cervical disc prolapse occcurs in 0.5-2% of the population and is thus a relatively common cause of neck or radicular pain radiating to one or both arms
it is usually due to degeneration of the disc but may be caused by an acute traumatic injury such as direct impact
it is most common at C5/6 disc where it tends to cause symptoms due to impingement of the C6 nerve root and pain and/or numbness and/or weakness on the C6 dermatome or myotome (C6 dermatome is outer aspect of upper limb extending down to thumb)
a C4-5 disc prolapse affecting the C5 nerve root may cause pain/numbness on outer aspect of shoulder and weakness of the deltoid
a C6-7 disc prolapse affecting the C7 nerve root may cause pain/numbness in hand and middle finger or triceps and finger extensor weakness
a C7-T1 disc prolapse affecting the C8 nerve root may cause pain/numbness on outer aspect of forearm and 5th finger or weakness of the hand flexors
compression into the spinal cord is a neurosurgical emergency and is suggested by either:
pain, tingling, numbness, and/or weakness in both arms and/or both legs
coordination or walking difficulty
bladder and/or bowel control issues such as incontinence or urinary retention
most occur in 30-50yr olds
it may only last a few days or may last months although most tend to become pain free by 4-6 months
Investigation
MRI scan cervical spine is the usual diagnostic modality
Management
analgesia - those with severe radicular pain may benefit from neuropathic pain modulators rather than opiates
soft cervical collar may provide acute symptomatic relief
ice / heat packs
initial rest
phyical therapy to strengthen and stretch the neck
chin tuck exercises
strengthen neck muscles to gain a posture with ears directly above shoulders rather than protruding forwards as this will reduce the stress on the discs