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Shoulder Pain Radiating Down Arm to Fingers: Getting a Tennis Player Back to His Game

shoulder pain radiating down arm to fingers

It started as a nusance and has now has progressed. Shoulder pain radiating down arm to fingers is now constant.  Rest and NSAID’s are not effective.  What is Cervical Radiculopathy?  What is the basic anatomy of the neck?  What causes Cervical Radiculopathy? What are the symptoms of Cervical Radiculopathy? How is Cervical Radiculopathy diagnosed?  What are the treatment options?  What are the regenerative treatment options?  Meet GB.  Let’s dig in. 

 

What Is Cervical Radiculopathy? (AKA Pinched Nerve) 

Cervical Radiculopathy is a clinical condition in which a nerve or nerves in your neck becomes irritated or compressed.  It is also known as ” a pinched nerve”.  The causes are discussed below. It can affect individuals of any age with peak prominence between ages 40-50 years of age (1). 

Basic Anatomy of the Neck (Bones, Discs & Nerves) shoulder pain radiating down arm to fingers

Bones

There are 7 boney building blocks that make up your spine.  They are called vertebral bodies.  They are numbered from 1 to 7 and preceded by the letter C to denote Cervical.  For example the first bone in the cervical spine is the C1.  In another blog I have discussed the importance of the C1 bone and it role in providing stability in the upper neck. 

Discs

Sandwiched between each of the neck bones is a soft, compressive wafer also known as a disc.  The disc is very important as it absorps and distributes the forces of daily living.  It is made up of two components.

Annulus Fibrous:  thick tough outer layer that surrounds the disc.  It is similar to the sidewall in a tire.  It encases and protects the gel like center.  

Nucleus Pulposus:  Gel like material in the center of the disc.  It is composed of water, collagen and proteoglycans (2).  The Nucleus Pulposus stability and flexibility for the spine. 

The discs are suspectible to injury.  Common examples include disc bulges, disc herniations and extrusions. 

Nerves

Nerves exit the spinal cord as it travels down into the spine. At each level of the spine a specific nerve exits.  For example at the C5/6 level the C6 nerve exits the spine.  It provides important information to that part of the body.  The nerve exits though a boney doorway just as you exit your home or office daily.  This doorway is also known as the Neural Foramen.  It is composed of bone.  Nerves are very fragile and are surrounded by fat which provides protection and a level of cushion.  The Neural Foramen can be narrowed which can cause irritation, compression or injury to the exiting nerve. Causes and symptoms are discussed below. 

What Causes Cervical Radiculpathy? 

Cervical Radiculopathy is due to spinal nerve inflammation, irritation or compression.  The most common causes of Cervical Radiculopathy are:

Disc Injury

The disc is an important shock absorber.  Unfortunately it is susceptible to injury.  Examples include disc bulges, herniations and extrusions. These injuries can irritate or compress the exiting nerve root.  This results in a “pinched nerve”.  Disc herniation accounts for approximately 21.9% of Cervical Radiculopathy cases (3).  

Cervical Spine Degeneration

Degeneration of the cervical spine can result in narrowing of the bony doorway through which the spinal nerve exits. Irritation or compression of the nerve can result in pain radiating down the arm to the fingers.

Tumor

A tumor whether malignant or benign may grow near the Neural Foramen and push against the nerve root.

Trauma

Weekend warrior endeavors, repetitive motion activities and motor vehicle accidents can cause irritation of the spinal nerve with pain and dysfunction. 

Facet Joint Overgrowth

A facet is a small paired joint on the backside of the spine.  It  provides important stability and limits movement. There is a facet joint at each level of the spine.  Trauma, inflammation and degeneration can cause the joint become injured and enlarged.  Overgrowth of the facet joint can cause narrowing of the Neural Foramen with subsequent irritation or compression of the exiting nerve. 

Synovial Cysts

The facet joint is lined with cartilage and covered with a protective membrane called the synovium.  A Synoival Cyst is a fluid filled sac that can develop in the facet joint. The Synovial Cyst can create pressure and irritation or compression of the exiting nerve.  Ouch!

 

What Are the Symptoms of Cervical Radiculopathy?

Symptoms vary depending upon the severity and location of the injury.  They may be limited to one side or conversly can affect both sides of the neck and arms. The most common symptoms include

How Is Cervical Radiculopathy Diagnosed? 

Determining the cause of the cervical radiculopathy begins with a complete history of physical examination.  Details of previous traumas including motor vehicle accidents is important.  At the Centeno-Schultz Clinic you will spend quality time with a board certified, fellowship trained physician who is committed to your care and success.  Specific physical examination tests will be performed to document weakness, numbness and neck function.  This may include:

  • How well you can bend your neck and roll your head in all directions
  • If there is tenderness around the neck
  • If there are muscle spasms around the neck and shoulders
  • Areas of tenderness that create shooting pain down shoulder or arm

Radiograhic studies are necessary and include:

X-ray:  Useful to document narrowing of disc spaces, Neural Foramen narrowing and curvature of the spine (Scoliosis) 

CT  AKA CAT Scan:  Helpful to access bone spurs, narrowing of the Neural Foramen, facet overgrowth and calcifications of the spinal ligaments.  Diagnostic accuracy is between 72-81% (4).

MRI: The most common imaging for Cervical Radiculopathy with a diagnostic accuracy of 88% (5).  MRI captures muscles, ligaments, tendons, nerve and all boney structures along with any narrowing of the neural foramen. 

 

Cervical Radiculopathy Treatment Options?

Treatment options will depend upon the severity of the injury and clinical symptoms.  When appropriate conservative care should always be first line of therapy. 

Conservative Care

Options include rest, safe anti-inflammatory medications, chiropractic care and physical therapy. Gentle cervical traction, mobilization and strengthening is often times helpful.  To treat the burning arm pain some patietns are starting on nerve medications like Neurontin, Lyrica or Cymbalta.  The nerve pain is rarely responsive to oral narcotics. 

Steroids

Steroids are powerful anti-inflammatory medications.  They can be taken orally, injected into the muscle or injected into the spine.  Examples of commonly used steroids include Depo-Medrol, Betamethasone, dexamethason, triamcinolone, Celestone and Kenalog.  The dangerous side-effects have been discussed in previous blogs.  The major side effects include:

  • Destroying cartilage (6)
  • Increasing the risk of infection 
  • Systematic Problems

Surgical Treatment

Surgery is often recommended when conservative care and steroids fail to provide signficant or sustained benefit. The specific type of surgery will depend upon the cause and severity of the injury.  Discectomy is a common surgical procedure where the protruding disc is surgically trimmed in a hope of reducing the pressure and irritation on the spinal nerve. Unfortunately trimming of the disc can further weaken the disc side wall predisposing the disc to future injury including herniation and disc degeneration. 

Regenerative Treatment Options

At the Centeno-Schultz Clinic we are experts in the treatment of neck injuries. We stopped using high dose steroids and nerve burning procedures in 2005.  Treatment options include precise x-ray guided injections of PRP and Bone Marrow Concentrate which contains stem cells.  All procedures are performed by board certified, fellowship trained physicians under x-ray or ultrasound guidance.  Treatment goals are to reduce inflammation and improve blood flow for best clinical outcomes.  Our clinical results are available here

To better understand what occurs with a disc injury and why steroids and surgery are not your best option please click on the video below.

 

Meet GB 

GB is a 49 y/p competitive tennis player who was referred by his chiropractor.  He had a several month history of right arm numbness and weakness that was constant and unresponsive to conservative or chiropractic care.  Onset of symptoms was not associated with any trauma.  The forearm weakness and tingling in his fingers was progressive in nature. He specifically denied any neck pain, tension or restriction in range of motion. Physical examination was most significant for right arm weakness, diminished sensation to light touch and pain in his mid to lower neck aggravated by rotation and looking upward. MRI of the cervical spine was notable for 2 level disc injury with severe compression of the exiting spinal nerves. 

GB underwent x-ray guided PRP injections into areas of injury.  This included a two-level epidural injection, facet injection and supporting ligaments. The procedure was performed at the Centeno-Schultz Clinic in Broomfield.  An ambulatory surgical center or hospital suite was not required as we have a several state of the art procedure rooms within the clinic. 

Here are his self reported results.  

1 month after treatment GB noted signficant improvement.

“Thirty days later and I can say that I am a believer in your work.   I have not gotten onto a tennis court since before the PRP injection, but I can tell you that the numbness in my ring finger is completely gone and my pinkie finger is 95% back.   The numbness in the back of my hand is totally gone and (probably most importantly) I feel like the strength in my forearm has returned.  I no longer struggle with the simple tasks I did prior to the procedure (doing the dishes, tying my shoes, brushing my teeth, lifting my laptop…)”. 

At 9 months following the treatment GB continued to improve.

“We are now nearly 38 weeks past the day of the procedure.  I can tell you that whatever Dr. Schultz did inside my neck completely cured the problem.   While I did have to rebuild strength and regain some of my form on the tennis court, to this day I have no numbness in my hand, and my arm is back to full strength.   For what it’s worth, in May my doubles partner and I won a National level tournament title in our age division (50’s) in Boise and I’ve successfully captured singles victories in Scottsdale as well as here in Denver. 

Thank you for the work performed on my neck; allowing me to regain the ability to play tennis at a high level.   I am thrilled at the results of the PRP procedure.”

 

In Conclusion

Cervical Radiculopathy is a medical conditiion in which a nerve or nerves in your neck become irritated or compressed.  Also kinown as  ” A Pinched Nerve”.

The cervical spine is made up of bones, disc and nervess

Cervical Radiculopathy is due to spinal nerve inflammation, irritation or compression.  The major causes include disc injury, disc degeneration, tumor, trauma or facet overgrowth. 

Common Cervical Radiculopathy symptoms include neck pain, arm pain, shoulder pain radiating down arm to fingers, numbness and tingling and weakness

Diagnosis requires history, physical examination and in most cases radiographic studies.  MRI is preferred study of choice.

Treatment options include conservative care, steroids and steroids.

PRP and Bone Marrow Concentrate injections allow patients to avoid the signficant complications of steroids and surgery. 

If you’re suffering from symptoms associated with shoulder pain radiating down arm to fingers, numbness, tingling or arm weakness , please make sure to consider Regenexx procedures for cervical conditions at Centeno-Schultz Clinic.  You can schedule an evaluation in office or from the comfort of your home.  Stop the sufferring today. 

 


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3.Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994 Apr;117 ( Pt 2):325-35. doi: 10.1093/brain/117.2.325. PMID: 8186959.

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6.McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA.2017;317(19):1967–1975. doi: 10.1001/jama.2017.5283

 

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