spine

Arm Pain and Weakness

Any injury near the root of a nerve can result in pain at the end of the nerve where sensation is felt. An injury to the vertebrae or discs in your neck can cause pain, numbness, or weakness in your shoulder, arm, wrist, or hand because the nerves that extend out from between the neck provide sensation and allow for movement in these areas. This condition and the radiating pain which accompanies it, is called Cervical Radiculopathy.

cervical_radiculopathy

The cervical disc acts as a shock absorber between the bones in the neck. Typically soft disc herniations are seen in people in their 20’s and 30’s. The normal gelatin-like shock absorbing center of the disc dehydrates gradually, and as this happens the space between the vertebral bodies collapses. As the disc space narrows, added stress is applied to the facet joints of the spine. This causes neck pain as a result of further wear, arthritis, and degenerative disease. The cervical disc can also protrude and put pressure on the spinal cord or nerve roots when the rim of the disc weakens. This is known as a herniated cervical disc/disc bulge.

Causes of Cervical Radiculopathy

Several conditions can put pressure on nerve roots in the neck. The most common causes for cervical radiculopathy are:

  • Herniated cervical discs - When the outer layer of the disc cracks and the center of the disc breaks through and protrudes, putting pressure on the nerve that exits the spine at that point. The nerve may become irritated, swollen and inflamed when pinched by a herniated disc.
  • Spinal stenosis - This occurs when the space in the center of the vertebrae narrows and squeezes the spinal cord and nearby nerve roots.
  • Degenerative disc disease - The water content of the discs diminish with age and other chemical changes which then causes the discs to shrink in height. Without sufficient cushioning, the vertebrae may begin to press against each other, pinching the nerves, or form bony spurs.

Anatomy

Discs are soft, rubbery cushions found between the hard bones (vertebrae) that make up the spinal column. The discs in the cervical spine (neck) are composed of a thick outer ring of cartilage (Annulus fibrosus) and an inner gel-like cushion (Nucleus). These function as shock absorbers for the cervical vertebrae, and also allow for movement. The spinal canal is a hollow space in the middle of the spinal column that contains the spinal cord and other nerve roots.

Cause

A disc herniates or ruptures when part of the nucleus pushes through the outer edge of the disc and migrates toward the spinal canal and nerves. The spinal nerves are very sensitive to even slight amounts of pressure, which can result in pain, numbness, or weakness in one or both arms

Risk Factors/Prevention

In children and young adults, discs have high water content. As people age, the water content in the discs decreases and the discs collapse and become less flexible. As the discs begin to shrink the spaces between the vertebrae get narrower. Scientific research has shown certain conditions that can weaken the disc, these include:

  • Improper lifting
  • Smoking
  • Excessive body weight that places added stress on the discs
  • Sudden pressures (Accidents, Injuries)
  • Repetitive strenuous activities (Lifting, Twisting, Rotation, Work related injuries)

Symptoms

Neck
As with pain in the lower back, neck pain is also common. When pressure is placed on a nerve in the neck, it causes pain in the muscles between your neck and shoulder (Trapezius muscles). The pain may shoot down the arm. The pain may also cause headaches in the back of the head. Other symptoms include:

  • Weakness in one or both arms (If you also have significant weakness in both arms or legs, you could have a serious problem and should seek immediate attention.)
  • Tingling (a "pins-and-needles" sensation) or numbness in one or both arms
  • Loss of bladder or bowel control
  • Burning pain in the shoulders, neck, or arm
  • Difficulty with your grip strength
  • Difficulty with your handwriting
  • Difficulty with your balance
  • Difficulty opening jars
  • Tremors

Diagnosis

During your consultation, Dr. Pablo Pazmino will take a complete medical history to rule out other conditions that can cause symptoms similar to cervical herniations. Dr. Pablo Pazmino will also perform a complete and thorough physical examination. Radiography (X-rays) and other diagnostic imaging tests (MRI) will then be reviewed so that Dr. Pablo Pazmino can evaluate your bony quality, any instabilities, herniations causing any neural compression, bony spurs or other abnormalities to reveal the extent of damage to your cervical spine.

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Education

At Santa Monica Spine we pride ourselves in our duty to educate our patients. Dr. Pablo Pazmino uses his background as a teacher to ensure that you understand your pathology, imaging and treatment options completely during each visit. Our patients often comment on their amazement at the amount of time and effort we take to review their studies, often in a manner which they have never seen before. We want our patients to be involved in every step of the process and we feel that education is the first step towards achieving that goal together.

Medical History

At Santa Monica Spine / Beverly Spine we are very thorough. Dr. Pablo Pazmino will rely on you to provide us with a complete history of any and all medical illnesses, hospitalizations, surgeries, or chronic conditions which you may have had in the past, or for which you have seen other physicians in the past.

More specifically we will require a history of your neck and arm pain itself. What is the exact location of the neck pain? Arm pain? When did the problem begin? What does the pain feel like? Has your neck been injured before? Have you previously been treated for neck pain?

Nonsurgical Treatment

Nonsurgical treatment is effective in treating the symptoms of neck pain. Symptoms of neck pain may last for days, several months, or become chronic. If symptoms are mild, Dr. Pablo Pazmino may recommend a variety of nonsurgical treatments.

  • Rest. A soft cervical collar or neck brace may be used to limit neck motion and relieve irritation.
  • Medication. Dr. Pablo Pazmino may prescribe nonsteroidal anti-inflammatory medications (NSAIDs) or other non-narcotic pain relievers to relieve your pain and reduce swelling. Muscle relaxers, analgesics, and anti-inflammatory medications are also helpful.
  • Cold compresses or ice can also be applied several times a day for no more than 20 minutes at a time.
  • After any spasms settle, gentle heat applications may be used.
  • Acupuncture. Dr. Pablo Pazmino works with a team of Acupuncture specialists and may recommend this if indicated for your symptoms
  • Physical therapy. In some instances a specifically guided course of Physical Therapy is all that is required. Dr. Pablo Pazmino works hand in hand with a small group of therapists. Any physical activity should be slow and controlled, especially bending forward and lifting. This can help ensure that symptoms do not return-as can taking short walks and avoiding sitting for long periods. For the neck, exercises or traction may also be helpful. To help avoid future episodes of pain, it is essential that you learn how to properly stand, sit, and lift. A cervical traction device, hot and cold therapy, or active exercise program may help relieve symptoms. Exercises may include neck strengthening, neck and shoulder stretching, and aerobic exercises. Patients may also receive gentle massage and perform activities to improve posture.
  • Injections: A series of selective nerve root blocks or epidural injections of a cortisone-like drug may lessen nerve irritation and allow more effective participation in physical therapy. These injections are given on an outpatient basis over a period of weeks. Dr. Pablo Pazmino only works with a small group of physicians who he trusts to perform these injections. Click here to see some of the recommendations Dr. Pablo Pazmino makes in regards to injections and pain management physicians.

injection_therapies

Nonsurgical treatment may take away most of the symptoms, but it does not treat the underlying structural cause. Follow-up visits are necessary so Dr. Pablo Pazmino can check if symptoms have gotten better, worse, or have stayed the same.

Surgical Treatment

If conservative treatment fails to relieve your pain over the course of 6 to 12 weeks, Dr. Pablo Pazmino may recommend a surgical option. The surgical procedure Dr. Pablo Pazmino recommends depend on the underlying condition, and he will discuss your options with you. In most instances, surgery not only relieves the pain, but also improves functioning and movement of the affected areas.

Surgery may be necessary for patients with progressive neurologic symptoms or severe pain that does not improve with other treatments. Surgery may be required if a disc fragment lodges in the spinal canal and presses on a nerve, causing significant loss of function. Surgical options in the neck are varied and depend entirely on the patient, the symptoms and the pathology. For some patients, a smaller surgery may be performed on the back of the neck that does not require fusing the bones together. These posterior approach options can include a microdiscectomy or posterior procedure like a minimally invasive microscopic Foraminotomy (see graphic below), depending on the size and position of the disc herniation.

cervical_posterior

In the neck, an anterior approach may be required. Anterior approaches can be either an anterior cervical discectomy and fusion or an arthroplasty. This involves removing the entire disc to take the pressure off the spinal cord and nerve roots. The procedure for both an arthroplasty and a fusion are similar up to this point. A fusion, (ACDF, an Anterior Cervical Discectomy and Fusion), is the current gold standard for treatment of a degenerated or herniated disc. With this procedure after the discectomy is performed, a spacer is placed in the disc space and a metal plate may be used to stabilize the spine. This eliminates painful motion from the involved area through a cervical fusion. Final fusion occurs at 12-16 months. Patients are not required to wear a soft collar, unless needed for comfort while driving.

anterior_cervical

A Cervical artificial disc replacement is the new treatment for a degenerated or herniated disc. With this procedure after the discectomy is performed, an artificial disc replacement is placed in the disc space and either spikes or a keel are used to stabilize the spine. This eliminates painful motion from the involved disc and eliminates the comorbidities associated with a fusion. Complete range of motion is achieved within 2-12 weeks. Patients are not required to wear a soft collar, unless needed for comfort while driving.

cervical_artificial

A Cervical hybrid artificial disc replacement is the new treatment for a degenerated or herniated disc in a patient with a prior fusion. With this procedure after the discectomy is performed, an artificial disc replacement is placed in the disc space and either spikes or a keel are used to stabilize the spine. At a prior level there has already been a fusion performed or can be performed during our procedure. This combination of arthroplasty and fusion eliminates painful motion from the involved disc and eliminates the comorbidities associated with a fusion. Complete range of motion is achieved within 2-12 weeks. Patients are not required to wear a soft collar, unless needed for comfort while driving.

cervical_hybrid

We have done research on our initial outcomes with cervical arthroplasty and presented these findings at national and international meetings. If you are interested in our outcomes please read our findings in the research section.

Each of these surgical procedures is performed with the patient under general anesthesia. They may be performed on an outpatient basis or require an overnight hospital stay. You should be able to return to work in 2 to 6 weeks after surgery.

Newer Cervical artificial disc replacements are on the horizon as a new treatment for a degenerated or herniated disc in a patient with a prior fusion. Dr. Pablo Pazmino is the Principal Investigator for the Discover Cervical Arthroplasty from DePuy. This is an ongoing clinical trial and we are currently recruiting patients with cervical pathology for entry into the study. With this procedure after the discectomy is performed, an artificial disc replacement is placed in the disc space and spikes are used to stabilize the new disc to the spine. The arthroplasty eliminates painful motion from the involved disc and eliminates the comorbidities associated with a fusion. Complete range of motion is achieved within 2-12 weeks. Patients are not required to wear a soft collar, unless needed for comfort while driving. To find out if you qualify contact us via telephone or email.

When Should You Seek Medical Care?

If severe pain occurs following an injury (motor vehicle accident, diving accident, or fall), a trained professional, such as a paramedic, should immobilize you to avoid the risk of further injury and possible paralysis. Emergent medical care should be sought immediately.

Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs.

Radiating pain, or numbness in your arms or legs which causes weakness in the arms or legs without significant neck pain should also be evaluated.

If there has not been an injury, you should seek a Spinal Evaluation with Dr. Pablo Pazmino when pain is:

  • Accompanied by pain that radiates down the arms or legs
  • Accompanied by headaches
  • Accompanied by numbness, or tingling
  • Accompanied by weakness!

Many patients seek care for Arm Pain and Weakness pain by Dr. Pablo Pazmino because as an Orthopaedic surgeon he is specifically trained to diagnose, treat, and help prevent problems involving the muscles, bones, joints, ligaments, and tendons. Although Dr. Pablo Pazmino confines his practices to Spinal pathology he also treats a wide variety of diseases, injuries, and other conditions, including Arthritis/Spondylosis.

 

 

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