Cervical radiculopathy

Cervical radiculopathy is the term used to describe a pinched nerve in your neck region (cervical spine), which affects the nerves that travel to your arms, shoulder and hands. It happens when the surrounding muscles, cartilage, bones or tendons are damaged or have some level of degeneration.

You have seven cervical vertebrae in your neck, with a disc of cartilage between each. These vertebrae protect your spinal column and provide stability and rotation for your head. Eight nerve roots originate in this part of your spinal column and exit through a space called the intervertebral foramen. Damage to these nerves can result in inflammation that causes pain, numbness and lack of function in your arms, neck, shoulder and hands.

Cervical spine. 

Causes

There is a wide range of causes of cervical radiculopathy;

Disc herniation

Otherwise known as disc prolapse or a 'slipped disc', this happens when you damage one of the intervertebral discs that cushion your spinal vertebrae. Your discs are fibrous capsules filled with a gel-like substance. As you age, these discs can bulge, stiffen, lose volume and become more susceptible to injury. If damaged, the gel-like substance can leak out from the discs and put pressure on your spinal nerves. Disc prolapse is a commonly-seen feature in arthritis.

Bone spur

If your intervertebral discs are damaged, collapse or become worn, they lose height and volume and the ability to provide cushioning. Your body responds by building extra bone around the disc to strengthen it. These new areas of bone are called bone spurs. They can pinch your spinal nerves by narrowing the space where they emerge (stenosis) and cause stiffening of your spine. They are a common cause of cervical radiculopathy, especially in older people.

Spinal stenosis

Spinal stenosis occurs when the spinal column becomes narrower, compressing the spinal cord and/or spinal nerves. It can be due to damaged discs or ligaments, bone pressing on your nerve, or Paget's disease, which is a rare bone condition.

Trauma

Injury to your cervical spine can be caused by blunt trauma or a heavy impact to your head. Your intervertebral discs are designed to take the force of impact, but can easily burst or rupture if this force is too strong, if they have begun to degenerate, or have been injured before. Your ligaments and muscles can also sustain damage during an accident, creating localised pain and inflammation.

Other causes

There are a wide range of other causes of cervical radiculopathy, including the following:

• Tumours - these can compress spinal nerves;
• Obesity - excess weight can put pressure on your nerves;
• Poor posture - this puts pressure on surrounding muscle, tendons and ligaments, often leading to inflammation of your spinal nerves;
• Repetitive actions or sports - constantly repeating a particular move or action can cause localised inflammation and nerve compression;
• Diabetes - if you have diabetes, you are more prone to nerve compression;
• Pregnancy;
• Arthritis - both rheumatoid and osteoarthritis, and;
• Infections - contracting certain infections such as Lyme disease and herpes zoster makes you prone to nerve compression.

Signs and symptoms

The range of symptoms you experience may differ, depending on which nerve root is being pinched and the cause of it. Many cases of cervical radiculopathy do not cause any pain - just weakness, pins and needles or numbness in the affected limb. However, symptoms include the following:

• Tingling and weakness in your arm, neck, shoulder and upper back;
• Sharp nerve pain that radiates down your arm or to your fingers;
• Pain and stiffness in your neck;
• Pain that originates in your neck when you make certain head movements, and;
• Tingling and weakness in your fingers or thumbs.

Methods for diagnosis

Medical history

Your doctor will take a full medical history to note any injuries, accidents, work or sports-related muscle pain you have experienced. It is helpful to mention all your symptoms, with details such as when the pain or numbness started, what caused it, what makes it better or worse, what activities trigger it and any other relevant information you can think of.

Physical examination

You may be asked to perform a number of gentle neck, hand and arm movements to assess your mobility. Areas of numbness and weak muscles will be noted to help build a diagnostic picture.

X-rays

Spinal X-rays will detect any bones that are sitting out of place, fractures and bone spurs.

Electromyography (EMG) and nerve conduction study

This procedure uses small electric shocks to assess muscle and nerve function. The study can detect the presence and location of nerve injury.

Computerised tomography

A computerised tomography (CT) scan can detect any bony causes of cervical radiculopathy.

Magnetic resonance imaging

Magnetic resonance imaging can be used to identify tissue damage and spinal stenosis.

Blood tests

You may be asked to provide a blood sample to rule out the following underlying conditions:

• Diabetes;
• Polymyalgia rheumatica;
• Cancer, and;
• Infection.

Types of treatment

The type of treatment depends on the cause of cervical radiculopathy:

Medications

• Corticosteroid injections can provide immediate relief by calming down inflammation and reducing pain. They tend to be injected directly into the area that is most inflamed, allowing movement to return;
• Oral corticosteroids work in the same fashion as injections, but are more systemic, working throughout the body to reduce inflammation and pain and freeing up tendons that have become swollen and immobile. They tend to be used as a short-term solution, as there are side effects associated with long-term use;
• Non-steroidal anti-inflammatory drugs (NSAIDs) reduce inflammation, fever and pain and work quickly. They do have side effects though, such as tummy upsets, diarrhoea and headache, so they are normally only used in the short-term.

Physiotherapy

A physiotherapist is an expert in how your muscles work and, in particular, how to rehabilitate them after an injury or sprain. They can assess the condition of your muscles, tendons and ligaments, then design exercise programs to strengthen them. Your physiotherapist can teach you exercises and stretching techniques that you can then use at home.

Soft collars

You may be given a soft collar to wear for a few weeks - this will rest your neck muscles and, as they reduce movement, will also reduce nerve pinching. Long-term use of a collar is not beneficial and might make your condition worse.

Surgery

Surgery to relieve nerve compression will be considered if other treatments are not successful. All forms of surgery carry risks - these can be discussed with your surgeon before a decision is made:

• Laminectomy - trimming your vertebrae to improve symptoms associated with spinal stenosis;
• Discectomy - the removal of part of a damaged disc that is putting pressure on your sciatic nerve, and;
• Fusion surgery - this procedure returns a slipped disc to its correct position through use of metal rods and a bone graft.

Home care

• Icepacks or heat packs can provide immediate relief from some types of pain. Experiment to see which works for you. Icepacks should not be placed directly on your skin, as they may cause nerve damage. First wrap the icepack in a towel and only use for 10 minutes each time;
• Avoid triggers. If you have an injury or inflammation due to overuse, the best remedy is to avoid that action until you have healed;
• Stretching exercises, gently rotating your head and side tilts will encourage blood flow and relax tired muscles, and;
• Make sure you have the correct height pillow to suit your neck. Ask your doctor or physiotherapist for advice.

Traction

This involves using a specially-designed treatment couch, which allows gentle stretching to relieve compression on your spinal column.

Manipulative therapies

Chiropractic and osteopathic manipulation techniques may help relieve symptoms associated with spinal compression. Deep tissue massage can also help by relaxing tense muscles and stopping muscle spasms. Applying a heat pack beforehand encourages muscular relaxation.

Acupuncture

Acupuncture and dry needling may help relieve neck pain, by targeting tense muscle groups and aiding relaxation.

Potential complications

Complications from surgery for cervical radiculopathy can include infection, anaesthetic risk, paralysis and damage to local nerves and tissues.

Prognosis

The outlook for most cases of cervical radiculopathy is good. Using self-care measures, medications and keeping as physically healthy as possible will help keep symptoms at bay. Physiotherapy will help keep your spine flexible.

Prevention

Some instances of cervical radiculopathy cannot be prevented, but avoiding activities that may damage your neck is advisable. Maintaining good posture and avoiding activities that trigger your symptoms can help.