Pain in the neck ,shoulder and arm: possible cervical radiculopathy

Dear Ask The Doctor: I have a lot of shoulder and arm pain, and now my Dr. thinks it's coming from my neck. MRI results: C3-4: small central disc bulge causing mild flattening of the thecal sac without stenosis. C4-5: disc bulge with superimposed soft disc protrusion causing indentation of the cord and moderate canal stenosis. foramina are patent bilaterally. C5-6: broad central disc protrusion indentation of the cord with moderate canal stenosis. Mild foraminal stenosis bilaterally secondary to uncovertebral joint hypertrophy with impingement of the exiting C6 root. C7: central disc extrusion extending inferiorly causing indentation of the cord with moderate canal stenosis. Foramina are patent bilaterally. What does this all mean?

Dear Renee: The pain in your neck and shoulder might be due to a cervical nerve compressionyou’re your doctor thinks, according to the results of your recent MRI, but it would be important to rule out also an inflammation of the peripheral nerves at the level of the arm and hand. In the younger patients, cervical radiculopathy may be a result of a disc herniation or an acute injury causing impingement of an exiting nerve. In the older patient, cervical radiculopathy is often a result of spinal canal narrowing (stenosis) from bone (osteophyte) formation, decreased disc height and degenerative changes due to aging process. The treatment strategy usually includes: physical therapy program aimed to reduce pain and inflammation, and the use of anti-inflammatory medication (“Motrin”, “Advil”), also a re-education of your posture may improve quality of life. You should be independent in a stretching and strengthening routine and continue with these exercises under the periodic supervision of a physical therapist initially and then completely on your own. If your condition fails to improve with a comprehensive rehabilitation program and selective injections , you may be presented with a surgical evaluation. Often, you can experience progressive improvement over the first 6-8 weeks with conservative treatment. If there is no significant improvement in this time frame, consider a surgical evaluation.