Arm Pain of Spinal Origin

What is Arm Pain of Spinal Origin?

Arm pain of spinal origin can be described as discomfort or pain felt anywhere in the arm including the wrist, elbow, or shoulder as a result of a pinched nerve (nerve compression) or irritated nerve in the spinal cord. The pain can occur as a dull constant pain or a sudden sharp pain that can develop suddenly or over time. The pain may be confined to one area of the arm or may radiate to other areas of the arm such as the hand, wrist, elbow, or shoulder.

What are the Risk Factors of Arm Pain of Spinal Origin?

In general, men are affected slightly more than women by this condition. Risk factors include:

• Neck trauma
• Spinal nerve injury
• Heavy manual labour
• Operating vibrating equipment
• Driving
• Smoking

What are the Causes of Arm Pain of Spinal Origin?

Most often arm pain from spinal nerve compression occurs due to degenerative changes of the spine from aging or an injury that causes a bulging or herniated disc.

Degenerative Changes: As spinal vertebral discs age, they become stiffer, dry out, lose water content, lose height, and ultimately bulge out. This causes a collapse of the disc space and loss of disc space height. The body reacts to the collapsed disc by forming more bone called bone spurs around the disc to strengthen it.  These bone spurs lead to stiffening of the spine as well as narrowing of the foramen (small openings on each side of the spinal column where the nerve roots exit) leading to compressed or pinched nerves.

Herniated disc: A herniated disc most often occurs with sudden trauma felt with bending, twisting, pulling, or lifting movements. A disc herniates when the nucleus (jelly-like centre) pushes against its annulus (outer ring). When the herniated disc bulges out toward the spinal canal, it exerts pressure on the sensitive nerve root, causing pain and weakness in the area the nerve supplies.

What are the Symptoms of Arm Pain of Spinal Origin?

The pain in most cases originates from a compressed nerve in the neck and travels down the arm area. The pain can be described as sharp or burning in nature. Neck movements such as straining or extending the neck or turning the head may result in pain. Other symptoms may include:

• Weakness in the muscles of the neck, shoulder, arm or hand
• A sensation of “pins and needles” or tingling in the hand or fingers
• Loss of sensation

Diagnosis of Arm Pain of Spinal Origin

To diagnose arm pain of spinal origin, your doctor will discuss your symptoms and perform a physical examination. During the physical exam, your doctor will prompt you to perform certain arm and neck movements to assess for muscle weakness, reflexes, or certain tender points on the neck, shoulder, arm or hand to find out the origin of the pain. Furthermore, imaging tests such as X-rays or MRI scans may be ordered for further details and confirmation of the diagnosis.

Treatment of Arm Pain of Spinal Origin

Treatment for arm pain of spinal origin depends on the severity and cause of the nerve compression. Treatment normally includes both non-surgical and surgical options with non-surgical option being the first line of treatment.

Nonsurgical treatment options include medications such as NSAIDs and oral corticosteroids, physiotherapy, steroid injections, and narcotics in the case of severe pain.

Surgical treatment options will be considered if conservative management fails to alleviate pain symptoms. There are many surgical procedures to treat arm pain of spinal origin. Based on your symptoms and the location of the nerve root involved, your doctor will recommend a suitable spinal decompression surgery, such as:

• Laminotomy or laminectomy: Both procedures include removing a small section of the bony arches of the spinal canal, known as the lamina, which creates more room in the spinal canal, relieving pressure.
• Foraminotomy or foraminectomy: These procedures are conducted to enlarge openings for the nerve roots to exit the spinal cord by removing portions of tissue and bone causing compression.
• discectomy: This procedure includes removing a portion of a disc to mitigate pressure on the nearby nerve roots.
• Corpectomy: This procedure involves removing the body of a vertebra, as well as the discs to decompress the spinal cord and nerves.
• Osteophyte removal: This procedure includes removing bony growths called osteophytes or bone spurs causing irritation of the nerves.

Prevention of Arm Pain of Spinal Origin

Some of the preventive measures that should be followed include:

• Maintaining proper posture
• Quitting smoking
• Maintaining a healthy body weight
• Regular exercise
• Avoiding heavy lifting activities