Cervical Radiculopathy

Cervical radiculopathy is often referred to as a pinched nerve in the neck. It can feel like radiating pain from the neck to the shoulder, shoulder blade and arm, or hand. Weakness and lack of coordination in the arm and hand can also occur. The condition most often affects individuals in their 50s. Athletes, heavy laborers, and workers who use vibrating machinery are commonly affected.Sitting for long periods of time, or individuals with arthritis in the cervical (neck) region can also be affected.

Conservative care options including physical therapy can help reduce symptoms. A physical therapist can help alleviate the acute neck and arm symptoms that result from the condition, as well as improve general strength and function. Most cases of cervical radiculopathy are resolved with physical therapy and does not require surgery.

What is Cervical Radiculopathy?

Cervical radiculopathy occurs when a nerve root coming off the spinal cord becomes compressed. This compression can occur for various reasons. In younger people, it may occur when a cervical disc herniates due to trauma from an injury. In older individuals, it most often occurs spontaneously as a result of arthritis or decreased disc height in the neck region.

The cervical spine consists of 7 cervical vertebrae bones. Each of these vertebra is separated by a gel-like disc. The discs provides shock absorption for the spine. The spinal cord travels through a canal within the cervical vertebrae. Spinal nerve roots extend out from the spinal cord before branching off going to specific locations within the arm. The spinal nerves send signals to our muscles for movement, as well as sensations we feel in the entire arm. Think of the spinal cord as a tree trunk, and the spinal nerves are the tree’s branches. If an impingement or abnormal pressure is placed upon a branch near the trunk, everything along that branch will become affected.

What can impinge a spinal nerve:

• Arthritis or disc wear-and-tear with age
• Herniated or bulging discs from trauma or degeneration
• Spinal stenosis, a narrowing of the spaces in which the nerves travel
• Tumor, which can be benign or malignant, impinging the nerve root

When the spinal nerves are impinged they cannot properly send messages to the muscles from the brain. Nor can they receive proper sensation from the specific arm location the nerve travels. Everywhere in the arm the spinal nerve travels will be affected. A pinched nerve in the neck can cause pain, weakness, and loss of sensation in the arm, even though the pinch is in the cervical region.

What Does Cervical Radiculopathy Feel like?

Symptoms of cervical radiculopathy vary depending on the nerve root involved, and commonly occur on the same side of the body as the affected nerve. The symptoms may include:

• Pain in the neck, shoulder blade, shoulder, upper chest, or arm, this pain can radiate into the fingers following the path of the nerve root involved.
• Pain can be described as “sharp” or “pins-and-needles” or “popping sensation” in cervical region.
• General dull ache or numbness anywhere along the pathway of the nerve.
• Weakness in the shoulder, arm, or hand.
• Pain that worsens with certain neck movements or positions.
• Pain that improves when the arm is lifted over and behind the head (relieving tension on the spinal nerve).

Symptoms may also be specific depending on the nerve root involved:

• C5 nerve root (between cervical vertebrae C4-C5): weakness in the deltoid muscle (front and side of the shoulder) and upper arm; with shoulder pain and numbness
• C6 nerve root (between cervical vertebrae C5-C6): weakness in the bicep muscle (front of the upper arm) and wrist muscles; with numbness on the thumb side of the hand
• C7 nerve root (between cervical vertebrae C6-C7): weakness in the triceps muscle (the back of the upper arm and wrist); with numbness and tingling in the back of the arm and the middle finger of the affected hand
• C8 nerve root (between vertebrae C7-T1): weakness with hand grip; and numbness in the little finger

The most common nerve root levels for this condition are C6 and C7.

How Is It Diagnosed?

When you seek the help of a physical therapist or physician, they perform a comprehensive evaluation and asks questions about your pain and daily activities. These may include:

• How and when did the pain start? Did the pain begin spontaneously or was there any trauma or popping experienced in the cervical region?
• Where are the symptoms located, and have they changed location or intensity since the onset?
• What makes the symptoms better or worse?
• What type of work do you perform?
• What hobbies or household activities do you regularly perform?

Your physical therapist or physician will gently test the movement of your neck and arms. They will check your tendon reflexes and strength, and conduct special tests on your neck and upper extremity to determine which spinal nerve root(s) may be involved, and to rule out other conditions. To provide a definitive diagnosis, your therapist or physician may collaborate with an orthopedist or other specialist. The orthopedist may order further tests, such as magnetic resonance imaging (MRI) or electromyography (EMG). An MRI can show soft tissues, including the spinal cord and nerve roots. This test can determine what is causing the compression on the nerves, including disc bulges or disc herniation. An EMG measures the nerve and muscle function. This test can tell how well your spinal nerves are communicating to your muscles.

Can this Injury or Condition be Prevented?

Your physical therapist or physician will educate you on the best ways to prevent cervical radiculopathy from recurring, including:

• Maintaining proper posture. Using a supportive pillow and proper posture when sitting at a desk or in the car.
• Setting up your workstation to minimize undue forces on the spine. You may be advised to use a hands-free phone, or adjust your computer monitor to avoid excessive twisting or extending of your neck in repetitive directions during the workday.
• Continuing with regular exercise to maintain spinal muscles flexibility and strength, including the upper body, middle back, and core muscles.
• Keeping a healthy weight to minimize unnecessary forces on the spine.