Cervical radiculopathy, commonly called a “pinched nerve,” occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal cord. This may cause pain that radiates into the shoulder and/or arm, as well as muscle weakness and numbness.
Cervical radiculopathy is often caused by “wear and tear” changes that occur in the spine as we age, such as arthritis. In younger people, it is most often caused by a sudden injury that results in a herniated disk. In some cases, however, there is no traumatic episode associated with the onset of symptoms. In most cases, cervical radiculopathy responds well to conservative treatment that includes medication and physical therapy.
When a nerve in the cervical spine (neck) is irritated or damaged and causes pain and/or neurological symptoms, doctors call this condition – cervical radiculopathy. The nerves in the spine exit the spinal column through holes in the bones of the spine (vertebrae) from the right and left sides. The nerves exiting the spinal canal (nerve roots) are numbered from 1 to 8, based on the same vertebra numbering, which starts at 1 underneath the skull. Radiculopathy can cause different pain, tingling, and numbness along the shoulder, arm, and/or hand depending on which nerve root is damaged.
In older people, cervical radiculopathy is usually caused by the changes that occur naturally as we age, like arthritis. In comparison, younger people are more likely to develop radiculopathy due to a sudden injury.
Other causes of radiculopathy include:
Those suffering from cervical radiculopathy typically experience pain, weakness, or numbness in areas corresponding to the affected nerve. Aside from different affected areas, types of pain can vary as well. Patients have described dull general pain to sharp burning pain.
In most cases, the pain of cervical radiculopathy starts at the neck and travels down the arm in the area served by the damaged nerve. This pain is usually described as burning or sharp. Certain neck movements—like extending or straining the neck or turning the head—may increase the pain. Other symptoms include:
Some patients report that pain decreases when they place their hands on top of their head. This movement may temporarily relieve pressure on the nerve root.
Radiculopathy at different spine levels causes different symptoms:
There are many treatment options for cervical radiculopathy depending on the underlying causes and severity of the patient’s symptoms. For some, non-surgical treatments can help, while more severe symptoms may require surgery.
Non-surgical Treatments
Physical therapists can help patients develop a stretching and exercise routine to help alleviate radiculopathy symptoms.
Physiotherapists can apply manual therapy techniques especially in the acute stage of treatment. Manual therapy can reduce neck pain, neural sensitivity and improve cervical spine range of motion. Commonly used techniques include soft tissue massage, mobilisations and manual traction. It is important that manual therapy is complimented with appropriate exercise therapy for a comprehensive management plan.
Initial management will aim to address the presenting symptoms and pain. This may be achieved with soft tissue techniques, patient education and relevant pain management strategies. Successful treatment of Cervical Radiculopathy involves various modes of treatment. Recent national guidelines for the non-operative management of Cervical Radiculopathy support the use of patient education, non-steroidal anti-inflammatory medication, individualised physical activity, motor control exercise and manual therapy .
Medications
As there is often an inflammatory cause for the pain experienced with CR, non-steroidal anti-inflammatory drugs (NSAIDs), e.g. Voltaren and Nurofen, can be useful in reducing symptoms. Reducing inflammation and therefore compression of the nerve root can aid a quicker resolution of pain and recovery. Please ensure you seek professional advice from your GP and pharmacist.
Exercises
Strengthening exercises are important in the management of Cervical Radiculopathy. Physiotherapists can work with you to identify the most appropriate and effective exercises for your presentation. Strengthening can assist in recovery and address contributing factors of your neck pain. Exercises to address not only the symptoms but target the underlying cause of the injury can assist in preventing re-injury. Common areas of focus include the muscles acting on your neck, shoulder and back, such as the cervical extensors, deep neck flexors and upper trapezius muscles.
Neural tissue mobilizations may also be used as part of your treatment. They can reduce inflammation and pain and lead to improved movement and function. The type of neural tissue mobilizations used depend which spinal level and nerve is affected.
Medications or Injections
Over-the-counter medications, like aspirin and ibuprofen, could help reduce pain. Doctors can also prescribe prescription strength medications, such as muscle relaxants, to help manage pain. Another option is to carefully inject medication directly into the cervical spine (epidural steroid injection).
Cervical Discectomy and Fusion
One type of surgery to relieve radiculopathy, fusion surgery, removes the unhealthy disc. The empty disc space is replaced with a bone or plastic implant filled with bone or bone graft to encourage bone to grow through the implant (fusion). The implant helps restore disc height and remove pressure on the nerves or spinal cord. The fusion stabilizes the spine and keeps the vertebrae at the surgery level from moving.
Artificial Disc Replacement
In artificial disc replacement surgery, the worn out or damaged cervical disc is replaced by an artificial disc. In addition to restoring disc height and potentially reducing pain symptoms, artificial disc replacement may help patients keep forward-to-back, side-to-side, and left-to-right movement.
Whether radiculopathy is caused by wear and tear due to age or to injury, the associated pain can interfere with daily life. By identifying the cause of the radiculopathy, doctors can accurately determine a treatment plan to alleviate pain and symptoms, whether it be non-surgical treatments, such as rest or physical therapy, or surgical treatments, like fusion. For some patients, replacing the damaged disc with an artificial disc, like Mobi-C Cervical Disc, may be a good alternative to fusion surgery.
