The disks are the cushions, or shock absorbers, between the vertebrae (bones) of the spine. They are made of cartilage, and have two parts. The harder outer part (annulus) encloses a softer gel-like part (nucleus). You might imagine a jelly donut.
A herniated disk is where some of the jelly squirts out of a “crack” in the donut. The part that pushes out can put pressure on one or more of the nerves travelling in the spinal canal. The chemicals in the nucleus can also irritate the nerve. This combination of pressure and irritation can lead to a condition called radiculopathy. This can be any combination of pain, numbness, or weakness going down the arm.
Many people with arm pain from a herniated disk will get better with time. As many as 60% improve in the first six weeks, and as many as 80% by three months.
The diagnosis may require an MRI scan of the neck, as the disks themselves, as well as the nerves, cannot be seen on a regular x-ray. Localizing the exact disk which is herniated is also important to guide any of the invasive treatments such as injections or surgery.
One treatment option is to “wait and see”, sometimes using physical therapy, massage, acupuncture, or chiropractic to help control symptoms. Sometimes oral steroids are used to decrease inflammation. Other medications may include a “nerve stabilizer” such as Neurontin (gabapentin), or a non-steroidal anti-inflammatory (NSAID).
Another option is what is called an epidural steroid injection. In this procedure, a Pain Management doctor uses an x-ray machine for guidance to inject a medication similar to Cortisone around the pinched nerve. The goal is to decrease inflammation around the nerve and improve arm symptoms.
Finally, the surgical option is to go in and remove the part of the disk that is pushed out and compressing the nerve. This is called an anterior cervical discectomy and fusion. This has about a 90% chance of relieving arm pain, but it must be understood that it may not help neck pain at all. It can usually stop the arm from getting weaker, but does not always result in the recovery of full strength. The effects on numbness are less predictable.