History of the Herniated Disc
The history is the patient’s story: how the symptoms began, where the symptoms are located, what is the interference in the quality of life, what relieves and what aggravates the symptoms. A herniated disc commonly causes arm pain because the herniation compresses a nerve that ultimately goes into the arm. However, the nerve compression may only cause numbness, or weakness instead of pain or may cause all or some of those symptoms in an arm. (numbness, weakness, pain). Occasionally, a central disc herniation causes symptoms from spinal cord compression and may effect the arms and legs.

Physical Exam of the Disc Herniation
The physical exam is performed by the doctor to determine the effects of herniation. An examination of the function of the nerves in the arms and the legs determines if there is any weakness, numbness, or reflex change. An examination of the movement of the neck may cause symptoms to radiate into the arm or arms.
 
Diagnostic Studies of the Disc Herniation
The purpose of diagnostic studies is to answer the question, “where on the electrical diagram is the interruption that explains the patient’s clinical situation.” (history and physical exam) Diagnostic studies are designed to produce a picture of the interruption (MRI, Myelogram, C.A.T. scan, Discogram, etc.) or to indicate which nerve may be electrically interfered with (EMG or SSEP). The diagnostic studies must correlate with (explain) the patient’s history and physical exam to be meaningful. Many tests show age related changes that exist in people who do not have pain. (in addition, there are people who have disc herniations who do not have any symptoms and degenerative changes are common in the spine as patients mature) 
Treatment of the Disc Herniation
 
Natural History
The natural history is the rate that nature cures a particular condition. Nature has been curing things for 3 billion years and a certain percentage of patients with a particular diagnosis are going to be healed by nature. For disc herniations, nature does a good job of relieving symptoms. By 6-8 weeks, most people with arm symptoms improve.
Why do people with herniations improve?The problem is a 3-dimensional equation between the degree of tension on the nerve and space available for the nerve. The people who improve have a favorable combination of the space available for the nerve and the degree of tension on the nerve. Nature adequately adapts the nerve to its environment in the majority of patients. 

Conservative Care
The purpose of conservative care is to relieve symptoms and improve function. Conservative Treatement does not always “cure” but often it “relieves.” The laundry list of potential treatments for the herniated disc includes: physical therapy, chiropractic care, injections, medications, etc. 

Surgery
The goal of surgery is to take the pressure of the nerve. This can be accomplished by direct removal of disc material and/or providing the space for the nerve that nature has failed to do. The herniation causes the symptoms in the arm, decompression of the nerve allows the nerve freedom and the potential to reverse its “injury state” from compression. Surgery improves specific symptoms in the arm more than other symptoms. (e.g. surgery is very effective for arm pain but less effective for numbness.)