Neck Pain with Arm Pain

Neck pain is a common problem and will affect most of us at some point during our lives. The neck is made of bones (vertebrae) separated by softer cartilage known as spinal discs. The neck, like all other joints, has ligaments, muscles and tendons that work together to support the neck and help perform movement.

Neck problems are normally caused by an injury, accident, or normal age-related changes and lifestyle factors. These include:

• An accident or injury (e.g., following a fall or whiplash from a road traffic collision)
• Sleeping awkwardly
• Holding your neck in the same posture for too long (e.g., sitting slouched on the sofa, looking down at a laptop/mobile phone, painting and decorating)
• Worry or stress
• Having low levels of physical activity

The spine has two main functions; one is to perform and allow movement while the second is to cover and protect the spinal cord and nerves that serve the rest of the body. The many vertebrae and discs allow movement in all directions while still protecting the spinal cord.

Neck pain can sometimes spread to one or both arms and sometimes in the hand. If any of the nerves from the neck are irritated then symptoms of pain, numbness or tingling can be felt somewhere else in the arm and at times the hand. This is known as nerve related pain. Nerve related pain isn’t a condition in itself, but a symptom of another condition such as a problem with the discs or arthritis that can irritate the nerve. Medically, this can be known as cervical radiculopathy, nerve root pain, or radicular pain. This pain can vary from mild to severe symptoms, and will differ between people, and some may have little to no neck pain at all. 

Neck pain that spreads to the upper arms may be caused by other tissues in the neck such as muscles and joints. This type of arm pain is called referred pain.

The symptoms can vary from person to person. For some people, pain may occur suddenly, perhaps from a neck strain or whiplash injury. For others, it may come on gradually over time and for no apparent reason. Some people wake up with it. For some people, the pain is constant and for others the pain may flare up from time to time. 

The most common symptoms of neck with arm and hand pain are:

• Pain in the back or sides of your neck, which can sometimes extend to the shoulder regions, arm and hand
• Have tension headaches, where the pain can travel to the back of your head and sometimes into your ear or behind your eye
• Have pain when resting or when moving
• Have tightness in the muscles of your neck and upper shoulders, especially if you’ve been still such as sitting or sleeping in one position for a long time
• Your neck won’t turn as far as it normally does, for example when you try to look over your shoulder while reversing the car
• The muscles and joint of the neck feel tender or tight to touch
• Symptoms can be varied and range from dull to sharp pains, burning pain, tingling and numbing sensations
• The painful arm may feel heavy or weak
• You may notice arm and hand pain is made worse by specific activities, movements or positions that are unique to you
• You may notice arm and hand pain is eased on specific activities, movements or positions that are unique to you  

Some people may describe clicking noises when moving the neck. This is called crepitus, and it can be caused by air bubbles popping, or tissues and bones moving over each other, in the joint. Other joints often do this too, and is a normal part of body movement, but noises from your neck usually seem louder because they’re happening closer to your ears. While this can sound alarming, it is a common symptom and should not limit your usual activity.

Diagnosis is usually made from a consultation with your Health Care Professional, involving a detailed history of the onset of symptoms, current pattern of symptoms and your current functional ability.

An image or investigation is generally not needed to confirm pain. If the Health Care Professional needs further information to finalise the diagnosis, they will organise further tests or they will refer you to a specialist.

The primary aim of treatment is to help manage your pain. This allows you to move more and help you return to normal activities sooner. Initial treatment therefore is aimed at pain control. This might involve pain medication, or the use of heat or cold treatments.

Once your pain is under control, working on the movement and strength of your neck is what will help long term.  Keeping your neck moving is an essential part of your treatment and recovery. Remain as active as the pain allows. Keep moving, even if only slowly at first, and move your neck for short periods every hour, therefore the use of a collar is not usually required.

Some people find that relaxation, meditation, or mindfulness helps to reduce stress and tension across your shoulders and neck.

If your sleep is affected, changing the number of pillows may be helpful. Versus Arthritis suggest your head and neck should be supported so your head is level with your body in a neutral position. The pillow should fill in the natural hollow between the neck and shoulders – a soft or moulded pillow may be useful, or a supportive roll inside your pillowcase can support the hollow of your neck.

If your work requires you to maintain a static position for long periods (sitting at a desk, driving a HGV, standing at a checkout), it is important to change positions as often as possible. This can include standing up from your chair and working at a higher surface, going for a walk, doing some stretches, or simply moving the area of the body that feels stiff and sore. The only wrong position is the one that you stay in all day.

You can help to reduce pain, ease stiffness, strengthen your muscles and improve overall general fitness by Keeping active. Below are some basic exercises specific to your neck to get you started.

Staying active with nerve pain may seem daunting, however activity is one of the most important elements of managing neck pain with arm symptoms.

If the neck and arm is very painful initially, you may find a short period of rest is helpful, however, prolonged periods of rest are not recommended.

There is no one treatment that works for everyone. When being active with neck and arm pain you should concentrate on movements and positions that ease your symptoms, and avoid those movements or positions that increase your pain. For example, if looking up increases your arm pain you should avoid it, and if looking down eases your arm pain you should do it more frequently. Remember, you should only go as far as is reasonably comfortable for you.

Keeping active has been shown to be the most helpful treatment for neck pain with referred arm and hand pain. It doesn’t matter what type of activity you do, as long as you Keep Active. So choose something that you like to do it, and keep at it. Staying active can improve fitness, confidence in movement, mobility and strength. Activity can also reduce stress and tension, improve mood and quality of sleep, and help support you getting back to normal activity.

It is normal to experience some discomfort when moving, and individuals may start at different points. Pain should not increase excessively during or immediately after the activity. Discomfort should return to pre-activity levels 24-48 hours after the activity has finished.

Unless you have a serious injury or have sudden continuous severe pain, you can usually treat your neck pain without having to see your doctor. If after 2 weeks of treating yourself you feel the pain isn’t any better or is worsening, you should see a Health Care Professional

You should see your Health Care Professional if you: 

• Have pain that doesn’t show any signs of improvement, within a couple of weeks of self help
• Have pain that has rapidly deteriorated or suddenly worsened despite self help
• Have new pain, tingling, numbness or weakness in your face, arms or legs
• Suddenly develop neck stiffness along with difficultly lifting both arms above your head, particularly in the morning when you wake up 
• Develop sudden stiffness in the neck and/or shoulders resulting in a lack of movement 
• Are experiencing double vision, dizziness, nausea or sudden fainting
• Are noticing changes with your speech and/or difficulty swallowing
• Are noticing changes to your balance or walking pattern 
• Are feeling clumsy or are falling more often
• Have a history of inflammatory arthritis, immuno-suppression, cancer, Tuberculosis (TB), drug abuse, AIDS or other infection
• Feel unwell, have a fever, or unexplained weight loss
• Are experiencing significant and regular changes to your usual sleeping pattern
• Have a history of recent injury (e.g. from a road traffic accident or a fall) or a history of neck surgery
• Experience a loss of feeling/pins and needles between your inner thighs or genitals
• Have numbness in or around your back passage or buttocks
• Have altered feeling when using toilet paper to wipe yourself
• Have increasing difficulty when you try to urinate
• Have increasing difficulty when you try to stop or control your flow of urine
• Have a loss of sensation when you pass urine
• Are leaking urine or recent need to use pads
• Can't tell when your bladder is either full or empty
• Experience the inability to stop bowel motion
• Have a change in ability to achieve an erection or ejaculate
• Experience a loss of sensation in genitals during sexual intercourse

This information is also available as a card created by the East Midlands Spinal Network. These cards are available in many different languages from the East Midlands Spinal Network website.

If you do not have any of the above, you may be able to effectively self manage your condition