Cervical Radiculopathy

Neck pain can be very painful and disabling, but it is much less concerning than the pain and symptoms associated with cervical nerve root injury.

People sometimes refer to this problem as a pinched nerve. Your health provider calls a pinched nerve in the neck cervical radiculopathy.

The main causes of cervical radiculopathy include degeneration, disc herniation, and spinal instability.

We can think of the neck as a stack of bones. Each neck bone (called a cervical vertebra) is round in shape, with a ring of bone attached on the back.

The vertebra bones are stacked on top of each other with a cushion (the intervertebral disc) between them. The bony rings form a long bony tube that protects the spinal cord as it travels down the neck and back.

At each vertebral level, the cord sends out nerves to each side of the neck through canal-like openings in the bony tube.

A bulged or herniated disc can narrow the opening and put pressure on the nerve. In fact, the disc doesn’t even need to touch the nerve; the caustic chemicals leaking out of the disc can irritate and inflame the nerves.

Degeneration in the spine can lead to the development of bony spurs. These spurs can then project into the canal where the nerves exit the spine. If the spur is large enough, it can compress and pinch the nerve.

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

Certain diseases can also lead to instability. Whatever the cause, movement in the spine beyond what is normal can irritate the nerves of the neck causing symptoms of cervical radiculopathy.

The symptoms of cervical radiculopathy are from an irritated nerve. These symptoms are not the same as those that come from mechanical neck pain. Mechanical neck pain usually starts in the neck and may spread to include the upper back or shoulder. It rarely extends below the shoulder. Headaches are also a common complaint of both radiculopathy and mechanical neck pain.

The pain from cervical radiculopathy usually spreads further down the arm than mechanical neck pain. Unlike mechanical pain, 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 usually affected.

Spine specialists try to determine which nerve is affected based on information from the patient. A careful mapping of where the symptoms are felt can indicate which nerve is affected, and therefore where in the neck the injury is located.

Next, the specialist examines you to see which neck movements cause pain or other symptoms. Your skin sensation, muscle strength, and reflexes are tested in order to gather more information about which nerve is affected, and to what degree.

The neck and nerves are challenged through various tests to gather as much information as possible.

X-rays of the cervical spine can show whether degeneration has caused the disc to degenerate, the canal to compress or if a bone spur is occupying the area of a nerve.

If more information is needed, a magnetic resonance imaging study (MRI) will be ordered. 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.

Sometimes it is not clear where the nerve pressure is coming from. Symptoms of numbness or weakness can happen when the nerve is being pinched anywhere along its path, not just in the neck.

An example of this is numbness in the hand due to carpal tunnel syndrome in the wrist. Electrical studies of the nerves going from the neck to the arm can also help to identify which nerve is affected, where, and to what extent.

The chiropractic approach is to help restore a more normal motion and position of affected spinal joints and bones by specific chiropractic adjustments.

Chiropractors do not always adjust or manipulate the spine in the presence of certain disc and nerve problems in the neck.

Depending on your exam findings, more conservative techniques can be incorporated into your treatment plan. Alternative treatments include acupuncture, cold laser, ice, traction, soft tissue massage, electrical muscle stimulation, ultrasound, traction, exercise and stretching.

A pinched nerve in the neck is called cervical radiculopathy. Photo:File