Herniated Disc: Understanding Back Pain Beyond Muscle Strain
A herniated disc is a condition when one of the rubbery cushions also known as the discs that are placed in between the bones that make up your spinal cord
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Persistent arm and shoulder pain doesn’t always trace back to the cervical spine and misidentifying the source can mean years of ineffective treatment.
Neck and arm pain is one of the most common reasons patients visit a spine specialist. In many cases, the cause is a pinched nerve in the cervical spine, which is a condition called cervical radiculopathy. But not all arm pain comes from the spine. When symptoms don’t improve with appropriate treatment or don’t quite fit the expected pattern, another source of the problem should be considered.
What Is Cervical Radiculopathy?
Cervical radiculopathy occurs when a nerve in the neck becomes compressed or irritated, usually by a herniated disc or bone spur. This typically causes pain, numbness, or weakness that radiates down one arm, following a specific pattern depending on which nerve root is affected.
For example, compression at C6–C7 usually causes symptoms along the thumb, index, or middle finger. Mild disc changes at this level are also extremely common in adults over 40. So common, in fact, that they are often found incidentally in people with no symptoms at all.
A disc bulge on MRI does not automatically explain a patient’s pain. The clinical findings must match the imaging, and when they don’t, the diagnosis needs to be reconsidered.
What Is the Brachial Plexus?
The brachial plexus is a network of nerves that originates from the spinal cord in the neck and travels through the shoulder and down the arm. It controls movement and sensation across the entire upper limb, from the shoulder to the fingertips.
Because the brachial plexus carries multiple nerve roots together, a problem at this level tends to affect a much wider area than a single pinched nerve in the spine would. Symptoms may involve the entire arm, all five fingers, or the shoulder, and may also include changes in blood flow, swelling, or temperature regulation, since autonomic nerve fibers also travel through the plexus.
When a Nerve Tumor is the Cause
Nerve sheath tumors, also called peripheral nerve tumors, are growths that develop in the tissue surrounding a nerve. The most common types are schwannomas and neurofibromas. They are usually benign and grow slowly over months or years, which means symptoms often build gradually before anyone suspects a tumor is involved.
Dr. Ekkapot Jitpun, a board certified neurosurgeon with over 10 years of experience in peripheral nerve surgery at Vejthani International Hospital explained that, when a nerve sheath tumor develops along the brachial plexus, it progressively compresses the nerve, causing pain that worsens over time and spreads across the arm. Because its early symptoms can closely resemble cervical radiculopathy, it is frequently missed, particularly when only a standard cervical MRI is performed.
Identifying a brachial plexus tumor requires dedicated imaging of the plexus itself, which is a separate scan that is not routinely ordered unless it is specifically suspected.
What Is Complex Regional Pain Syndrome (CRPS)?
Complex Regional Pain Syndrome, or CRPS, is a chronic pain condition that can develop as a secondary response to nerve injury or ongoing nerve irritation. It is characterized by pain that is disproportionately severe relative to the initial problem, and is often accompanied by visible changes in skin color, swelling, heightened sensitivity to touch, and intolerance to temperature changes.
CRPS can be triggered by an underlying nerve condition, including a nerve tumor. When the root cause goes undetected, the pain syndrome continues to worsen, and treatments aimed at the wrong diagnosis will have little to no effect.
Signs that may require further evaluation
Pain or numbness affecting the entire hand and all fingers, combined with swelling, skin color changes, cold sensitivity, or a progressive frozen shoulder. These features may point to a condition beyond a standard cervical disc problem and require closer investigation.
How is this Kind of Condition Diagnosed?
Reaching an accurate diagnosis in complex pain cases requires going beyond a routine cervical MRI. A thorough evaluation typically involves:
- A detailed neurological examination to map the exact pattern and distribution of symptoms
- Careful correlation between clinical findings and imaging, noting where they agree and, importantly, where they don’t
- Dedicated brachial plexus MRI when peripheral nerve involvement is suspected
- Multidisciplinary input from neurosurgery, pain management, and rehabilitation specialists
This level of assessment is especially important when a patient has not responded to standard treatment for an extended period or when new and unexplained symptoms continue to emerge.
What to keep in mind
Persistent pain that doesn’t follow an expected pattern or that continues to worsen despite appropriate treatment deserves a fresh look. Mild degenerative changes on a spinal MRI are common in adults and may be entirely unrelated to what the patient is experiencing.
Conditions involving the peripheral nerves and brachial plexus are underdiagnosed, partly because they require specialized imaging and a high degree of clinical suspicion to be identified. They are not always the first thing considered, but they should be when the simpler explanations don’t hold up.
If your arm or neck pain persists or does not follow a clear pattern, seeking a specialist’s evaluation is essential to ensure an accurate diagnosis before treatment begins. Getting the diagnosis right is the most important step. Because when it is missed, even the best treatment will not help.
For more information, please contact
Neuroscience Center, Vejthani International Hospital
Call: (+66)2-734-0000 Ext. 5400
English Hotline: (+66)85-223-8888
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