Movement Of The Neck-Part Four

Patient sometimes report than they wish their arm could be cut off when they are unlucky enough to suffer from the agonising pain of a nerve root impingement. Patients presenting with nerve root lesions look very tired as they have not slept for several nights, are not in the mood for jokes and hold their arm protected in a typical position. Depending on which nerve root is responsible the area of the pain in the arm varies, with pain running in severe waves down the limb and also feeling exceptionally sharp in nature. An immediate increase in pain severity follows any tension or stretch applied to the affected nerve root.

Patients typically find there are only one or two comfortable positions for the arm and maintain these carefully to ease the pain. They may hold the arm against the tummy or place the hand on top of the head to achieve relief. Countering the pain and the inflammation is very important in the early stages and patients should take maximum permitted doses of strong analgesics and anti-inflammatory drugs to prevent the escalation of pain mechanisms in the nervous system. Manual treatment is risky due to the condition's highly irritable nature but some input can be given to ease the joint movement and increase circulation.

Therapeutic management of patients with nerve root compression involves not so much doing many positive things but carefully avoiding any inputs which are too vigorous and aggravating. Mobilisations to the joints, use of a collar, neck traction and maintenance of an antalgic position are all potential avenues of intervention as the process settles naturally. The start of the improvement process heralds relief for the patient who can now gently accelerate the process of resolution by resuming normal activity and getting some sleep.

As the severe pain begins to settle the treatments can be stepped up with the careful watching for intervention interfering with the natural history of the pain and flaring it again. Sleeping can be improved by wearing a soft collar to limit the positions attained by the neck joints at night. Helpful mechanical inputs to the neural pain systems can be provided by performing regular gentle range of motion neck exercises. Painkillers are best maintained for somewhat longer than thought necessary as pain control is so important to the disability associated with this syndrome and patients need to cope with increased activity.

The arm pain should start resolving within six weeks and if it does not then a referral to an orthopaedic spinal surgeon might be indicated. While nerve root pains almost always settle on their own the period of severe pain can be too long in some cases to just wait until it resolves. The surgeon will want to know the history of previous neck pain and the reason, if known, for this episode, where the pain is and the worsening and easing factors. Examining this kind of patient physically is restricted by their pain levels but movements, sensation, reflexes and muscle power are typically assessed.

One nerve root is the most likely affected structure and this means that all the symptoms will be related to the functions which this nerve has. Reflex loss, loss of feeling, weakness of muscle groups and the distribution of the pain in the arm should all fit in terms of being attributable to the compression of this one nerve. If more than one root is affected the patient should be referred for a medical opinion.

After the examination the surgeon will have a clear idea of which nerve root is the likely culprit and will order an MRI scan to image the segment of the neck responsible. If a large disc protrusion is evident on the scan then a surgical removal of the disc prolapse is possible although this is less commonly performed than in the lumbar spine. After the recovery period it is useful for patients to keep themselves fit and try to return to as normal activity as possible in order to forestall any chances of developing consequences from the syndrome.

Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in Nottingham visit his website.