Tiger Woods recently withdrew from The Players Championship golf tournament due neck pain and spasm as well as shooting pain starting from the neck to the right hand. According to the Associated Press, Woods started noticing neck pain about two weeks before the Masters, which was about five weeks ago.
What does he have? Is his care appropriate? What will the MRI show? What will his treatment plan be?
Neck pain with symptoms of numbness or tingling to a hand is common problem I see in the office. Typically it is due to a pinch nerve of the neck which can be due to a herniated disc or arthritis. Symptoms of the numbness, tingling, and burning pain radiating from the neck to the shoulder or hand can last six to eight weeks. Patients may or may not have neck pain depending on the location of the nerve irritation.
Assuming no hand or arm weakness due to the pain, it is reasonable to wait six to eight weeks before getting a MRI. The vast majority of cases resolve by that time. If symptoms still persist or worsen, then a MRI can be done sooner. Although Woods has not indicated which right fingers are most affected from the pain, doctors can determine which nerve is most likely involved by referring to the dermatomal distribution or nerve map of the body.
If the pain is mainly from the neck radiating to the thumb, then the nerve pinched is the right C6 nerve. Index and middle finger involvement would be the right C7 nerve. The little finger discomfort would suggest the C8 nerve. If Woods reports that his entire hand feels asleep, it is possible there is are multiple discs pinched or that the area of irritation is large enough to affect more than one nerve.
How the neck is positioned relative to the spine can also impact the degree of pain. Certainly with the neck bent forward to extended backwards can cause the more nerve irritation by closing the spaces of the spine where the nerves come out. While normally not a problem, any degree of swelling or inflammation can make a normally good fit now too small for the nerve. Because golf not only requires the neck to be flexed to address the ball as well as force to drive, it isn't surprising that Woods often was seen standing up, rubbing his neck, flexing his fingers, and having some physical therapy treatments all to try and decrease his symptoms.
Treatment can include anti-inflammatories, like ibuprofen or naprosyn, steroids, narcotics for pain, as well as medications that decrease the nerve pain. To decrease the amount of pressure to the nerve, neck traction, which can be taught to patients by physical therapists, or acupuncture may be helpful. From news reports, it appears Woods has only done anti-inflammatories and physical therapy.
In my experience, rarely do individuals need neurosurgery to treat the symptoms.
Up to date, his care seems appropriate. It is unclear when the arm pain started. As noted previously that symptom can take six to eight weeks to resolve.
Woods is incorrect in the sense his future depends on the MRI. What the MRI will tell us is whether a herniated disc is the culprit or not. Without the MRI, doctors can predict with a high degree of certainty that the areas of concern are nerves C6 to C8. If there is a herniated disc, the real questions Woods should ask are the following
Will the symptoms come back?
Can golfing make the problem worse or will it merely flare-up symptoms?
Are there exercises or non-surgical treatments that can decrease likelihood of recurrence?
Is surgery necessary? If so, will it prevent symptoms from coming back or are the chances of recurrence the same without surgery?
If the MRI shows no herniated disc, it is possible the nerve irritation could be outside of the neck, though those are uncommon causes. Based on his description of symptoms, it is highly unlikely to be due to a shoulder or rotator cuff problem. Even less likely would be a mass or growth around the nerve.
It does not appear that his current symptoms are related to his car crash in November 2009, which apparently was low speed. The neck injury Woods suffered at that time sounded more muscle related. Those injuries tend to resolve in two to three weeks.
Prediction? MRI will show a herniated disc. If his symptoms continue to persist, then he will likely consider surgery. The question really will be whether surgery can cure his problem. If not, then he will simply need to deal with it the same way many individuals do for neck radiculopathy, pinched nerve of the neck.
There is a very good chance, however, given his ability to exercise and his legendary regimens for physical conditioning that he won't need any surgery. Time will tell.