Neck and arm pain: understanding cervicobrachialgia

Show us as precisely as possible where the pain starts and how far it travels. We want to know which fingers tingle, whether head or arm movements change anything, and whether sensation or strength is declining. What this prevents you from doing comfortably is just as important: sleeping, sitting for longer, carrying a shopping bag or holding a cup securely. Depending on your symptoms, we examine the cervical spine, shoulder and arm down to the hand. Strength, sensation and reflexes help assess possible nerve involvement. Where there are relevant signs, walking is also assessed. If it remains unclear where a nerve is affected, an additional neurological examination may help. A single painful test does not determine your diagnosis on its own.

An MRI can show, for example, whether a disc change or narrowing corresponds to a nerve root. The connection remains crucial: are the change and your symptoms on the same side, and do they fit the examination? An abnormal image alone does not explain what limits you in everyday life. Bring existing images and the written report. We review the images with you. Recurring pain also does not automatically mean new images are necessary. Changes in loss of function, warning signs or lack of improvement despite appropriate treatment may, however, raise a new question. If further imaging is needed, we arrange it. You do not need to organise it yourself simply to prepare for the appointment.

Provided no other urgent treatment is needed, non-surgical options may be considered: suitable adjustment of activity, guided movement and, where appropriate, medication. The choice depends on whether pain, restricted movement or impaired nerve function is the main issue. Medicines are also assessed in light of accompanying conditions and your other medication. We discuss a tangible goal with you. Perhaps you want to sleep with fewer interruptions or use your arm reliably in everyday tasks. This includes deciding how we will recognise progress and when to review the plan. Increasing weakness must not be addressed solely with more pain-relieving measures; it may require prompt further assessment, including a surgical opinion where appropriate.

OrthoCoast also provides periradicular treatment in the cervical spine. In PRT, medicines are delivered specifically to the area around a nerve root. This option is considered for appropriate nerve root pain, for example when previous treatment is not helping enough. Tingling in the hand alone is not an indication. The aim is relief that can make further movement and treatment easier. How well and for how long cervical PRT works cannot be predicted for an individual; the scientific evidence is limited. It does not remove bony narrowing. Benefits, alternatives and risks are therefore weighed up together. In the cervical spine, the spinal cord and important blood vessels are close to the treatment area. As well as temporary symptoms, rare serious complications are possible, including bleeding, infection and injury to nerves, the spinal cord or blood vessels, potentially causing paralysis or stroke. This requires an individual information and consent discussion. The ‘Image-guided injections and PRT’ page gives a fuller explanation of preparation and observation afterwards.