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    2019
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Cervical Radiculopathy

Cervical Radiculopathy

Cervical radiculopathy (commonly referred to as “pinched nerve”) occurs when the nerve in the neck is compressed or irritated.  In other words, damage or disturbance of nerve function that occurs due to one of the nerve roots near the cervical vertebrae causes cervical radiculopathy.  Nerve root degeneration in the cervical area will trigger pain.  The pain that emanates radiates into the shoulder.  There will also be muscle weakness that travels down the arm and into the hands.  The patient will suffer loss of sensation along the nerve pathway into the arm.  The area of the pain depends on where the damaged roots are located.

Principal factor that leads to cervical radiculopathy is “wear and tear” changes that occur in the spine as we age.  In majority of cases, cervical radiculopathy responds well to traditional treatment techniques that includes medication and physiotherapy.

Causes of cervical radiculopathy:

Damage to the nerve can occur as a result of pressure from a ruptured disc, degenerative changes in the bone, arthritis or other injuries that compresses the nerve roots.  In youngsters it is often caused by abrupt trauma that results in a herniated disc, bulging disc or intervertebral disc, causing the disc material to compress, which in turn inflames the nerve root, leading to pain.

Degenerative changes:

As we age, disc may lose height and begin to bulge.  They also lose water content and begin to dry out, thus getting stiffer.  This will result in collapse of the disc space and loss of disc space height.  As there is not enough disc height, vertebrae move close together.  Body produces more bone (bone spurs) to strengthen the disc as a response to collapsed disc.  Stiffening of the spine happens due to the proliferation of bone spurs.  These bone spurs will narrow the foramen, where the nerve roots exit, thus pinching the nerve root.  These degenerative changes in the disc are called arthritis or spondylosis.  This is a natural phenomenon that occurs in everyone.  In fact, almost half of all middle-aged people and elderly people have worn disc and pinched nerve.  However, the presence of pain is subjective.

Herniated disc:

A disc herniates when its jelly-like center (nucleus) pushes against its outer ring (annulus).  An injury or wear and tear causes the nucleus of the disc to squeeze all the way through.  Nerve root comes under pressure when the herniated disc bulges out towards the spinal canal.  A herniated disc may cause pain and weakness in the areas the nerve supplies.  Lifting, pulling, bending or twisting movements may cause the disc to herniate.

Symptoms of cervical radiculopathy:

The predominant symptom of cervical radiculopathy is pain and weakness which spreads into the arm, neck, chest, upper back and/or shoulders.  Generally, pain starts at the neck radiates to the area of the nerve root.  Pain can be either burning-like pain or sharp pain.  As a result of the pain, certain neck movements may be difficult, like extending or straining the neck or turning the head.  The patient may feel a loss of sensation in the fingers or hands.  Some patients may experience tingling or “pins and needles” in the fingers or hand.  Some patients reported a temporary relief from pain when they put their hands on top of their head as it releases the pinched nerve temporarily.

Diagnosing cervical radiculopathy:

After a careful analysis of your past medical history and your current health status, your doctor will ask about the symptoms you suffer.  Your neck, shoulder, arms and hands will then be examined by the doctor, looking for muscle weakness, loss of sensation or any change in your reflexes.  Your doctor may also ask you to perform certain neck and arm movements to see if there are any trigger points along the course of the nerve.  Imaging tests such as x-ray, CT scan, MRI scan and electromyography may also be ordered to pinpoint the condition.

Treatment for the condition:

Treatment for cervical radiculopathy primarily depends on the underlying cause of the patient’s symptoms as well as the severity of the condition.  Conservative treatments are the first-line of treatment, those include:

Physiotherapy:

Physiotherapy aims at improving pain, numbness and weakness that the patient suffers on account of the condition.  A physiotherapist can teach you exercises that will lessen the pain.  Postural physiotherapists mainly focus on stretching and flexibility exercises to ease the symptoms of cervical radiculopathy, keeping in mind the patient’s needs.  Training is an important treatment aspect in physiotherapy.  Improving the strength of neck and back, and increasing the flexibility of the hand may help the patient to hold a better posture, thus becoming more resistant to pain.  Primarily, the goal of physiotherapy is to train the individual in exercises that will ameliorate the symptoms of the condition.      

Rest and activity modification:

Try not to indulge in strenuous activities, such as sports or lifting heavy objects.  Sitting in a better posture while sitting and driving might provide some relief.

Ice/heat therapy:

A relief from intense pain can be obtained by applying an ice pack or a heated gel pack to the neck.  For example, if there is an intense pain triggered by an activity, applying ice pack may reduce inflammation and pain arising out it.  While applying ice or heat therapy, make sure there is a layer that prevents direct contact with the skin.  You can keep ice/heat pack for 15 or 20 minutes with about a two-hour break in-between.

Medications:

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first-line of drugs prescribed to relieve inflammation related to cervical radiculopathy.

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Q&As on Cervical Radiculopathy

What is Cervical Radiculopathy?

The condition cervical radiculopathy involves the compression of the nerves by arthritic bone spurs or debris from a herniated disc. As a result of this compression, the neck and upper arms may experience discomfort, numbness, sensory impairments, or motor dysfunction.

Pathologies that affect the nerve roots may lead to cervical radiculopathy, which manifests as symptoms. For example, a herniated disc, cervical spinal stenosis, or degenerative spondylotic alteration causes compression, inflammation, traction, and lesions on the nerve root. Also, as we age, the “wear and tear” changes in the spine are the leading cause of cervical radiculopathy. 

What Causes Cervical Radiculopathy?

Spondylitis and herniated disc are two leading causes of cervical radiculopathy. 

Spondylitis: Aged individuals are more likely to develop spondylosis, resulting in stenosis or bony spurs. Spondylosis may mechanically compress the neuroforamen from both sides, reducing nerve root excursion. The intervertebral disc injury-induced cytokines may potentially contribute to this disorder.

Herniated disc: When a disc herniates, the nucleus, which resembles a jellyfish, pushes against the outer ring called an annulus. The disc nucleus might completely squeeze through due to damage or deterioration. A herniated disc may result from lifting, tugging, bending, or twisting motions. A herniated disc that protrudes toward the spinal canal puts pressure on nerve root endings. 

What are the symptoms of Cervical Radiculopathy?

The symptoms of cervical radiculopathy extend from the neck and may also be experienced in the arms, shoulder, or hand. In the region where the inflamed nerve travels, symptoms will manifest. The spine expert can often determine which nerve is affected by looking at the signs.

Pain, numbness, neck discomfort, and weakness are some of the common symptoms. Other symptoms include pain in the back of the head (occipital headaches), difficulty moving the neck or turning the head or shoulders, and loss of sensation in fingers and hands.

How is cervical radiculopathy diagnosed?

Your doctor would first ask you to list all of your symptoms so they can be properly diagnosed, then they will examine your medical history and do a physical exam. 

Your shoulders, neck, arms, and hands will all be examined throughout the examination for any signs of muscular weakness or issues with your reflexes or senses. Your physician may instruct you to make particular arm or neck motions to see whether they aggravate or ease symptoms or other symptoms.

Imaging tests such as x-rays, CT scans, electromyography, and MRIs could be recommended to more precisely diagnose the condition.

How is Cervical Radiculopathy treated?

Cervical radiculopathy can be treated with medication, physical therapy, or surgery: 

Medication: These could include nonsteroidal pain relievers, corticosteroids, and potent anti-inflammatory drugs. Steroids may be administered orally or epidurally via injection.

Physical therapy: Your doctor could have a physiotherapist work on a training regimen designed especially for you, whether you undergo surgery. A healthy exercise regimen and knowledge of proper neck mechanics may significantly reduce the severity of many cervical spine issues.

Surgery: There are specific situations when non-surgical treatment for cervical radiculopathy would not help. In certain circumstances, like unbearable pain and increasing numbness, your doctor could advise surgery to address your cervical radiculopathy.

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