Neck and arm pain

Neck and arm pain is usually caused by the joints and/or nerves that originate from the neck and travel down the arm.

Symptoms you may feel are pain, tingling and numbness; sometimes the arm or hand feels weak. The symptoms vary for everybody.

There may not always be a known specific trigger for why your pain started, but it is not usually a serious condition. An MRI scan is not often required as we can diagnose you from the symptoms you report. However, if your diagnosis is unclear or the symptoms are worsening you may require further investigation such as a scan.

Most people can improve their symptoms and function with advice, pain relief and improving the movement and strength around the neck and arm. Being generally fit and active is also helpful in managing neck and arm pain. However, if the pain is unmanageable, you may be referred to a pain clinic to discuss further options, which may include injections. If all other treatments have not worked, a final option may be surgery, and this would be discussed with a Spinal Consultant. It is difficult to know whether surgery would completely resolve all your symptoms.

What is neck and arm pain?

Pain that travels down the arm from the neck can be caused by joints in the neck or irritation of the nerves.

These nerves can become irritated for several reasons, which may include stiffness of the muscles or the joints of the neck, inflammation, arthritis and/or a disc bulge.

The nerves may become sensitive or irritated. This can cause inflammation within the nerve.

Why me?

There may or may not be a specific reason or cause for your pain. It is thought that neck and arm pain is more common in people:

• Of a working age.

• Who sit or stay in the same position for long periods of time.

• Who are female.

• Under emotional stress.

Symptoms

When the nerve is irritated, it can cause symptoms such as pain, a tingling or ‘pins and needles’ sensation, numbness and/or weakness. Depending on where the nerve is irritated will depend on where you feel your symptoms.

Is it serious?

Neck and arm pain can be painful and cause you to struggle with your normal activities, but it is not usually serious or an emergency.

Cauda Equina syndrome and spinal myelopathy symptoms

These are rare conditions where the spinal cord gets compressed. If you have, or start to get, any symptoms listed below, you should seek urgent medical attention via an Emergency Department (A&E):

• Problems going to the toilet, including a new feeling of wanting to empty your bladder but being unable to, continuation of emptying your bladder when you thought you had finished, or incontinence of bladder or bowels.

• Tingling or numbness in your genitals, back passage (anus) or upper, inner thighs.

• Large reduction in strength and/or coordination of arms and hands and/or legs.

• Unexplained balance problems or unsteadiness in your legs.

Diagnosis and investigations

Neck and arm pain is diagnosed from the signs and symptoms that you describe.

Assessment of the neck, arm and nerve function by a healthcare professional will help to inform this diagnosis. If the diagnosis is unclear or injections are being considered, an MRI scan of the cervical spine may be arranged. This is aimed at looking at the ‘nerve roots’; however, there is often not a strong link between the severity of changes seen on an MRI and the amount of pain you are in.

Will it get better?

Neck and arm pain often gets better on its own with time, without surgery.

In most cases, pain relief from your GP, and physiotherapy is the first line of treatment. Physiotherapists offer advice, education, exercises, and in some cases, hands-on therapy to help with your symptoms.

Regaining your normal movement is important to help ease your symptoms. For most people, the pain does not come back, however for others, it might.

Management

Below are further ways that may help you in the management of your neck and arm pain.

What to avoid:

• Activity and movement are better than being still for most neck pain, so avoid staying in the same position for too long. If this isn't possible, try to take short breaks.

• If you sit a lot throughout the day, use a mirror to ensure your hand and chin aren't poking forward for long periods of time. Family and colleagues will be able to help with this too.

• Doing activities that increase your pain for long periods of time.

Medication for pain control

Controlling your pain allows you to continue to function and carry out your daily activities more comfortably.

Your GP may have already discussed medication to help with your pain and the correct ways to take pain relief. They may recommend that you take it as a short course rather than ‘as and when’ the pain is bad. This often includes paracetamol, co-codamol (Zapain), and non-steroidal anti-inflammatory medication such as ibuprofen. Please always read the instructions before using these products.

If you have nerve pain, your health care professional may also discuss additional medication, which specifically targets nerve pain.

Other pain control options

Some people may find relief with heat or ice packs, gels or a TENS machine. These may be helpful in the short-term and help you with physiotherapy exercises.

Pacing

Whilst the pain is limiting your activities, it is important to find a balance between doing too little, or too much, of what is causing you pain. This is a balancing act, and it is called pacing.

Take regular breaks from activities that trigger your pain and do other activities that are less bothersome. This is an important part of helping yourself during this time. As your symptoms settle, you will find you can start doing a little bit more.

Keep active

Try to keep as active as possible, with your normal activities or exercise. Being generally active will help to keep your neck moving and reduce any stiffness. Normal movement, exercise and activity will not cause harm if you work within manageable pain levels.

The more active you stay or become, the quicker your symptoms should settle.

If you don’t currently do any general exercise, it would be helpful to consider starting something gentle and build on it slowly as you feel more confident. If you have any other conditions that limit your ability to exercise, please discuss this with your healthcare professional.

Advice

There is a link between stress, anxiety and depression and ongoing back and leg pain, so you may find it useful to address these if they affect you. Research shows exercise, relaxation and/or social activities can help reduce stress.

There is a link between poor sleep and ongoing pain. You may find it useful to address this if it affects you. The NHS website has useful links on how to get a good night's sleep.

A rolled towel in the hollow of the lower back or the mid back, whilst sitting, may help to reduce your neck pain.

You may need to try several different pillows as there is no certain type that suits all.

Usually, ensuring the side of your neck is fully supported with a pillow during sleep is most helpful. This ensures the neck is in a neutral position.

Further management

Do not worry if you do not see improvements straight away – remember, time is often a very important factor. Some people with neck and arm pain may be referred to a pain clinic where additional treatments, alongside physiotherapy, may be discussed with you.

In very rare cases and where all other treatments have not worked, surgery may be indicated. A spinal surgeon would discuss this option with you.

Exercises

The neck is made up of many joints and muscles that need to move well to allow good function of the neck and arm, exercising this area is very important. You may feel some discomfort when you start the exercises, but this is normal.

The exercises should not cause you ongoing severe pain after completing them. If they do, stop the exercise and discuss this with your physiotherapist, as they will be able to show you adaptations.

Aim to do the exercises ‘little and often’ to begin with and throughout the day. You may feel it is more painful moving the neck towards the painful arm - this is normal. Start gently and build up the exercises as you are able.

Flexion

• Seated or standing, bend your neck forwards as far as is comfortable.

• You will feel a stretch at the back of your neck.

• Hold the position for three to five seconds.

• Repeat the above five to ten times.

Extension

• Seated or standing, bend your neck forwards as far as is comfortable

• You will feel a stretch at the back of your neck.

• Hold the position for three to five seconds.

• Repeat the above three to five seconds.

• Repeat the above five to ten times.

Side flexion

• Seated or standing, tilt your head towards your shoulder as far as is comfortable.

• You will feel a stretch on the opposite side.

• Hold for three to five seconds.

• Repeat on the opposite side.

• Repeat the above five to ten times on each side.

Rotation

• Seated or standing, turn your head towards one side as far as is comfortable.

• You will feel a stretch on the opposite side.

• Hold for three to five seconds.

• Repeat on the opposite side.

• Repeat the above five to ten times on each side.

Chin tuck

• Sitting tall, tuck your chin backwards. Do not tilt your head downwards.

• You may feel a stretch at the back of your neck.

• Hold for three to five seconds.

• Repeat the above five to ten times.

Shoulder stretch

• Seated or standing, push the chest up and out.

• You will feel the shoulders moving back and downwards.

• You will feel a stretch around the shoulders.

• Hold for three to five seconds.

• Repeat the above five to ten times.

Upper body rotation

• Seated, turn your body to one side using the chair to help you.

• Hold for three to five seconds.

• Repeat on the opposite side.

• Repeat the above five to ten times on each side.

If you require a full list of references for this leaflet, please email patient.information@sfh-tr.nhs.uk or call 01623 622515, extension 6927.