“Pinched nerve” symptoms, treatment

Usually, when something hurts, you do not have to look far to find the source of pain. Injury near the root of a nerve at the spine can result in pain at the end of the nerve where sensation is felt.

An injury in your neck (cervical spine) can result in pain, numbness or weakness in your shoulder, arm, wrist or hand. This condition is called cervical radiculopathy.

People sometimes refer to this problem as a ‘pinched nerve in the neck’. The main causes of cervical radiculopathy include degeneration, disc herniation and spinal instability.

Anatomy

Nerve roots go from the spinal cord in the cervical spine and then travel down into the arms. These nerves supply feeling to areas of the skin from the shoulder to the fingers. They also carry electrical signals to muscles to control movement of the arms, hands, and fingers.

Degeneration

As the spine ages, several changes occur in the bones and soft tissues. The disc between the bones of the spine (vertebrae) loses it water content and begins to collapse. This causes the space between the vertebrae to narrow. The added pressure may irritate and inflame the joints of the spine, causing them to become enlarged. When this happens the enlarged joints can press against the nerves. Degeneration can also cause bone spurs to develop which can also irritate the nerves.

Herniated disc

Repetitive bending, twisting, and lifting can place extra pressure on the shock-absorbing disc. If great enough, this increased pressure can injure the disc. Such an injury can cause the disc to become deformed and bulge.

If the injury is severe, the inner pulp of the disc can be forced out of the disc. This is called a disc herniation. When the herniated disc material touches a nerve root it can chemically and physically irritate the nerve root. Pain, numbness and weakness in the area the nerve supplies can be the result.

Spinal instability

Spinal instability means there is extra movement among the bones of the spine. Instability in the cervical spine can develop if the supporting ligaments have been stretched or torn from a severe injury to the head or neck.

People with diseases that loosen their connective tissue may also have spinal instability. Whatever the cause, extra movement in the bones of the spine can irritate or put pressure on the nerves of the neck, causing symptoms of cervical radiculopathy.

Symptoms

The symptoms of cervical radiculopathy are from irritated nerves. The pain from cervical radiculopathy usually spreads down the arm past the elbow. Radiculopathy also usually involves other changes in how the nerves work such as numbness, tingling, and weakness in the muscles of the shoulder, arm, or hand.

With cervical radiculopathy, the reflexes in the muscles of the upper arm are often affected. Headaches can be due to many causes, but are also a common complaint of cervical radiculopathy.

Diagnosis

Information you provide can help your doctor determine which nerve is causing problems.

The doctor will examine you to see which neck movements cause pain or other symptoms. Your skin sensation, muscle strength, and reflexes are tested in order to determine which nerve is affected.

X-rays of the cervical spine can often help to show any possible degenerative causes of cervical radiculopathy.

If more information is needed, your doctor may order magnetic resonance imaging (MRI). The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. This test gives a clear picture of the discs, nerves, and other soft tissues in the neck that do not show on X-ray.

Electrical studies of the nerves going from the neck to the arm may be requested by your doctor to see whether the nerve problem is in the neck or further down the arm. These tests are usually only needed when the area of nerve damage or degree of nerve damage is not clear.

Treatment

Initial treatment for cervical radiculopathy will almost always start conservatively. Most people will benefit from a broad based treatment approach that will include a combination of medications, a cervical collar, and a special pillow. Hands on treatment will vary between different health care facilities, but will usually include neck mobilization, strengthen/stretching exercises, traction, muscle stimulation, acupuncture and massage.

A thorough exam and history will help in identifying the appropriate treatment for you.

Failure to response to conservative care may indicate the need for more aggressive treatment such as epidural steroid injection or even surgery.

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