Pain in the Neck, Shoulder and a Numb Thumb


Q: I have had pain in my neck and left shoulder for two weeks. My doctor said it was stress and gave me pain pills and muscles relaxers. I still have the pain and my left thumb is numbed.


A:   The numbness in your left thumb, pain in neck and left shoulder as you described might be due a cervical nerve compression (C7-C8), but it would be important to rule out that cause and also 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 from bone (osteophyte) formation, decreased disc height and degenerative changes due to aging process. The same described before for the cervical spine applies to the lower back in terms of cause of pain and numbness in the legs, same causes, different spinal level.
The treatment strategy usually includes: physical therapy program aimed to reduce pain and inflammation, and the use of anti-inflammatory drugs (as ibuprofen), also a re-education of habits and posture of the patients to improve quality of life. Patients should be independent in a stretching and strengthening program and continue with these exercises under the periodic supervision of a physical therapist initially and then completely on their own. Patients whose condition fails to improve with a comprehensive rehabilitation program and selective injections should be presented with a surgical evaluation. Often, patients should show 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.

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