If you have pain in the neck that radiates to the shoulder (usually the back or top of the shoulder), arm (biceps or triceps), forearm or hand, it may be coming from a nerve being compressed in the neck. Depending on the amount of pressure exerted on the nerve, you might experience different feelings in different places. You might feel pain, pins and needles, numbness or some combination of the above. These are different sensations, but they all come from the same cause – nerve compression. In the neck, this nerve compression can come from stenosis, which just means narrowing. The narrowing or stenosis may result from several causes.
So once you begin to see that your symptoms are related to nerve pressure, one can understand that the pain can be intermittent or continuous and may be related to the position of your neck. The size of the tunnels or foraminal canals can change with the position of the neck. This is why I often see symptoms aggravated by tipping the head backwards or twisting to the right or left, and I will explain why a little later.
Turning or twisting the head may give rise to symptoms of nerve compression that includes:
Needles and pins
Over a longer period of time, weakness may begin to become noticeable and the muscles may begin to shrink or atrophy.
The location of your symptoms (pain, tingling, electrical shock, numbness, weakness) that you feel is directly related to the nerve that is getting crushed. For example, if the C6 nerve root is affected, the pain could be felt on the top of the shoulder, front of the arm (biceps), outside of the forearm down to the thumb and index finger. This is because these are the areas that the C6 nerve root supply and why you will feel pain specifically in these areas. The C6 nerve root does not supply sensation to the little finger.
I like to think of nerves like electrical wires that are passing through tunnels or (foraminal) canals. The nerves are happy when they are not being compressed as they pass through these tunnels and they work properly. When significant pressure is applied to a nerve then one of three things can occur, pain, numbness, or weakness. These are the things that you will notice and feel. If you follow along with the concept of an electrical wire, then you will also notice that certain wires will supply feeling and strength to certain areas of skin to certain muscles.
In the neck, the tunnels are not perfectly smooth to start with.