When neck pain becomes persistent or involves symptoms extending beyond the neck, consulting a neurologist is often necessary. A neurologist specializes in disorders affecting the brain, spinal cord, and peripheral nerves. Their expertise is crucial when pain suggests the nervous system is compromised, such as when a structural problem in the neck irritates or compresses nerve pathways. The neurologist’s primary role is to accurately diagnose if the neck pain has a neurological origin and determine the extent of any resulting nerve damage.
Conditions Indicating Neurological Involvement
Neck pain warrants a neurological assessment when symptoms point to the involvement of the spinal nerve roots or the spinal cord. A common condition neurologists address is cervical radiculopathy, often called a “pinched nerve.” This occurs when a nerve root is irritated or compressed as it exits the spinal cord, frequently caused by a herniated disc or degenerative changes like bone spurs. The hallmark symptom is sharp pain that radiates from the neck, down the shoulder, and into the arm or hand, following the path of the affected nerve.
Nerve root compression can also cause sensory changes, such as numbness or tingling in a specific pattern (dermatome), and motor deficits like muscle weakness. The location of these symptoms helps the neurologist determine the involved cervical nerve level (e.g., C6 affects the thumb and index finger). This pattern of radiating pain and functional deficit distinguishes radiculopathy from localized neck muscle pain.
A more concerning condition requiring neurological attention is cervical myelopathy, which involves compression of the spinal cord within the neck. Since the spinal cord carries signals to the entire body, compression affects multiple functions, often presenting symptoms in the hands and legs. Patients typically experience clumsiness, difficulty with fine motor tasks like buttoning a shirt, and balance issues or an unsteady gait.
Myelopathy can cause numbness and tingling in the extremities, often on both sides, and may or may not include significant neck pain. Identifying spinal cord compression is a priority due to the potential for progressive dysfunction. Both radiculopathy and myelopathy require the neurologist’s expertise for diagnosis and management.
Diagnostic Procedures for Neck Pain
The diagnostic process begins with a detailed neurological examination to pinpoint the location and severity of the nerve issue. This involves testing reflexes, which may be diminished with nerve root compression (radiculopathy) or exaggerated in the lower body with spinal cord compression (myelopathy). The neurologist also assesses muscle strength and sensation in the arms and hands, looking for weakness patterns that correlate with specific nerve roots.
Following the physical exam, the neurologist utilizes medical imaging to visualize the structural cause of compression. Magnetic Resonance Imaging (MRI) is preferred because it provides detailed images of soft tissues, including the spinal cord, discs, and nerve roots. The neurologist interprets the MRI to confirm disc herniation, bone spurs, or spinal canal narrowing (stenosis) pressing on neural structures. Computed Tomography (CT) scans may also be used for a clearer picture of the bony structures in the cervical spine.
A specialized diagnostic tool is electrodiagnostic testing, which includes Electromyography (EMG) and Nerve Conduction Studies (NCS). NCS measures how quickly electrical signals travel through peripheral nerves, evaluating nerve integrity and function. EMG involves inserting a fine needle electrode into specific muscles to record their electrical activity at rest and during contraction.
Combining NCS and EMG results helps the neurologist determine if muscle weakness stems from a nerve root problem (radiculopathy) or a peripheral issue. This testing confirms nerve damage and helps assess its severity and chronicity. These objective measurements are invaluable for mapping the extent of the injury and formulating a targeted treatment plan.
Non-Surgical Treatment Strategies
Once a nerve-related cause for neck pain is confirmed, the neurologist manages non-surgical treatments aimed at reducing inflammation and alleviating nerve irritation. Pharmacological management often includes medications targeting nerve pain, such as anticonvulsants or tricyclic antidepressants, which modulate pain signals. Muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs) may also be prescribed to address muscle spasms and inflammation surrounding the compressed nerve.
Interventional procedures are a significant part of treatment, often performed or ordered in collaboration with pain specialists. Epidural steroid injections (ESIs) involve injecting a corticosteroid into the epidural space near the inflamed spinal nerves. This reduces swelling around the compressed nerve root, often providing temporary pain relief and allowing the patient to participate more fully in physical therapy.
Other injection techniques include nerve blocks or facet joint injections, which target specific painful nerves or the small joints in the vertebrae. Nerve blocks temporarily stop pain signals and can be used diagnostically and therapeutically. The neurologist also coordinates physical therapy tailored to nerve recovery, focusing on gentle range-of-motion exercises, posture correction, and strengthening to stabilize the cervical spine.