Cervical Radiculopathy is a clinical term describing neurological symptoms originating from the cervical spine (neck) which is irritated. This is commonly called “pinched nerve”. The nerve roots from the cervical spine may be compromised by many structures in the neck.
What are the Causes?
There could be many reasons to cause cervical radiculopathy. It could be due to a disc prolaspe in the cervical spine, or bony changes like stenosis and osteophytes (bone spurs)impacting the canals where the nerve runs through. In middle aged to elderly, it is more common to have degenerative changes causing these symptoms. Whilst in the younger popluation, it is more likely a disc prolapse or trauma.
What are the symptoms?
Symptoms usually include pain, weakness and or numbness to shoulder down to the fingers. This can be in a determatomal pattern depending on which level the affected cervical segment is. Most people feel pins and needles and may experience weakness like inability to grip or lift.
How is it diagnosed?
Immediate scans are not always required with cervical radiculopathy. Careful clinical findings and assessment by a Physiotherapist can identify the symptoms. Your neck movements, strength, sensation, reflexes and some special tests may be assessed. Other diagnostic tests may involve a plain X-Ray, MRI, nerve conduction tests may also be used in conjunction.
What are the treatment options?
There are many options when it comes to treating cervical radiculopathy. This depends on the level of pain, level of irritability, length of symptoms and if there are any abnormal signs.
- Medication – Your doctor may prescribe oral steroids or NSAIDS (Anti-inflammatories) to help reduce inflammation and irritability.
- Injections – when oral medications are not effective to help reduce the inflammation, steroid epidural injections via X-Ray to the affected level can be effective in reducing pain in the short and long term.
- Physiotherapy – There are many techniques we use to help with cervical radiculopathy. Treatment is usually broken down into 3 phases
- Reduction – Your Physiotherapist is trained to assess the severity of your problem. It is very important to reduce the acute pain which may be inflammatory in nature and to identify movements and exercises which help relieve the arm pain. Treatment may include traction, manual therapy and exercises to help offload structures compressing on the nerve. Specific exercises to restore neck range of movement, strengthening exercises, Mechanical Diagnosis & Therapy (Mckenzie) exercises, dry needling, massage are some techniques Physiotherapists use. You may be recommended supports , postural rolls to help with your problem.
- Maintenance – As the pain starts to settle and the correct exercises are utilized, we recommend to continue the exercises which have been effective for a period of time until the pain has subsided. This could be up to 4- 6 weeks. It is important to maintain good posture during this period to prevent recurrences.
- Recovery & Prevention – Once the pain has settled and depending on what activity or goals you’d like to return to, your Physiotherapist will be able to identify other factors that may cause recurrence like poor muscle activation, poor work setup etc. The aim is to be able to return to previous activity pain free.
- Surgery – This is the last resort for those who have failed conservative treatment or if there are significant neurological symptoms. The most common procedures are Anterior Cervical Disc Fusion (where the cut is made through the front and the vertebraes are fused). Other procedures include Posterior Cervical Laminectomy (where the cut is made from the back). Anterior Disc Replacements are also increasingly common as well. Surgery can offload the nerve when there is bony spurs and large disc herniation.
Blog By Stephen Lee (Physiotherapist, Cred Mckenzie Therapist)