What is the medical term for neck pain radiating down the arm?

Cervical Radiculopathy: Medical Term for Neck Pain Radiating Down Arm

The medical term for neck pain radiating down the arm is cervical radiculopathy, which describes pain and neurological dysfunction caused by compression or irritation of nerve roots in the cervical spine. 1, 2

Definition and Clinical Presentation

Cervical radiculopathy presents with:

• Pain radiating from the neck into the distribution of the affected nerve root
• Sensorimotor impairment in the affected nerve root distribution
• Neck pain with radiation to the ipsilateral arm
• Possible motor dysfunction, sensory deficits, or reflex changes 2, 3

The most common neurological findings include:

• Diminished deep tendon reflexes (particularly of the triceps)
• Painful neck movements and muscle spasm
• Sensory loss in a dermatomal distribution 4

Pathophysiology

Cervical radiculopathy most commonly results from:

1. Cervical disc herniation
2. Cervical spondylosis (degenerative changes)
3. Foraminal stenosis 3

These conditions lead to compression and inflammation of the spinal nerves or nerve roots, causing the characteristic radiating pain pattern.

Diagnostic Approach

Clinical Tests

Several specialized tests can help confirm the diagnosis:

• Spurling test (neck extension and rotation to the affected side reproduces symptoms)
• Shoulder abduction test (relief of symptoms when placing hand on head)
• Upper limb tension test 4

Imaging

According to the American College of Radiology (ACR) guidelines:

• Imaging is not required initially unless there is history of trauma, persistent symptoms, or red flags 1, 4
• MRI is most appropriate for patients with Grade III and IV neck pain (neurological signs of nerve compression or major pathology) 2
• CT scan is superior for identifying bony abnormalities 2

Red Flags Requiring Urgent Evaluation

• Fever
• History of recent infection
• Intractable pain despite therapy
• Neurological deficits
• Abnormal inflammatory markers
• Age >50 with vascular disease 2

Management

Conservative Treatment

Most cases (up to 75%) improve spontaneously with conservative management 5:

• Physical therapy including strengthening, stretching, and potentially traction
• NSAIDs at the lowest effective dose for the shortest duration
• Short-term use of cervical collar for immobilization
• Exercise therapy including scapular resistance exercises and neck-specific exercises 2, 4

Interventional Options

• Epidural steroid injections may provide relief but carry risks of serious complications 4
• Selective nerve blocks can target specific nerve root pain 6

Surgical Intervention

Surgical decompression should be considered for:

• Persistent radicular pain after 6-12 weeks of conservative treatment
• Progressive or profound motor weakness
• Significant neurological deficit 2

Surgical options include:

• Anterior Cervical Discectomy with Fusion (ACDF) for severe foraminal narrowing
• Posterior laminoforaminotomy for lateral disc displacement or foraminal stenosis 2

Prognosis

The overall prognosis is favorable, with most patients improving over time with focused, nonoperative treatment 4, 6. Surgical outcomes for relief of arm pain range from 80% to 90% with either anterior or posterior approaches 5.

Common Pitfalls

1. Misdiagnosis: Cervical radiculopathy can be confused with peripheral neuropathy, thoracic outlet syndrome, or shoulder pathology.

2. Delayed Recognition of Red Flags: Failing to identify signs of myelopathy, infection, or malignancy that require urgent intervention.

3. Overreliance on Imaging: Imaging findings don't always correlate with clinical symptoms; clinical examination remains paramount.

4. Premature Surgery: Rushing to surgery before adequate trial of conservative management in non-urgent cases.

5. Inadequate Pain Management: Undertreatment of pain can lead to chronicity and disability.