
• Shoulder disorders • NSAIDs
• Carpel tunnel syndrome • Collar
• Peripheral neuropathy • Short-wave diathermy
• Spinal cord tumour • Gentle traction
• syringomyelia • The need for surgery is
rare nut may be required
to decompress the nerve
Treatment roots or cords
Cervical disc prolapse

• Usually occurs in young adults

• This should be distinguished from cervical
spondylosis
Symptoms and signs

• Lateral cervical protrusion

Acute neck pain often with severe pain radiating into
the arm or hand with paresthesia and weakness
Restricted neck movement,spasm in neck muscles
Paraesthesia in dermatomal pattern in the arm and
hand
weakness of the muscles supplied by affected nerve
root
Diminished reflexes
• Midline protrusion
If massive may cause no root pain but
may produce a spastic quadriplegia by
interfering with the anterior and lateral
columns of the spinal cord.
bladder symptoms +-
Milder degree of midline protrusion
may cause a spastic gait with reduced fine
movements in the hand and associated
bladder involvement
Investigations
• AP and lateral X-ray of cervical spine
• MRI (investigation of choice)
• CT myelography if unsuitable for MRI

Treatment
• In mild cases,
analgesia, collar, heat treatment
• Acute onset of neurological signs – indication for surgery.
surgery involve removal of disc material by an anterior approach with or without
intervertebral fusion
Thoracic outlet syndrome
• Symptoms in the arm and hand due to compression of nerves or vessels
within the thoracic outlet
• Common in females in 20-40 years of age
• Compression of the nerve- common
• Compression of the subclavian artery and vein less frequent
• Compression is usually due to
scalene muscles
Tendons
Fibrous band
Cervical rib
• Post stenotic arterial dilatation- infrequent will lead to distal
embolization
• Frequently history of a hyperextension neck injury is present (30%)
Symptoms
Pain – positional nature, worse at night
Paraesthesia

Examination
ROOS TEST : reproduction of symptoms
on repeated hand clenching with both
shoulders abducted to 90 degrees and
elbow flexed to 90 degrees
ADSONS TEST:
In a patient sitting on a stool, the radial pulse is felt
patient is asked to take deep breath and then the
face to same side (affected side)
Test is positive if radial pulse disappears
• Diagnosis is mainly based on clinical grounds

Investigations- seldom used

• Electomyogram
• Nerve conduction study
• Angiography
• Venography
• Doppler flow
Treatment
a)Consevative management- 50% will be benefitted
Gentle neck stretching exercise
Relaxation therapy
Analgesia
Physiotherapy
b) Surgery
Excision of cervical rib
Scalenotomy
OSTEOARTHRITIS
Dr. Narendra pinto
MBBS, MS(SL), FRCS(Eng) ,FRCS(Ed)
Senior Consultant Orthopaedic and Trauma
• Commonest type of arthritis and leading
cause of disability over the age of 65
• Degenerative disease of a joint caused by
wear and tear that affects the articular
cartilage and subchondral bone.
• At first the synovial membrane is normal but
later thickening of fibrosis occurs
AETIOLOGY
a)Primary
Idiopathic
b)Secondary
Trauma
Congenital/developmental anomaly
Obesity
Hypermobility
Inflammatory arthritis
• Involves all tissues in the joint

CLINICAL FEATURES
• Can affect any synovial joints, commonly affects the
hands, feet, spine and the large weight bearing joints
• Mechanical pain. Less pain in the morning. Aggravated
by waliking
• Joint stiffness
• Deformity
• Nodal osteoarthritis-affects the hands
• Joint effusion
• Crepitus
• OA of foot- Bunions
• May be associated with joint inflammation-
intermittent and unpredictable
INVESTIGATIONS
• Narrowed joint space
• Osteophytes
• Sub chondral osteosclerosis
• Cyst formation
• Looser bodies
TREATMENT
• Symptomatic treatment
• Analgesics
• Physiotherapy
• Surgery
Arthroscopy or open debridement: occasionally synovectomy
and removal of osteophytes can give temporary relief
Replacement arthroplasty
Osteotomy
Arthrodesis : surgical fusion of the joint, relive the pain
eg- First MTP joint in hallux rigidus