There are many causes of neck pain and hand numbness. Medical second opinion by experienced spine surgeon is required to differentiate between surgical and medical causes of neck pain and hand numbness. Leading spine surgeon from Boston shares his opinion on the best diagnostic evaluation of neck pain and hand numbness. Which MRI findings and symptoms indicate that surgery is required? Dr. Anton Titov, MD. Neck pain and hand numbness causes. Medical second opinion. Video interview with leading expert in spine surgery. Neck pain and tingling in arm and hand can signify nerve pinching or spinal stenosis. Neck pain and hand numbness causes include spinal tumors. Numbness or tingling in hands often result from spinal nerve compression as it exits via foramina. Neck pain treatment starts from physiotherapy and medical therapy. Medical second opinion confirms that cervical disc degeneration diagnosis is correct and complete. Medical second opinion also helps to choose the best treatment for cervical spinal stenosis. Neck pain and hand numbness causes also depend on how active is lifestyle of patient. Seek medical second opinion on stiff neck and be confident that your treatment is the best. It is important to develop supportive muscles in neck and shoulder girdle. Stiff neck causes often relate to muscle spasm and poor support from muscles. Decision on surgery has three factors in neck pain and hand numbness situations. What are clinical symptoms that patient is reporting? Dr. Anton Titov, MD. What are findings on neck MRI? Dr. Anton Titov, MD. Did patient respond to conservative therapy of ibuprofen or aspirin? Dr. Anton Titov, MD. Neck pain and hand numbness causes are many and they require medical second opinion to find best treatment. Hand numbness and neck pain causes. Medical second opinion. Dr. Anton Titov, MD. Neck pain and arm hand numbness are very frequent complaints of the patients. What is the typical diagnostic path for somebody who experiences these symptoms? Dr. Anton Titov, MD. What kind of decision making this person with neck pain or hand numbness should follow to identify the cause and the most appropriate treatment? Dr. Anton Titov, MD. Dr. Eric Woodard, MD. Spine neurosurgeon, former Chief of Spine Surgery, BWH, Harvard Medical School. Certainly. In a similar fashion to the lumbar spine, the cervical spine is subject to age related degenerative changes or arthritic changes. In the cases of neck pain and hand numbness many of the spaces narrow. This the nerves exit the spine can become narrowed by spurs. They are narrowed by settling and by arthritic overgrowth of joints. This is an arthritic condition, and the vast majority can be treated with rest, sometimes with massage. Treatment can include anti-inflammatory medications, such as aspirin or ibuprofen. Rehabilitation of the supporting musculature also helps in neck pain and hand numbness. Dr. Eric Woodard, MD. I point to the trapezius muscle and the shoulders as being very important components in the supporting musculature. Pain that involves predominately the hand or the arm is suggestive of spinal stenosis or vertebral disc herniation. Especially if these symptoms are associated with weakness or worsening numbness. when it does not respond to fitness, stretching and strengthening. In these cases, especially if the symptoms progress, these are patients who are candidate for a more aggressive radiographic procedures such as a spine MRI. Even as recently as ten years ago CT myelography was very common. CT myelography involves injecting dye into the spinal canal followed by a CT scan to outline the contours of the spine. Much of that has been replaced by the MRI. MRI of the spine is the gold standard today. The MRI is the best means to diagnose causes of back pain. This you can diagnose either a disc herniation or spinal stenosis. Then at least you know, you have honed in on the diagnosis. Where that goes further in terms of treatment is somewhat different. Dr. Anton Titov, MD. The old surgical adage says: Do not treat the radiographic findings - treat the patient. Many patients would have certain cervical disease on MRI but nevertheless would experience some limited symptoms. How do you decide in your practice whether to proceed to the surgical treatment or to keep treating patient conservatively? Dr. Anton Titov, MD. Dr. Eric Woodard, MD. That is correct. The decision to move toward surgery is a combination of three things. #1: the clinical symptoms that the patient is reporting. #2: the radiographic findings . This show the appropriate compression and / or appropriate disease process from a descriptive fashion. #3: response to initial non-surgical therapy. When those three factors are combined to indicate that surgery is superior than continuing with conservative factors, then surgery is appropriate. Dr. Anton Titov, MD. You are exactly correct in saying that the radiograph alone does not indicate surgery. In fact, clinicians have studied this. In the lumbar spine up to 40% percent of asymptomatic patients have radiographic findings that on some level could be considered surgical. you have to have a combination of appropriate symptoms, appropriate radiographic findings and appropriate failure of conservative management. Dr. Anton Titov, MD. This seems to be a recurring topic in orthopedic surgery. There is a study in Finland, when somebody for knee ligament injury and meniscus injury compared the sham fake surgery versus the real surgery to repair ligaments. One year later those patients in both study arms wanted to do the same type of surgery that they had. that included the sham fake surgery as well. Dr. Eric Woodard, MD. The placebo effect can be very powerful, yes. Neck pain and hand numbness causes. Video interview with leading spine surgeon. Spine surgery for neck pain or medical treatment? Dr. Anton Titov, MD. Who is candidate for surgery?