Diagnosing and Treating Neck Pain and Hand Numbness: A Spine Surgeon's Guide

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• Causes of Neck Pain and Hand Numbness
• Initial Diagnostic Evaluation
• MRI Role in Diagnosis
• Conservative Treatment Options
• When is Surgery Considered?
• Importance of Medical Second Opinion
• Full Transcript

Causes of Neck Pain and Hand Numbness

Neck pain and hand numbness have many potential causes. Dr. Eric Woodard, MD, a leading spine surgeon, identifies age-related degenerative changes in the cervical spine as a primary culprit. These arthritic changes cause the spaces where nerves exit the spine to narrow. This nerve compression, or spinal stenosis, is often due to bone spurs, joint overgrowth, or disc herniation. Symptoms like tingling in the arm and hand directly result from this pinching of the spinal nerves. In rarer cases, spinal tumors can also be a cause of these symptoms.

Initial Diagnostic Evaluation

The diagnostic path for neck pain and hand numbness begins with a clinical assessment. Dr. Eric Woodard, MD, emphasizes evaluating the patient's reported symptoms. Pain that predominantly involves the hand or arm strongly suggests nerve root compression. The presence of associated weakness or worsening numbness is a significant clinical finding. Dr. Anton Titov, MD, discusses the importance of understanding a patient's lifestyle, as activity level can influence symptoms. The initial approach typically involves a trial of conservative measures before advanced imaging is considered.

MRI Role in Diagnosis

An MRI of the spine is the gold standard for diagnosing the causes of neck pain. Dr. Eric Woodard, MD, explains that MRI has largely replaced older techniques like CT myelography. This advanced imaging provides the best means to visualize the spinal structures. It can accurately diagnose a disc herniation or confirm spinal stenosis. The MRI findings are crucial for honing in on a precise anatomical diagnosis. However, Dr. Woodard cautions that radiographic findings alone do not dictate treatment.

Conservative Treatment Options

Most cases of neck pain and hand numbness are treated conservatively. Dr. Eric Woodard, MD, states that the vast majority of these arthritic conditions respond to non-surgical therapy. Initial treatment includes rest, anti-inflammatory medications like ibuprofen or aspirin, and sometimes massage. A critical component is rehabilitation of the supporting musculature. Dr. Woodard specifically points to strengthening the trapezius muscle and shoulder girdle. This muscle support is essential for alleviating a stiff neck often caused by muscle spasm.

When is Surgery Considered?

The decision to proceed with surgery is based on a combination of three key factors. Dr. Eric Woodard, MD, outlines this critical decision-making process. The first factor is the clinical symptoms the patient reports, such as progressive weakness. The second factor is the presence of appropriate compressive disease on the spine MRI. The third and final factor is the failure to respond to an adequate trial of conservative management. Surgery becomes appropriate only when these three factors collectively indicate it is superior to continuing non-surgical care. Dr. Anton Titov, MD, highlights studies showing that a significant percentage of asymptomatic people have abnormal MRI findings, reinforcing that you treat the patient, not the scan.

Importance of Medical Second Opinion

Seeking a medical second opinion is a crucial step for neck pain and hand numbness. It confirms that a diagnosis of cervical disc degeneration or spinal stenosis is correct and complete. A second opinion from an experienced spine surgeon like Dr. Eric Woodard, MD, helps ensure the chosen treatment is the best one. This process provides confidence, especially when weighing the significant decision between continued conservative care and surgery. It is the best way to be certain your treatment plan is optimized for your specific condition.

Full Transcript

Dr. Anton Titov, MD: There are many causes of neck pain and hand numbness. A medical second opinion by an experienced spine surgeon is required to differentiate between surgical and medical causes of neck pain and hand numbness. A 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? Neck pain and hand numbness causes. Medical second opinion. Video interview with a leading expert in spine surgery. Neck pain and tingling in the 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 results from spinal nerve compression as it exits via foramina. Neck pain treatment starts with physiotherapy and medical therapy.

A medical second opinion confirms that a cervical disc degeneration diagnosis is correct and complete. A 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 the lifestyle of the patient is.

Seek a medical second opinion on a stiff neck and be confident that your treatment is the best. It is important to develop supportive muscles in the 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 the clinical symptoms that the patient is reporting? What are the findings on neck MRI? Did the patient respond to conservative therapy of ibuprofen or aspirin?

Neck pain and hand numbness causes are many, and they require a medical second opinion to find the best treatment. Hand numbness and neck pain causes. Medical second opinion. 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? What kind of decision making should this person with neck pain or hand numbness follow to identify the cause and the most appropriate treatment?

Dr. Eric Woodard, MD: 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.

The nerves exit the spine and 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. I point to the trapezius muscle and the shoulders as being very important components in the supporting musculature.

Pain that involves predominantly 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 candidates for 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. 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 surgical treatment or to keep treating the patient conservatively?

Dr. Eric Woodard, MD: That is correct. The decision to move toward surgery is a combination of three things. Number one: the clinical symptoms that the patient is reporting. Number two: the radiographic findings that show the appropriate compression and/or appropriate disease process from a descriptive fashion.

Number three: response to initial non-surgical therapy. When those three factors are combined to indicate that surgery is superior to continuing with conservative factors, then surgery is appropriate.

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% 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 with 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 a leading spine surgeon. Spine surgery for neck pain or medical treatment?

Dr. Anton Titov, MD: Who is a candidate for surgery?