Neck and Shoulder Pain Treatment
Jupiter and West Palm Beach Offices serving all of Florida
Break down (degeneration) of the cervical disc occurs as we get older. Daily wear and tear, repetitive movement related to employment and sports, as well as injuries, and genetics also contribute to this process.
Degeneration is the slow break down of the cervical disc, which causes the disc to become thinner making the room for exiting nerves smaller, and cushion between bones less. This process causes symptoms of radiating pain, numbness, tingling, and/or weakness in the arms or shoulders, and may also cause generalized neck pain and spasms.
Cervical disc herniation is the rupture of the cushion (disc) that absorbs shock and allows movement of the neck. Spinal discs are composed of an inner thick spongy like material (nucleus pulposus) and a leather like outer ring of tough, fibrous material (annulus fibrosis).
If the outer fibrous material is acutely injured or develops a weak area, the potential for the inner material to express outward is greatly increased. When it does, it is called a herniation. A herniation can cause havoc to the spinal cord and exiting nerves depending upon size and location. When a herniation causes pain, weakness, numbness, tingling, or burning it is referred to as radiculopathy.
Determining the health of your cervical spine usually requires:
- A good history of your neck complaints.
- A good physical exam
- Diagnostic films – XR, CT, MRI
A conservative approach most times is the first line of treatment for cervical spine pain. This includes: rest, ice, heat, anti-inflammatory medications, life style modifications, and a careful exercise based approach to health. Conservative treatments are directed at these symptoms and do not represent a cure for the degenerative process or disc herniation.
Introduction of coordinated care with a physical therapist may be prescribed if self-directed conservative therapy does not improve the discomfort or radicular complaints.
Should your discomfort not improve with conservative therapy the spine surgery team may refer you to a pain management doctor for an injection of steroid medication in your neck. The pain doctor or spine surgeon will review your diagnostic films and your chief complaints of pain and then will determine the best injection for you. Most common injections are epidural injections, transforaminal and facet injections, again depending on your neck pathology and pain.
Surgery is indicated for the cervical spine in many scenarios, most commonly when pain, weakness, or parethesias (numbness / tingling) do not improve with conservative therapy and when pathology is present on imaging compressing the exiting nerves.
Surgery is also indicated when the spinal cord is being compressed. Sometimes cord compression does not cause pain, but because the tissue is so fragile it can be permanently damaged causing weakness and changes in gait.