Neck Pain: Causes, Symptoms, and Treatment Options

Cervical spine pain

Hello Doctor, the patient has the following conditions:
1.
On June 19, there was localized pain in the left posterior thorax (the area around the scapula) that did not respond to corticosteroid injections.
Subsequently, the patient experienced numbness in the left hand, and pain medications were ineffective.

2.
The patient underwent traction and rehabilitation therapy, which did not alleviate the symptoms and instead led to increased numbness.
The pain in the posterior thorax persists.
Various examinations, including a CT scan of the head, MRI of the cervical spine, electrocardiogram, and neck ultrasound, all returned normal results.
3.
Starting on July 14, the patient began experiencing dizziness, nausea, vomiting, and worsening pain in the occipital region when tilting the head backward, along with vague neck pain.
4.
As of today, the patient continues to experience the aforementioned symptoms.

Could you please advise on what might be happening and how to proceed? Is there any risk involved? Thank you for your assistance.

Mrs. Chen, 60~69 year old female. Ask Date: 2009/07/17

Dr. Gao Chunde reply Neurology

According to Scenario 1, it truly resembles typical symptoms of cervical radiculopathy; however, I find it difficult to understand why the cervical MRI is normal.
Additionally, traction has been ineffective.
If this is indeed the case, one should consider isolated neuritis or neuropathic pain, as this represents a non-compressive pathology, making traction ineffective, and MRI typically does not capture these conditions.

In Scenario 3, it could indicate another issue, particularly vestibular disorders causing postural dizziness.
It may also be a side effect of pain medications or oral cervical medications, such as neuropathic pain medications or muscle relaxants.
If dizziness and headaches are accompanied by diplopia, imbalance while walking, or even unilateral facial or limb numbness or weakness, or slurred speech, it is crucial to seek medical attention promptly (neurology), as the problem may extend to the brainstem.

For Scenario 3 alone, one could initially consult an otolaryngologist or directly see a neurologist as well.

Reply Date: 2009/07/17

More Info

Understanding neck pain and its associated symptoms can be complex, as it often involves multiple systems in the body, including the musculoskeletal and nervous systems. Based on the symptoms you've described, it seems that you are experiencing a combination of neck pain, headaches, and neurological symptoms such as numbness and nausea. Let's break down the potential causes, symptoms, and treatment options.

Causes of Neck Pain
1. Muscle Strain: This is one of the most common causes of neck pain. Poor posture, especially from prolonged computer use, can lead to muscle tension and strain. This can result in localized pain, which may radiate to the shoulders and arms.

2. Cervical Disc Issues: Herniated or degenerative discs in the cervical spine can compress nearby nerves, leading to pain, numbness, or weakness in the arms. This could explain the left hand numbness you mentioned.

3. Nerve Compression: Conditions such as cervical radiculopathy occur when a nerve in the neck is compressed or irritated. This can lead to pain that radiates down the arm, as well as neurological symptoms like tingling or numbness.

4. Cervical Spondylosis: Age-related wear and tear on the cervical spine can lead to osteoarthritis, which may cause pain and stiffness in the neck.

5. Tension Headaches: These can be triggered by neck pain and muscle tension, leading to headaches that may feel like pressure or tightness around the head.

6. Cervicogenic Headaches: These are headaches that originate from the cervical spine and can cause pain at the back of the head and neck.

Symptoms
From your description, the following symptoms are notable:
- Localized pain in the left upper back and neck.

- Numbness in the left hand.

- Nausea and vomiting, particularly when tilting the head back.

- Headaches that feel like pressure or throbbing in the back of the head.

Treatment Options
1. Physical Therapy: Engaging in physical therapy can help strengthen neck muscles, improve flexibility, and alleviate pain. A physical therapist can provide tailored exercises and techniques to relieve pressure on nerves.

2. Medications: While you mentioned that corticosteroids and pain medications have been ineffective, it may be worth discussing alternative medications with your physician. Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and pain.

3. Cervical Traction: This technique can relieve pressure on the cervical spine and may help alleviate symptoms. However, if it has exacerbated your symptoms, it may not be suitable for you.

4. Injections: If conservative treatments fail, corticosteroid injections may provide relief by reducing inflammation around the affected nerves.

5. Surgery: In severe cases where there is significant nerve compression or structural issues in the cervical spine, surgical intervention may be necessary.

6. Lifestyle Modifications: Ergonomic adjustments to your workspace, regular breaks from screen time, and practicing good posture can help prevent further strain on your neck.

When to Seek Further Evaluation
Given the persistence of your symptoms, particularly the combination of neck pain, neurological symptoms, and nausea, it is crucial to follow up with a healthcare provider. They may consider additional imaging studies, such as an MRI of the cervical spine, to evaluate for any structural abnormalities that may not have been detected previously.

Conclusion
Your symptoms suggest a complex interplay between musculoskeletal and neurological issues. It is essential to work closely with your healthcare provider to develop a comprehensive treatment plan tailored to your specific needs. If symptoms worsen or new symptoms arise, such as weakness in the arms or legs, difficulty walking, or changes in bowel or bladder function, seek immediate medical attention.

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