What is Neck-Arm Syndrome?
Neck arm syndrome or neck arm pain are umbrella terms that encompass various conditions affecting your neck or upper back that also include some arm symptoms. The most common type of neck arm pain is Neck-Shoulder Pain, which is obviously a relationship between neck and shoulder pain.
Neck-arm pain is specific to dysfunctions that refer to symptoms down the arm and can cause abnormal neural tension or compression.
Common Causes of Neck-Arm Pain
- Abnormal Neurodynamics
- Cervical radiculopathy – pinched nerve
- Thoracic Outlet Syndrome
- Carpal Tunnel Syndrome
- Repetitive Strain Injury
- Tennis Elbow
What Causes Abnormal Neural Tension?
Neural tension refers to the amount of strain on a nerve at rest and with movement. An abnormal increase in neural pressure occurs when the nerve becomes caught or restricted anywhere along its path.
Common causes include a restriction in neck joint mobility, inflammation at soft tissue interfaces or muscle spasm around a nerve.
Neural tension can be increased or decreased by changing the position of your arm. Different arm positions will target other nerve branches. Your physiotherapist is highly experienced and assessment of your neurodynamics (nerve mobility).
What are the Symptoms of Neck-Arm Syndrome?
- Neck pain, stiffness or soreness
- Pins and needles
- Burning, sharp or dull pain radiating down the arm.
The location of your symptoms correlates with the muscles and skin innervated by the affected nerve. This is why you may experience numbness over only the 4th and 5th fingers, 2nd and 3rd fingers, or burning pain over the outside of your elbow but not the inside. Your symptoms are nerve specific. It is important to keep your physiotherapist updated on any changes in the location and degree of your symptoms.
How is Neck-Arm Pain Diagnosed?
The nature of your symptoms is instrumental in differentiating between Neck-Arm Syndrome and other causes of your arm pain. In addition, your physiotherapist can identify abnormal neural tension by moving your arm into specific positions to test the movement of each nerve as it travels down the arm.
The range of movement on your affected side is compared to your unaffected side to see what is normal for you. Once the presence of abnormal neural tension has been confirmed, your physiotherapist will conduct a series of tests to determine the area and structures which are restricting the movement of the nerve.
Neck-Arm Pain Treatment
Abnormal neural tension normally resolves with treatment of the primary dysfunction. Commonly this is within your neck or upper back joints, where the nerve exits the spinal canal.
Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation, restore full joint movement and normalise muscle activity at the site of the dysfunction. These may include thermal therapy, acupuncture, electrotherapy, taping techniques, soft tissue massage, joint mobilisation and alignment techniques, muscle stretches and neurodynamic exercises.
Your physiotherapist is high;y skilled in the techniques that will work best for you and will tailor your rehabilitation to help you achieve (and maintain!) your own functional goals.
What Results Can You Expect?
Pure Neck-Arm Pain is generally resolved completely when the primary dysfunction is fixed. The length of recovery is often affected by how long you have had the symptoms.
You can expect a noticeable decrease in your arm symptoms within the first few treatment sessions in most cases.
In some cases, a local dysfunction in the arm may also be present. This is most common in Carpal Tunnel Syndrome and Tennis Elbow, where both areas will need to receive treatment to enable a full recovery!
If you have any concerns or have some specific questions regarding your condition, please ask your physiotherapist.
Neck Pain Causes
Neck Joint Injuries
Nerve-related / Referred Pain
When Should You Be Concerned About Neck Pain?
There is one situation where there’s no need to wait several weeks before deciding if your neck pain is serious.
If you’ve had an accident with forces that may have been sufficient to fracture your spine or tear nerves, seek a medical assessment as soon as possible. In this instance, either call an ambulance or head to a hospital emergency department.
Red Flags for Neck Pain
Otherwise, the rule of thumb is to start a more thorough medical investigation only when you meet all three of these conditions.
The three general red flags for neck pain are:
- it’s been bothering you for more than about six weeks
- it’s severe and/or not improving, or getting worse
- there is at least one other “red flag” (see below)
Red flags are reasons to seek a professional opinion rather than to worry. Seek the advice of your physiotherapist or doctor if any of these red flags apply to you.
- Light tapping on the spine is painful.
- A torn artery may cause severe, throbbing or constrictive (novel pain), with a high risk of a stroke. Pain is the only symptom of some tears. Most cases are sudden, on one side, and cause neck and head pain (in the temple or back the skull), but the pain is usually strange. Any hint of other symptoms? Promptly attend a hospital emergency.
- There are many possible signs of spinal cord trouble in the neck, with or without neck pain, mainly affecting the limbs: e.g. poor hand coordination; weakness, “heavy” feelings, and atrophy; diffuse numbness; shooting pains in the limbs (especially when bending the head forward); gait awkwardness. Sometimes patients present with both neck pain and more remote symptoms and don't realise they are related.
- Unexplained episodes of dizziness or nausea, and vomiting may indicate a problem with the stability of the upper cervical spine.
- Weight loss without dieting (it's a potential sign of cancer).
- Mystery fevers or chills, especially in people with diabetes).
- A severe headache that comes on suddenly is a “thunderclap headache”! Most are harmless, but it is always wise to investigate thoroughly.
- Symptoms of meningitis (inflammation of the membranes covering the brain and spinal cord, caused by infection or drug side effects). The presence of a fierce headache or an inability to bend the head forward, fever, or an altered mental state.
- The main signs that neck pain might be caused by autoimmune disease specifically include:
- a family history of autoimmune disease,
- gradual but progressive increase in symptoms before the age of 40,
- marked morning stiffness,
- pain in other joints as well as the low back,
- difficult digestion,
- irritated eyes, and
- discharge from the urethra (bladder).
- Steroid use, other drug abuse, and HIV are all risk factors for a serious cause of neck pain.
- If you feel pretty unwell in any other way, that could indicate that neck pain isn’t the only thing going on.
More info: Neck Pain
How Can You Relieve Your Neck Pain?
Neck Physiotherapy Treatment
The best treatment for your neck pain is determined entirely by the specific reasons for WHY you are suffering neck pain. Everyone is different, but there are some common similarities.
Your physiotherapist is highly skilled at the diagnosis and treatment of mechanical neck pain and headache. Posture correction is essential, but it depends on the availability of enough joint and muscle flexibility to attain a good posture, plus muscle strength and endurance to maintain your proper position. Address any deficit.
We understand that your neck pain may not be solely about stiff or wobbly joints or tight/weak neck muscles. A whole gamut of information that your physiotherapist will analyse during your diagnostic consultation and then commence correcting your problems. They'll also consider other systemic conditions that can cause neck pain, e.g. cancer, and direct you towards the appropriate healthcare practitioner if necessary.
Fortunately, the vast majority of neck pain does come from your neck joints and muscles. Pleasingly, researchers have shown that a combination of neck joint and muscle treatment performed by your physiotherapist and some specific strengthening exercises are an effective way to eliminate your neck pain, stiffness and headaches.
Please get in touch with your trusted healthcare practitioner for advice specific to the diagnosis and management of your neck pain.
Common Neck Pain Treatment Options
If you are in severe neck pain or have a stiff neck, it is best to assess promptly to exclude any red flag conditions such as cancer and then commence the best neck treatment straight away.
Chronic neck pain can be a lingering problem due to habit. Research tells us that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your neck symptoms, the better your outcome.
What's the Best Pillow for Neck Pain?
The correct pillow is also vital. If you are waking through the night or in the morning with a stiff or painful neck, it may be that it's your pillow and not your neck that is the cause.
Will A Posture Brace Help Your Neck Pain?
Posture support braces have improved over the years, with new designs beneficial in building awareness of the correct posture. Bracing or posture taping is excellent for teenagers, the elderly or those using computers.
There are various posture braces available. You can find more information about posture braces via our online shop.
Should You Wear A Neck Collar?
A neck collar is not recommended for most non-traumatic injuries as the collar encourages muscle weakness. However, in severe neck spasm conditions such as wry neck or whiplash, a collar is sometimes used in a few days to assist with muscle relaxation. Rarely is a neck collar required beyond four days.
Please ask your physiotherapist for specific advice.
For more advice, please consult your neck physiotherapist.
Article by Jamie Van Beek
What Causes Neck Pain Without Injury?
Neck Pain without injury is a common complaint in the clinic. It can be frustrating to wake up without any triggering event and be stuck with neck pain.
The driver of this pain may be a muscle strain, a sprained facet joint or a bulging disc. These structures become injured due to repetitive microtrauma instead of a single event associated with injury. The microtrauma may be caused by poor posture, poor sleeping positioning or repeated movements throughout the day, which place a high load on the neck.
How Do I Fix My Posture?
The spine is made up of three curves. A concave curve in your lower back, a convex curve in your mid-back and another concave curve in the neck. Research has shown that people with neck pain have a flattening of the curve in their neck, resulting in a forward head posture. 1
An injury to any part of the spine can cause changes to spinal alignment, which can often flow onto the neck. A flattened lower back curve is a common postural adaptation from lower back pain. This increases the postural demand of the muscles which keep the head upright. Over time, these muscles may spasm and produce pain or fail and allow the head to float forward.
This is just one possible mechanism out of many. Your physiotherapist can identify which previous injuries may be contributing to your neck pain and the influence it's having on your neck.
Forward head postures may also result from sustained positions such as looking down at a phone and looking down at laptops and gaming. Text neck is becoming more prevalent in our community.
What Is The Consequence of a Forward Head Posture?
Each vertebral level in the neck is made up of three joints. At the front, the vertebral bodies and discs make up the joints of the spinal column. At the back, facet joints sit on either side of the spinal cord.
A forward head posture shifts the weight of the head forward, stressing the vertebral bodies and discs in the neck. A loss of this natural curve has been linked to conditions such as cervical spondylosis, bulging discs and chronic neck pain 
This condition has become known as Nerd Neck.
How Should I Sleep With Neck Pain?
Sleep positioning should focus on reducing strain on the front joints of the neck (the vertebral body and disc). In side-lying, this means sleeping as upright as possible in order to avoid curling up into the foetal position and encouraging a forward head posture. To achieve this, try moving your pillow a couple of inches upwards and stretching your neck up to meet it.
When sleeping on your back, it's important to find a pillow that fully supports your neck to prevent it from rotating. The pillow also shouldn’t be too thick, to prevent encouraging a forward head posture.
Sleeping on your back is not recommended due to the sustained positions the neck has to maintain all night.
Solving Your Neck Pain
Whether your neck pain is caused by sleep positioning, poor posture or repetitive movements involving the neck, your Physiotherapist is trained to identify and treat the cause. Contact your Physiotherapist for an individualised assessment.
 Alpayci M, İlter S. Isometric Exercise for the Cervical Extensors Can Help Restore Physiological Lordosis and Reduce Neck Pain: A Randomized Controlled Trial. Am J Phys Med Rehabil. 2017 Sep;96(9):621-626. doi: 10.1097/PHM.0000000000000698. PMID: 28118272.