What is Cervical Radiculopathy?
Neck pain is a common problem that can lead to a lot of discomfort and disability in people of all ages. It can also lead to significant time off work, with up to 40% of employee absences due to neck discomfort. Cervical radiculopathy is a related issue where the root of a spinal nerve is squeezed or damaged. This can cause pain and symptoms to spread from the neck to other parts of the body such as the arms, neck, chest, upper back, and shoulders. Because of this pressure on the nerve, people often experience muscle weakness and decreased deep tendon reflexes, which are our body’s automatic responses to things like touching a hot stove.
What Causes Cervical Radiculopathy?
Radicular symptoms, or pain and other sensations that travel down a nerve from your spine, can occur when a spinal nerve root is squeezed or aggravated. This can happen due to several conditions.
In younger people, usually in their 30s and 40s, the most common causes of this nerve squeezing or impingement are damage to a spinal disc or a herniated disc, which is when the soft material inside a disc in your spine pushes out through a crack in the outer casing.
As people age, different factors come into play. In their 50s and 60s, the most common cause is typically disc degeneration. This is where the spinal discs, which act as shock absorbers between the bones of the spine, start to wear down with age.
In people in their 70s and above, the main cause tends to be foraminal narrowing due to arthritic change. Foraminal narrowing means the small openings on each side of the vertebrae (bones in your spine) where nerves leave the spine become narrow because of arthritis, which is a condition that causes inflammation and stiffness of the joints. So it can squeeze or impede the nerves.
Risk Factors and Frequency for Cervical Radiculopathy
Cervical radiculopathies are not as common as lumbar radiculopathies, but they still do occur, affecting approximately 85 out of every 100,000 people. The C7 nerve root is the one that’s most commonly affected, being involved in over half of all cases. Around a quarter of cases involve the C6 nerve root, while the nerve roots from C1 to C5 and the C8 are less likely to be affected.
People who are more likely to develop this condition are those who do manual labor involving heavy lifting, or those who drive or operate equipment that vibrates. Smokers are also at increased risk, especially those with a long history of smoking.
- Cervical radiculopathies affect about 85 in every 100,000 people.
- The C7 nerve root is most commonly impacted, accounting for over half of the cases.
- Around one-fourth of cases involve the C6 nerve root.
- The C1 to C5 and C8 nerve roots, on the other hand, are less likely to be affected.
- People who carry out heavy manual labor, operate vibrating equipment, or drive a lot, are at greater risk.
- Chronic smokers also have an increased risk.
Signs and Symptoms of Cervical Radiculopathy
If a patient comes in complaining of pain that seems to be radiating along a nerve pathway or muscle weakness, it’s important to ask about their job-related risks, if they’ve had any injuries, and details about the pain. Cervical radiculopathy, a condition where a nerve root in the neck becomes inflamed or damaged, usually affects one side. However, on rare occasions, it can affect both sides. This can make it hard to diagnose without advanced imaging techniques, especially if the patient has been in an accident.
When doing a physical check-up, one way to identify potential nerve problems is by examining the patient’s reflexes. This involves positioning the patient in a way that allows each reflex arc (the pathway along the body that a nerve signal travels) to be tested individually. Because people vary in how strongly they reflex, it’s more important to compare the left and right sides of the neck than to focus on the strength of the reflex. If a nerve is being pinched, the reflex on that side may be weaker. This corresponding muscle strength would also be weaker, which is a critical marker.
A method used to diagnose cervical radiculopathy is the Spurling test. In this test, pressure is applied to the nerve openings along the spine while the patient’s head is extended and rotated. If the test leads to pain traveling down the upper limb on the same side as the head rotation, this is considered a positive result. In some instances, pulling gently on the neck (cervical traction) can help ease this radiating pain.
Testing for Cervical Radiculopathy
If you’re experiencing pain in your neck or upper extremities, your doctor might order an X-ray of your neck (also known as the cervical spine). From different angles, this X-ray can show if the spaces between your spinal discs are narrower than they should be, which may be causing your discomfort.
If you’ve recently suffered a traumatic injury and are feeling symptoms like tingling and weakness which indicate nerve root damage (also known as radicular symptoms), you might undergo a CT scan, which is a powerful X-ray that makes detailed pictures inside your body. But, a CT scan doesn’t capture soft tissues (like muscles, organs, and blood vessels) very well, which makes it less effective when looking at conditions not related to injuries.
If nerve root damage is suspected, a better option can be a Magnetic Resonance Imaging (MRI) scan. This type of scan is particularly good at capturing images of your body’s soft tissue, allowing doctors to see things like herniated discs (when the soft center of a spinal disc pushes through a crack in the tougher exterior casing) and nerve compressions. However, while these conditions often correlate with nerve root damage symptoms, issues like a herniated disc are not always the cause, hence why MRIs might sometimes show false positives.
Another useful test is electromyography. This diagnostic procedure involves testing the electrical activity of your muscles. It’s useful to confirm if a nerve serving a muscle is not working effectively. Moreover, selective nerve root blocks (a type of injection) can both provide short-term pain relief and prove if the source of the radiating pain is the nerve root.
Treatment Options for Cervical Radiculopathy
Treatment for cervical radiculopathy, a condition that causes pain from a pinched nerve in your neck, usually starts with the simplest and least invasive treatments before moving onto more intense or invasive care. While surgery can often help, there’s not much proof that it’s better than non-surgical treatment when the condition is in its early stages. In fact, more than 85% of people find that their cervical radiculopathy gets better on its own within 8 to 12 weeks without any specialized treatment.
However, to help relieve the pain and other symptoms related to the nerve inflammation, it can be beneficial to begin with non-surgical treatments. These might include taking anti-inflammatory drugs, doing physical therapy, and getting steroid injections in your back. A well-planned physical therapy program can significantly ease your symptoms. Also, if you do eventually need surgery, physical therapy can help you recover faster. Certain medical equipment can also help alleviate symptoms. For example, a special neck pillow can help make sleeping easier during your recovery period. A soft neck collar can also provide some temporary relief.
The primary source of pain in cervical radiculopathy stems from inflammation, so taking non-steroidal anti-inflammatory drugs (NSAIDs), which are a type of common over-the-counter pain reliever, for 1 to 2 weeks can provide some relief of your symptoms. You might also be prescribed a limited course of oral steroids, although this is controversial due to potential risks and side effects. Other medications like tricyclic antidepressants or gabapentin can also be effective in treating your symptoms. Opioid pain medications, while not generally recommended for regular use, can help manage intense pain from the pinched nerve but use with caution as they can delay recovery or return to work if surgery is eventually needed.
Research shows that injections of steroids into your back can significantly relieve pain and quickly help you return to your normal activities. Many patients find substantial, lasting relief from just one treatment. Half of the people treated in this way reported at least 50% relief for weeks after the injection.
Treatments like acupuncture have also been shown to significantly help symptoms. Avoid chiropractic or direct osteopathic manipulation, as these can make the pain worse. However, indirect osteopathic techniques can help ease your symptoms.
For those who don’t find relief through non-surgical treatments, surgery can be an effective solution. There are two main types of surgery performed for this condition: anterior (from the front) and posterior (from the back) approaches. In an anterior procedure, the surgeon typically removes entire intervertebral disks that are causing the nerve compression and replaces them with fusion material or artificial disks. The posterior approach often involves a laminectomy, partial removal of the disk (discectomy), and widening of the foramen (foraminotomy) — with or without fusion. Both of these methods are effective. As with any surgical procedure, however, there are potential risks, including anesthesia-related complications, nerve problems, blood vessel issues, and damage to the laryngeal nerve, which controls your vocal cords.
What else can Cervical Radiculopathy be?
If you’re experiencing certain symptoms, your doctor might consider the following conditions as part of their diagnosis:
- Brachial plexus injury in sports medicine
- Cervical disc injuries
- Cervical discogenic pain syndrome
- Cervical facet syndrome
- Cervical spine sprain
- Rotator cuff injuries
- Strain injuries
Recovery from Cervical Radiculopathy
Physiotherapy treatments for neck pain caused due to pinched nerves (also known as cervical radiculopathy) often include techniques like gentle traction (pulling), mobilisation (movement), and manipulation (adjusting) of the neck. Research suggests that traction is particularly effective.
In this context, traction refers to pulling the neck slightly to relieve pressure on the nerves. This method has shown better results when done by a machine (mechanical traction) rather than by hand (manual traction). However, more research is needed to compare these two methods.
Apart from traction, manual therapy for cervical radiculopathy can also include massages and various exercises such as stretching, strengthening, and neurodynamic exercises, which involve movements that can “floss” the nerves to reduce irritation.
These therapeutic efforts have multiple benefits. They can help reduce pain, improve function, and speed up recovery. The timing of the treatment and intensity of the treatment plan can influence these outcomes. Although individual treatments may not work on their own, combining these therapies has shown to reduce the symptoms of cervical radiculopathy. Though, it’s important to note, more studies are required for a better understanding of these treatments.