Neck pain is often attributed to muscles, ligaments, or bones in the cervical spine. While general practitioners or orthopedic specialists address many cases, a neurologist becomes involved when the discomfort suggests involvement of the nervous system. These specialists focus on disorders affecting the brain, spinal cord, and peripheral nerves extending into the neck and arms. Their expertise lies in identifying if neck discomfort is a symptom of a deeper problem related to nerve compression or damage. A neurologist shifts the focus from the musculoskeletal structure to the underlying neural pathways.
Specialized Diagnostic Tools
The diagnostic process often begins with a comprehensive neurological examination, which tests various functions of the nervous system. The neurologist systematically checks deep tendon reflexes, assesses muscle strength in the arms and hands, and evaluates sensation across different skin regions. This detailed physical examination helps localize where a potential nerve issue might be occurring in the neck or upper spine. By comparing responses on both sides of the body, the specialist can often predict the specific nerve root level that is compromised.
To assess nerve function, a neurologist frequently uses electrodiagnostic testing, specifically Electromyography (EMG) and Nerve Conduction Studies (NCS). These tests measure the electrical activity within the muscles and the speed at which electrical signals travel along sensory and motor nerves. They confirm the presence of nerve damage, determine its severity, and pinpoint the exact anatomical location of the injury.
During the Nerve Conduction Study, small electrical impulses are delivered to the skin surface, and the resulting signal is measured further down the nerve pathway. The EMG component involves inserting a fine needle electrode directly into specific neck and arm muscles to record their electrical activity at rest and during contraction. Abnormal readings indicate whether a nerve root is pinched near the spinal cord or if the damage is located further out in the peripheral nerves.
Neurologists also review imaging like Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans, focusing on neural structures. They examine the images for signs of nerve root impingement, where a disc herniation or bone spur might be pressing on a spinal nerve. They also look for compression of the spinal cord itself, which indicates a serious neural problem.
Conditions Neurologists Identify
One common nerve-related issue a neurologist identifies is cervical radiculopathy, or a pinched nerve in the neck. This condition occurs when a nerve root exiting the spinal cord in the cervical spine is compressed or irritated. Symptoms include sharp pain that radiates from the neck down the shoulder and into the arm, often following a specific nerve pathway known as a dermatome.
The compression of a cervical nerve root can also lead to sensory changes, such as numbness or a tingling sensation described as “pins and needles” in the hand or fingers. Depending on which nerve root is affected, the patient may also experience measurable muscle weakness in the corresponding arm or hand, a sign of motor nerve involvement. Identifying the precise nerve level involved, such as C6 or C7, guides the subsequent treatment strategy and prognosis.
A serious condition is cervical myelopathy, which involves compression of the spinal cord itself, rather than just a single nerve root. This often results from advanced spinal stenosis or large disc herniations that significantly narrow the central spinal canal. The symptoms tend to be less localized than radiculopathy and involve the function of the entire body below the compression point.
Patients with myelopathy may report difficulty with balance, an unsteady gait, or problems with fine motor skills, such as buttoning a shirt or writing. The neurologist is key in diagnosing this condition early, as delayed treatment can lead to irreversible neurological deficits if the spinal cord damage progresses. They may also diagnose peripheral nerve entrapment syndromes, where a nerve is compressed further down the pathway in the shoulder or arm, sometimes mimicking neck pain.
Managing Nerve-Related Neck Pain
Once a nerve-related diagnosis is confirmed, the neurologist initiates management focused on reducing nerve irritation and pain signals. Pharmacological approaches often move beyond simple over-the-counter pain relievers to target the specific mechanism of neuropathic pain. They may prescribe medications known as nerve stabilizers, which work by calming the hyperactive pain signals transmitted by the damaged nerves.
Muscle relaxants are used to address the secondary muscle spasms that often accompany cervical nerve root irritation, which can exacerbate the discomfort. These prescriptions aim to modulate the electrical and chemical signaling processes within the nervous system. The selection of the specific drug depends on the severity of the pain, the patient’s overall health profile, and the nature of the nerve damage.
For localized and intense nerve inflammation, the neurologist may recommend or perform specific injection therapies to deliver anti-inflammatory agents directly to the site of the problem. Epidural steroid injections are a common procedure, targeting the space surrounding the compressed nerve root to quickly reduce swelling and irritation. These injections are often performed under fluoroscopic guidance to ensure accurate placement near the affected neural structure.
The neurologist coordinates a multidisciplinary treatment plan, often involving physical therapy to improve strength and range of motion without aggravating the nerve. If conservative measures, including medication and injections, fail to provide lasting relief over several weeks to months, the neurologist escalates care. They then refer the patient to appropriate specialists, such as a neurosurgeon or an orthopedic spine surgeon, for evaluation regarding potential surgical decompression.