{"id":4165,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neckandarmpainneurology\/"},"modified":"2024-12-27T10:57:57","modified_gmt":"2024-12-27T10:57:57","slug":"neckandarmpainneurology","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/neckandarmpainneurology\/","title":{"rendered":"Neck and Arm Pain Neurology"},"content":{"rendered":"\n

Download PDF<\/a> <\/p>\n\n\n\n

Three Myths of Neck\/ Arm Pain<\/h4>\n\n\n\n
\u200b\"Cervical
Plain cervical x-ray is usually a waste of time

<\/td>		\u200b\u200b\u201cI need a plain x-ray to look for Cervical Spondylosis\u201d<\/strong>EVERYONE gets cervical spondylosis as they get older \u2013 like grey hair. There is poor correlation between radiological \u2018age-related\u2019 changes and neck pain. Doing a plain cervical x-ray on someone with neck pain and telling them they have cervical spondylosis\/arthritis\/\u201dwear and tear\u201d may be harmful \/reduce the effectiveness of physio. Plain X-ray only indicated if red flags.

\u201cI need an MR Cervical Spine to manage this patient\u201d<\/strong>
We often are asked for MR Cervical Spine to \u2018show the cause\u2019 of someone\u2019s pain or because a physiotherapist has suggested it. MR C-spine is rarely helpful:
a)<\/strong> because usually it is muscular pain with radiation not radiculopathy;
b)<\/strong> cervical radiculopathy usually improves with conservative treatment;
c)<\/strong> neurosurgery is rarely offered\/has little evidence base in this area. MR C-Spine is not available open access in NHS Lothian . We request it mainly to look for spinal cord pathology.

\u201cNerve conduction studies may be helpful\u201d
<\/strong>Usually neck and arm pain is not radicular. We do not arrange nerve conduction studies in patients with ulnar nerve sensory symptoms.
Carpal tunnel syndrome should go to the hand clinic first.
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Image Copyright: NHS Scotland https:\/\/www.nhscfsd.co.uk\/our-work\/modernising-patient-pathways\/specialty-delivery-groups\/neurology\/<\/a><\/figcaption><\/figure>\n\n\n\n

\u200b\u2022 Patients with neck and arm pain and associated neurological symptoms make up a substantial number
of referrals to medical neurology in NHS Lothian
\u2022 Most patients with these symptoms may be better managed in primary care or secondary care services
other than neurology.<\/p>\n\n\n\n

M.A & J.S. 20-12-22<\/strong><\/p>\n\n\n\n