Cervical spine related arm symptoms

Clinical subcatergories within this category include:

• Cervical radiculopathy
• Radicular arm pain
• Non-specific radiating arm pain

Cervical radiculopathy

Patient resources

• NHS Inform – Neck problems self-management-advice
• NHS Inform – Exercises for neck problems

Definitions

Cervical Radiculopathy is where there is a neurological deficit within the upper limb, often occurring with radicular pain, in keeping with a single nerve root level.

Typical Signs & Symptoms

Cervical radiculopathy can present clinically as pain, sensory loss, motor weakness and reflex deficit in the distribution of the affected nerve root.

Prevalence

The annual incidence of cervical radiculopathy in men is 107 in 100,000 and in women is 64 in 100,000.  The most commonly affected nerve roots are C7 (50 – 70%), C6 (>20%), C8 (10%), and C5 (2 – 10%).

Risk Factors

• White race
• Cigarette smoking
• Prior lumbar radiculopathy
• Other risk factors that have been proposed include lifting heaving objects, frequent diving from a board and driving equipment that vibrates.

Prognosis

Most people with cervical radiculopathy will improve regardless of the treatment, with over 85% of acute cervical radiculopathy resolving without any specific treatments, within 8 to 12 weeks.

Differential diagnosis

The differential diagnosis is broad but includes trauma and non-musculoskeletal disease processes that can be classified as neoplastic, inflammatory, infectious, vascular, endocrinological or neurological.

Radicular arm pain

Patient resources

• NHS Inform – Neck problems self-management-advice
• NHS Inform – Exercises for neck problems

Definitions

Radicular arm pain describes pain in one or both arms, often on the background of neck pain. The pain typically corresponds to a specific dermatomal pattern, without any clinical signs of reduced nerve function.

Typical signs & symptoms

• Unilateral or bilateral arm pain in a dermatomal pattern
• Neck pain – if present, which is less severe than any arm pain
• Neurological examination of the arms is expected to be normal. If there are signs of loss of nerve function in keeping with the corresponding nerve root level to the pain distribution, consider cervical radiculopathy as the clinical diagnosis.

Prevalence

Studies report radicular arm pain has an annual incidence of 63 to 107 cases per 100,000, and incidence peaks in the fourth and fifth decades.

Risk Factors

• White race
• Cigarette smoking
• Prior lumbar/cervical radiculopathy
• Other risk factors that have been proposed include lifting heaving objects, frequent diving from a board and driving equipment that vibrates.

Prognosis

• Episodes of radicular arm pain are usually transient, with improvements in pain and disability seen within a few weeks to a few months
• Half of people recover spontaneously within 6 weeks
• reoccurence of symptoms is common

Factors associated with a poorer prognosis

• Workplace factors – time off work, problems or dissatisfaction at work, heavy work, or working unsociable hours
• Psychological factors – low or negative moods, stress, overprotective family, lack of support, social withdrawal, the belief that pain and activities are harmful, belief that the problem will last a long time and inappropriate expectations of treatment.

Differential diagnosis

The differential diagnosis is broad but includes trauma and non-musculoskeletal disease processes that can be classified as neoplastic, inflammatory, infectious, vascular, endocrinological or neurological.

For example, you may wish to consider;

• Shoulder/elbow/wrist pathology
• Acute trauma – eg whiplash
• Cervical myelopathy
• Non MSK causes of neck/arm pain
• Vascular conditions (thoracic outlet syndrome)
• Connective tissue disorders like polymyalgia rheumatica

Non-specific radiating arm pain

Patient resources

• NHS Inform – Neck problems self-management-advice
• NHS Inform – Exercises for neck problems

Definition

Non-specific or somatic radiating arm pain can describe pain referred into the shoulder or arm from the cervical spine that is not related to irritation or compression of a nerve root.

It is often characterised by an absence of objective physical findings and symptoms that do not correspond with objective spinal pathophysiology.

Typical signs & symptoms

• Pain is described as dull, aching, gnawing and pressure with or without paraesthesia.
• Often activity related
• Usually felt deep and rarely cutaneous.
• It covers a wide area, is difficult to localise or put into words, and non-dermatomal.
• It can be in the shoulder area, upper arm, occasionally the whole arm.
• Often disproportionate pain and disability

Prevalance

Variable from limited research available. In a 16-year study in Sweden, the prevalence of self-reported neck-shoulder-arm pain rose gradually, from 23% to 25% in women and from 13% to 15.% in men

Risk Factors

• Psychological factors such as catastrophic thinking, symptoms of depression or anxiety, and heightened illness concern.
• Dissatisfaction with support from colleagues or supervisors 
• Ineffective stress management, poor sleep and social factors such as lack of social support and poor relationships.

Differential diagnosis

• Fibromyalgia
• Complex regional pain syndrome
• Shoulder pain

M.A & P.A – 14-05-26