Treatment for Tight Neck Muscles Impinging on Arm and Hand Nerves
The most effective treatment for tight neck muscles impinging on arm and hand nerves causing restricted movement and tingling is a combination of range of motion and strengthening exercises, along with manual therapy techniques targeting the neck, rotator cuff, and posterior shoulder girdle. 1
Initial Assessment and Diagnosis
- Radiographs should be considered as the initial imaging for chronic neck pain with radicular symptoms to assess for spondylosis, degenerative disc disease, and malalignment 1
- MRI is recommended for patients with persistent symptoms to evaluate soft tissue abnormalities, including potential nerve impingement 1
- Assessment should include evaluation of shoulder range of motion, strength, impingement signs, and scapular mobility 1
Non-Pharmacological Treatment Options
Exercise Therapy
- Range of motion and stretching exercises should be utilized to mitigate cervical and shoulder restriction 1
- Strengthening exercises focusing on neck, rotator cuff, and posterior shoulder girdle muscles are recommended 1
- Exercises addressing anterior shoulder girdle flexibility can improve mobility and reduce pain 1
- These exercises have shown significant improvements in cervical mobility and endurance in all three movement planes 2
Manual Therapy
- Manual therapy has demonstrated superior effectiveness compared to TENS for improving cervical mobility and endurance 2
- Cervical mobilization and manipulation techniques can provide pain relief and functional improvement 3
- Thoracic manipulation has shown moderate quality evidence for improving pain and function in acute and subacute neck pain 3
- For subacute and chronic mechanical neck disorders, manual therapy yielded significant improvements in active mobility and endurance that were maintained at 6-month follow-up 2
Heat Application
- Local application of heat (e.g., paraffin wax, hot pack) is beneficial, especially before exercise 1
- Heat therapy has received a higher strength of recommendation (77 on a 100-point scale) compared to ultrasound (25) for management of musculoskeletal conditions 1
Splints and Orthoses
- Splints and orthoses may be recommended to prevent or correct lateral angulation and flexion deformity 1
Pharmacological Treatment
Muscle Relaxants
- Cyclobenzaprine is indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions 4
- Improvement with cyclobenzaprine is manifested by relief of muscle spasm and associated symptoms including pain, tenderness, limitation of motion, and restriction in activities of daily living 4
- Cyclobenzaprine should be used only for short periods (up to two or three weeks) 4
- In elderly patients or those with hepatic impairment, therapy should be initiated with a 5 mg dose and titrated slowly upward due to higher plasma concentrations 4
Pain Management
- Paracetamol (up to 4 g/day) is the oral analgesic of first choice due to its efficacy and safety profile 1
- If paracetamol is inadequate, NSAIDs should be used at the lowest effective dose and for the shortest duration 1
- Topical NSAIDs are preferred over systemic treatments, especially for mild to moderate pain 1
Interventional Approaches
- Intra-articular injection of long-acting corticosteroid may be effective for painful flares 1
- For persistent symptoms not responding to conservative management, referral to a specialist for further evaluation may be necessary 1
Treatment Considerations and Cautions
- Avoid TENS as a primary treatment, as evidence suggests it provides limited benefit for chronic neck pain 5, 2
- Low-level laser therapy has not shown significant benefits for neck pain management 6
- Combined manual therapy and exercise therapy has not demonstrated superiority over exercise therapy alone in some studies, but manual therapy alone has shown benefits over TENS 2, 7
- Patients should be educated about early signs of common neck and shoulder dysfunction to prevent unnecessary pauses in treatment 1