Neck pain can be caused by a variety of conditions. One is facet disease, or degeneration of the joints in the neck. These are joints that allow you to turn your head back and forth and up and down. Just like a knuckle in your hand, they can become arthritic, painful, and enlarge over time. Patients will complain of pain that stays primarily in the neck but may also radiate up towards the base of the skull and out to the shoulder blades. Pain from diseased facets can be extremely debilitating. Thankfully we have modalities that can help. Please see our explanation of medial branch blocks and radiofrequency ablation for an in depth explanation of treatment.
Radiculapathy is a term describing a pinched nerve. The nerves exit the spinal cord through an opening called the neural foramen. Either a bulging or herniated disc or an enlarged facet joint can pinch the nerve. Bone spurs can also form, all of which can put pressure on the nerve. Patients will complain of neck pain and spasm, as well as pain that radiates down the arm into the hand. This pain is described as electrical or a “shock” down the arm, and can feel like it’s burning and numb. Severe case will cause weakness in the arm as well.
Radiculapathy is diagnosed by history, physical exam, and imaging. EMG and nerve conduction studies may also be performed to provide objective information of potential nerve damage. Minimally invasive treatments such as epidural steroid injections can provide relief. Sometimes the condition is too severe and requires surgical correction. Please see our explanation of epidural steroid injections and anterior cervical decompression and fusion for an in depth explanation of treatment.
Discs in the spine serve as both shock absorbers and spacers that lie between the bones of the spine. They have a fibrous outer ring called the annulus and a jelly middle called the nucleosus pulposis. The outer ring is constructed like a tire, with alternating fibers that mimic that or a radial tire lying on its side. Over time these radials can snap, and the disc begins to bulge.
The outer portion of the disc has pain fibers while the inside does not. As the disc degenerates it starts to expose the outer pain fibers to the inner jelly middle, which is full of inflammatory mediators. Once that occurs, the disc itself can become painful and is now known as discogenic pain. This can be treated with epidural steroid injections and physical therapy. Sometimes the condition is too severe and needs surgical correction.
A trigger point is a localized area of muscle damage that remains in spasm and causes localized pain as well as referred pain. This condition is diagnosed by history and physical exam. This condition can be treated with deep tissue massage as well as trigger point injection. Please see our explanation of trigger point injection for more information.