Degeneration of the cervical spine can result in several different conditionsthat cause problems. These are usually divided between problems that come frommechanical problems in the neck and problems which come from nerves being irritatedor pinched. A cervical radiculopathy is a problem that results when a nervein the neck is irritated as it leaves the spinal canal. This condition usuallyoccurs when a nerve root is being pinched by a herniated disc or a bonespur.
The purpose of this information is to help you understand:
- The anatomy of the cervical radiculopathy
- The signs and symptoms of cervical radiculopathy
- How the condition is diagnosed
- The treatments available for treatment of the condition
In order to understand your symptoms and treatment choices, you should startwith some understanding of the general anatomy of your neck. This includes becomingfamiliar with the various parts that make up the neck and how these parts worktogether.
Please review the document, entitled:
- Cervical Spine Anatomy
Cervical Radiculopathy ("Pinched Nerve")
When a nerve root leaves the spinal cord and the cervical spine it travelsdown into the arm. Along the way each nerve supplies sensation (feeling) toa part of the skin of the shoulder and arm. It also supplies electrical signalsto certain muscles to move part of the arm or hand. When a nerve is irritatedor pinched -- by either a bone spur or a part of the intervertebral disc -- itcauses problems in the nerve and the nerve does not work quite right. This showsup as weakness in the muscles the nerve goes to, numbness in the skin that thenerve goes to and pain where the nerve travels. In the neck, this conditionis called cervical radiculopathy. Let's look at the different causes of cervicalradiculopathy.
Pinched nerve from a herniated disc
Bending the neck forward and backward, and twisting left and right, placesmany kinds of pressure on the vertebrae and disc. The disc responds to the pressurefrom the vertebrae by acting as a shock absorber. Bending the neck forward compressesthe disc between the vertebrae. This increased pressure on the disc may causethe disc to bulge toward the spinal canal and the nerve roots.
Injury to the disc may occur when neck motion puts too much pressure on thedisc. One of the most painful injuries that can occur is a herniateddisc. In this injury, the tear in the annulus portion of the intervertebraldisc is so bad that part of the nucleus pulposus squeezes out of the centerof the disc. The annulus can tear or rupture anywhere around the disc. If ittears on the side next to the spinal canal, when the nucleus pulposus squeezesout, it can press against the spinal nerves. Pressure against the nerve rootfrom a herniated disc can cause pain, numbness, and weakness along the nerve.There is also evidence that the chemicals released from the ruptured disc mayirritate the nerve root, leading to some of the symptoms of a herniated disc-- especially pain.
Herniated discs are more common in early middle-aged adults. This conditionmay occur when too much force is exerted on an otherwise healthy intervertebraldisc. An example would be a car accident where your head hit the windshield.The force on the neck is simply too much for even a healthy disc to absorb andinjury is the result. A herniated disc may also occur in a disc that has beenweakened by the degenerative process. Once weakened, less force is needed tocause the disc to tear or rupture. However, not everyone with a ruptured dischas degenerative disc disease. Likewise, not everyone with degenerative discdisease will suffer a ruptured disc.
Pinched nerve from degeneration and bone spurs
In middle aged and older people, the degenerativedisc disease can cause bone spurs to form around the nerve roots. This usuallyoccurs inside the foramen -- the opening in the cervical spine where the nerveroot leaves the spine to travel into the arm. If these bone spurs get big enoughthey may begin to rub on the nerve root and irritate the nerve root. This causesthe same symptoms as a herniated disc. The irritation causes pain to run downthe arm, numbness to occur in the areas the nerve provides sensation to andweakness in the muscles that the nerve supplies.
A cervical radiculopathy causes symptoms that radiate out away from the neck.What this means is that although the problem is in the spine, the symptoms maybe felt in the shoulder, the arm, or the hand. The symptoms will be felt inthe area where the nerve that is irritated travels. By looking at where thesymptoms are, the spine specialist can usually tell which nerve is involved.The symptoms include pain, numbness and weakness. The reflexes in the upperarm can be affected.
When you are suffering from a cervical radiculopathy, there is usually alsoneck pain and headaches in the back of your head. These are sometimes referredto as occipital headaches because the area just about the back of the neckis called the "occiput."
Finding the cause of neck pain begins with a complete history and physicalexamination. After the history and physical examination, your doctor will havea good idea of the cause of your pain. To make sure of the exact cause of yourneck pain, your doctor can use several diagnostic tests. These tests are usedto find the cause of your pain -- not make your pain better. Regular X-rays,taken in the doctor's office, are usually a first step in looking into any neckproblem and will help determine if more tests will be needed.
A "complete history" is usually two parts. One part is written; a form thatyou fill out while you wait to see the doctor. While you fill out the form,take time to think about everything you can remember that relates to your neckpain and write it down. The more you can tell him, the faster he can diagnosethe cause and help relieve your pain. The second part of your history will beanswering questions. Your doctor will ask you to describe when your neck pain beganand the type of pain you are having.
For example, he may ask:
- When did the pain first begin?
- Have you increased your activity level?
- Have you had an injury, or surgery, to your neck at any time?
- Does the pain go down into your arms or legs?
- What causes your neck to hurt more or less?
- Have you had any problems with your bowels or bladder?
Once most of the information is gathered, your doctor will give you a thoroughphysical exam. During the exam your doctor will look at your neck to find outhow well your neck is functioning. This includes:
- How well you can bend your neck and roll your head in all directions
- How well you can twist your neck
- If there is tenderness around the neck
- If there are muscle spasms around the neck and shoulders
Tests that examine the nerves that leave the spine is also important. Thisincludes:
- Testing for numbness in the arms and hands
- Testing the reflexes
- Testing the strength of the muscles in the arms, hands, and legs
- Testing for signs of nerve irritation
X-rays show the bones of the cervical spine. Most of the soft tissue structuresof the spine, such as the nerves, discs, and muscles, do not show up on X-ray.X-rays can show problems that affect the bones, such as infection, fractures,or tumors of the bones. X-rays may also give some idea of how much degenerationhas occurred in the spine. X-rays alone will not show a herniated disc. TheX-rays will be useful in showing how much degeneration and arthritis are affectingthe neck. Narrowing of the disc space between each vertebra and bone spurs doshow up on X-rays.
Magnetic Resonance Imaging (MRI)
The MRI is the most commonly used test to evaluate the spine because it canshow abnormal areas of the soft tissues around the spine. The MRI is betterthan X-ray because in addition to the bones, it can also show pictures of thenerves and discs. The MRI is done to find tumors, herniated discs, or othersoft-tissue disorders. The MRI is painless and lasts about 90 minutes. Duringthe MRI, very detailed computer images of sections of the spine are taken. Unlikemost other tests, which use X-rays, the MRI uses magnetic fields and radio wavesto see the structures of the neck. Pictures can also be taken in a cross sectionview. The MRI allows the doctor to clearly see the nerves and discs withoutusing special dyes or needles. In many cases, the MRI scan is the only specialtest that needs to be done to find what is causing your neck pain.
Before the MRI, you will be asked to remove any metal objects, such as jewelry.You will also be asked if you have metal implants such as a pacemaker or jointreplacement. Because of the strong magnetic field, people with certain typesof metal implants cannot undergo MRI.
The MRI scanner is a very large machine with a tunnel-like area in the center.While you lay on a table, the table slides into the tunnel of the scanner. Oncein position, you will be asked to remain very still for the rest of the test. Duringthe test you will hear the clicking and thumping noises as the scanner moves.While the scanner is taking pictures, the technician can see the pictures ona monitor and record them.
Treatment for any spine condition should include two main goals:
- Relieve pain
- Reduce the risk of re-injury
The treatment of neck pain can range from the reassurance that nothing is wrongto very delicate surgery. Treatment is always based on the individual and hissymptoms. In general, treatment for neck pain falls into two broad categories:conservative treatment, meaning things you can do short of surgery, and surgicaltreatment.
Medications are commonly used to control pain, inflammation, muscle spasm,and sleep disturbance.
Some general tips about treatment with medicines:
- Medicine should be used wisely! Take all medications exactly as prescribed by your doctor and report any side effects to him.
- Some pain medicines are highly addictive!
- No pain medicine will control chronic pain if used over a long period of time.
- No medicine will cure neck pain of degenerative origin.
Mild pain medications can reduce inflammation and pain when taken properly.Medications will not stop degeneration, but they will help with pain control.
For a more detailed description of the use of pain medications in back andneck pain, please refer to the document entitled:
- Medications for Back Pain
A cervical collar is often used to provide support and limit motion while aninjured neck is healing. It also helps keep the normal alignment. Cervical collarscan be soft (made of foam) or hard (made of metal or plastic). Because thesecollars can restrict the movement of your head, you may need help eating andwith other activities. The skin under the collar needs to be checked every dayto prevent blisters or sores.
A special pillow may help your pain at night and allow you to sleep better.These cervical pillows are specially designed to place the right amount of curvaturein the neck while you sleep and decrease the amount of irritation on the nerveroots. The pillows can be purchased from drug stores and from your therapist.
Epidural Steroid Injection (Nerve Block)
If other treatments do not relieve your back pain, you may be given an epiduralsteroid injection, or a cervical nerve block. An epidural steroid injectionplaces a small amount of cortisone into the bony spinal canal. Cortisone isa very strong anti-inflammatory medicine that may control the inflammation surroundingthe nerves and may ease the pain caused by irritated nerve roots. The epiduralsteroid injection is not always successful. This injection is often used whenother conservative measures do not work, or in an effort to postpone surgery.
In some cases, the cervical radiculopathy will not improve with non surgicalcare. In these cases your surgeon may recommend surgery to treat your cervicalradiculopathy. Your surgeon may also recommend surgery if you begin to showsigns of:
- Unbearable pain
- Increasing weakness
- Increasing numbness
- Muscle wasting
- The problem begins to affect the legs also
One of the most common operations used to treat a cervical radiculopathy causedby pressure from bone spurs and a herniated disc is the Anterior Cervical Fusion.
For a complete description of the procedure to remove the disc and performa fusion for neck pain, you may wish to review the document entitled:
- Anterior Cervical Fusion
After surgery you will probably be placed in some type of brace while healingoccurs. Following an anterior cervical fusion it is not unusual to wear a bracefor 6 to 12 weeks while the fusion occurs. For a complete understanding of differenttypes of spine braces and to understand what types of braces are used, you maywish to review the document, entitled:
- Back and Neck Braces
Whether you have surgery or not, your doctor may have a physical therapistwork on an exercise program developed just for you. The physical therapist willteach you ways to prevent further injury to your neck. Many problems in thecervical spine can be improved greatly with a good exercise program and goodeducation on neck mechanics.
For a complete description of the rehabilitation of neck pain, you may wishto review the document entitled:
- Neck Rehabilitation
Copyright © 2003 DePuy Acromed.
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Anterior Cervical Diskectomy and Fusion (ACDF) ACDF is the most commonly performed procedure to treat cervical radiculopathy. The procedure involves removing the problematic disk or bone spurs and then stabilizing the spine through spinal fusion.What should you not do with cervical radiculopathy? ›
DO skip high-impact activities, such as running, if you have neck pain. DO exercises to maintain neck strength, flexibility, and range of motion.What is the gold standard for cervical radiculopathy? ›
Although anterior cervical discectomy and interbody fusion remains the gold standard of treatment, microendoscopic foraminotomies and discectomies done from posterior and anterior approaches are effective and safe. The role of disc arthroplasty in the treatment of radiculopathy is evolving.What makes cervical radiculopathy worse? ›
Axial compression of the spine and rotation to the ipsilateral side of symptoms reproduces or worsens cervical radiculopathy.What can a neurologist do for cervical radiculopathy? ›
A neurologist can diagnose the condition as well as provide treatment options such as injections or physical therapy. If you think you have radiculopathy, contact our team of neurology experts today so we can help develop an actionable plan for reducing your symptoms and increasing your mobility.What is the most common cause of radiculopathy? ›
Radiculopathy is caused by a pinched nerve in your spine. More specifically, it happens when one of your nerve roots (where your nerves join your spinal column) is compressed or irritated. You might see it referred to as radiculitis.What is the most common cause of cervical radiculopathy? ›
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.What nerves do C5 C6/C7 affect? ›
From the lateral cord, C5, C6, and C7 supply the pectoralis major and minor muscles, via the lateral and medial pectoral nerves, as well as the coracobrachialis, brachialis and biceps brachii, via the musculocutaneous nerve. The musculocutaneous nerve provides sensation to the skin of the lateral forearm.How is C5 C6 radiculopathy treated? ›
Both prescription and over-the-counter (OTC) medications are used to help relieve C5-C6 vertebral and nerve pain. Common medications include non-steroidal anti-inflammatory drugs (NSAIDs), pain-relieving medication such as opioids and tramadol, and/or corticosteroids.Can you see radiculopathy on MRI? ›
Cervical radiculopathy can be diagnosed with a thorough history and physical examination in many cases, but MRI should be used to confirm the diagnosis. The affected dermatomes can both overlap and vary for a certain nerve root in cervical radiculopathy.
The lower back is the most common area affected by radiculopathy. Thoracic radiculopathy: Thoracic radiculopathy is a pinched nerve that occurs in the upper region of the back, causing symptoms such as tingling, pain and numbness that can extend to the front of the body.Which is worse neuropathy or radiculopathy? ›
However, while radiculopathy is caused by the pinching of root nerves of the spinal column, neuropathy is damage or malfunction of peripheral nerves. It encompasses a much wider array of issues caused by nerve damage.What is the most common level of cervical radiculopathy? ›
Epidemiologic studies have shown that the C7 root (C6-7 herniation) is the most commonly affected, followed by the C6 (C5-6 herniation) and C8 (C7-T1 herniation) nerve roots. Impingement of the nerve root by disc material likely leads to nerve damage both by mechanical and chemical pathways.How can I calm my cervical nerves? ›
- soft cervical collar.
- hot or cold compress.
- practicing good posture.
- nonsteroidal anti-inflammatory drugs (NSAIDs)
If left undiagnosed and untreated, cervical radiculopathy can cause severe neck pain that extends to the chest, arms, upper back, and/or shoulders. Over time, the weakness in the limbs can slow down reflexes, thereby inducing severe incoordination that affects the person's daily life.How can I fix cervical radiculopathy at home? ›
HOW DO YOU FIX A PINCHED NERVE IN YOUR NECK AT HOME?
- REST AND SLEEP. ...
- ADJUSTMENT OF POSTURE. ...
- SWITCH TO AN ERGONOMIC WORKSTATION. ...
- ICE AND HEAT COMPRESS. ...
- OVER-THE-COUNTER PAIN RELIEVERS. ...
- SPLINT. ...
- PHYSICAL THERAPY. ...
- STRETCHING AND YOGA.
Surgery for cervical radiculopathy from a herniated disc should only be considered in those cases when 6 to 12 weeks of nonsurgical treatment fails to relieve neurological deficits in the arm, such as pain, numbness, and/or weakness.Do muscle relaxers help cervical radiculopathy? ›
Muscle relaxers, such as Flexeril or Skelaxin, are used to treat spasm often associated with radiculopathy. Nerve membrane stabilizers, such as Neurontin or Lyrica, help reduce the irritability of pinched nerves that are causing radiculopathy. Opioids are used when pain symptoms are severe.What does cervical radiculopathy pain feel like? ›
In cases where cervical radiculopathy involves pain, it can range anywhere from a dull, general discomfort or achiness to a sharp, shock-like or burning pain. Cervical radicular pain may be felt anywhere from neck all the way down the arm into the fingers.Is massage good for cervical radiculopathy? ›
Your physical therapist also may gently massage the muscles of your cervical spine and shoulder blade area. This helps your muscles relax and improves circulation to promote healing and pain relief.
Applying ice within the first 24 to 48 hours of a flare-up can help minimize inflammation, which can be a source of pain. If it helps, a person can lay down on the back and place a wrapped ice pack beneath the neck or shoulder as an easy way to keep it there for 10 to 20 minutes at a time.Is heat good for cervical radiculopathy? ›
Try to use ice or heat for up to 20 minutes a session. Then, wait a couple of hours before repeating. Over-the-counter medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen can relieve pain and reduce inflammation.Why is cervical radiculopathy so painful? ›
Different nerve roots along your spine extend to different parts of your body. When a nerve root becomes pinched, it can affect the nerves that are attached to it. This is why a pinched nerve (cervical radiculopathy) in your neck can cause pain that radiates down your arm.Is radiculopathy a red flag? ›
|Red Flag||Associated Disorder|
|History of malignancy||Metastatic disease|
Although radiculopathy may be suspected or diagnosed by the person's primary care physician, the condition should be treated by an experienced neurosurgeon. Within neurosurgery, there are sub-specialists whose expertise in treating conditions of the spine.What happens if radiculopathy is left untreated? ›
The longer a person leaves radiculopathy untreated, the higher the risk is for their damage and symptoms to become permanent. In fact, in severe cases, paralysis may occur if radiculopathy is left untreated for an extended period of time.Can a chiropractor treat cervical radiculopathy? ›
One of the most effective pain relief treatments for cervical radiculopathy is chiropractic care. Chiropractors are able to offer manual manipulation to adjust the spine to increase mobility. Another effective technique for treatment is cervical traction.How long does it take to get rid of cervical radiculopathy? ›
Over 85% of acute cervical radiculopathy resolves without any specific treatments within 8-12 weeks. Over 85% of acute cervical radiculopathy resolves without any specific treatments within 8-12 weeks.What are symptoms of C5-C6 nerve compression? ›
The compression of nerve roots in the neck impacts the neck, arms, hands and shoulders with radiating pain. Often, tingling and numbness in these areas are another common symptom of C5-C6 disc bulging. This can lead to muscle weakness and spasms and additional discomfort in the digits of the hands.What fingers are affected by C7? ›
It is suggested that the area of skin innervated by C7 is centred on the index finger, together with the thumb and middle fingers.
C6-C7 Herniated Disc Treatment and Recovery Time
These include physical therapy, better posture, or pain-reducing over-the-counter medication to reach total spine wellness. For major cases, C6-C7 surgery becomes a necessary course of action and injections or several surgical procedures can be conducted.
c5-c6 is one of the most common levels for a cervical disc herniation to occur. A c5-c6 herniated disc can affect the nerves that control the muscles in the arms, neck, shoulders, hands as well as the head, eyes, ears, or thyroid gland.How serious is a bulging disc C5-C6? ›
A bulging or herniated C5-C6 spinal disc can have far-reaching consequences, causing pain symptoms, paresthesia (numbness & tingling), weakness, and paralysis from the lower neck down to the toes!Where does C5-C6 cause pain? ›
C5-C6 (C6 nerve root): Pain, tingling, and/or numbness may be felt in the thumb side of the hand. Weakness may also be experienced in the biceps (muscles in the front of the upper arms) and wrist extensor muscles in the forearms. The C5-C6 disc is one of the most common to herniate.What is the arm squeeze test? ›
Arm Squeeze Test is a clinical test used to distinguish cervical nerve root compression from shoulder disease in case of doubtful diagnosis. Nerve compression syndrome is typically agitated when the middle third of the upper arm is squeezed or compacted.How do they test for cervical radiculopathy? ›
Magnetic resonance imaging (MRI) is the most common imaging study used when checking for cervical radiculopathy because it shows nerves and other soft tissues, such as herniated discs, so clearly.What is C5 C6 radiculopathy? ›
Cervical radiculopathy (CR) is a common pain syndrome characterized by sensorimotor deficits due to cervical nerve root compression and inflammation . In C5 or C6 radiculopathy, the proximal shoulder girdle muscles are commonly involved and it may be difficult for the patients to raise their shoulder .Does radiculopathy show up on xray? ›
In most cases, radiculopathy can be diagnosed with a thorough medical examination. However, further testing may be necessary to determine the cause of the radiculopathy. Possible tests include: X-ray (also known as plain films): test that uses invisible electromagnetic energy beams (X-rays) to produce images of bones.Does radiculopathy ever go away? ›
Most radiculopathy symptoms go away with conservative treatment—for example, anti-inflammatory medications, physical therapy, chiropractic treatment, and avoiding activity that strains the neck or back. Symptoms often improve within 6 weeks to 3 months.Can cervical radiculopathy affect the brain? ›
Cervical Nerves & The Brain
So if you damage a nerve in your low back, your legs may be impacted, but your arms typically won't be. So damage to the cervical nerves may disrupt signals from the brain to other areas of the body, but won't directly damage the brain itself.
Any exercise that incorporates a lot of jumping should be avoided – whether it be skipping rope, basketball, or something else. Generally speaking, strenuous exercises, like jumping, can put unnecessary strain on the area suffering from cervical radiculopathy.What causes radiculopathy flare ups? ›
Symptoms of radiculopathy vary by location but frequently include pain, weakness, numbness and tingling. A common cause of radiculopathy is narrowing of the space where nerve roots exit the spine, which can be a result of stenosis, bone spurs, disc herniation or other conditions.What are 4 of the main causes of cervical radiculopathy? ›
- Cervical Radiculopathy ("Pinched Nerve") When a nerve root leaves the spinal cord and the cervical spine it travels down into the arm. ...
- Pinched nerve from a herniated disc. ...
- Pinched nerve from degeneration and bone spurs. ...
- Medication. ...
- Physical Therapy.
The diagnosis cervical radiculopathy is most commonly based on clinical signs and symptoms that concur with nerve root compression identified via medical imaging (e.g., Magnetic Resonance Imaging (MRI) or computer tomography) .What causes cervical radiculopathy flare ups? ›
A common cause of radiculopathy is narrowing of the space where nerve roots exit the spine, which can be a result of stenosis, bone spurs, disc herniation or other conditions. Radiculopathy symptoms can often be managed with nonsurgical treatments, but minimally invasive surgery can also help some patients.What is the best pain medication for radiculopathy? ›
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of the initial treatment for LBP. With the use of all NSAIDs, elderly patients should be monitored for gastrointestinal (GI) and renal toxicity. Pain control with acetaminophen or a suitable narcotic may be more appropriate for elderly patients.How long does it take for cervical radiculopathy to resolve? ›
Over 85% of acute cervical radiculopathy resolves without any specific treatments within 8-12 weeks. Over 85% of acute cervical radiculopathy resolves without any specific treatments within 8-12 weeks.What does a pain management doctor do for cervical radiculopathy? ›
Pain management approaches that are typically discussed when this condition is diagnosed include pain relievers, cold compresses, physical therapy, and short-term opioid treatment. If these methods are ineffective, steroid injections or a nerve block may be recommended.What kind of doctor do you see for radiculopathy? ›
Although radiculopathy may be suspected or diagnosed by the person's primary care physician, the condition should be treated by an experienced neurosurgeon. Within neurosurgery, there are sub-specialists whose expertise in treating conditions of the spine.When is surgery necessary for cervical radiculopathy? ›
Surgery for cervical radiculopathy from a herniated disc should only be considered in those cases when 6 to 12 weeks of nonsurgical treatment fails to relieve neurological deficits in the arm, such as pain, numbness, and/or weakness.