Cervical Radiculopathy

Cervical radiculopathy is the medical term for a pinched nerve in the neck. The neck has seven cervical vertebrae (C1 to C7) and eight cervical nerve roots (C1 to C8). Nerve roots leave the spinal cord between the vertebrae in the neck and travel to the shoulders, arms and hands. In cases of cervical radiculopathy, a nerve root becomes irritated where it leaves the spinal cord.

Causes of Cervical Radiculopathy

The two most common causes of cervical radiculopathy symptoms are:

• Bone spurs (osteophytes), which commonly form as people age due to degenerative changes in the spine. Cervical radiculopathy symptoms occur when spurs begin to press on the nerve roots.
• A herniated disc, which occurs when the outside layer of an intervertebral disc tears, causing the inner substance (nucleus pulposus) to protrude from the disc. If the tear occurs on the side next to the spinal canal, the pulposus can cause a pinched nerve and lead to cervical radiculopathy.

Cervical radiculopathy may also occur as a result of an acute injury to the neck.

Cervical Radiculopathy Symptoms

Cervical radiculopathy symptoms usually begin in the neck, eventually spreading to the shoulder, arm or hand where the pinched nerve travels. The affected location usually indicates which nerve or set of nerves is involved. For example, a weakness in the shoulder may indicate that nerve C5 is affected, whereas weakness in the thumb extension or wrist could indicate a problem with the nerve called "C8."

In addition to cervical radiculopathy pain in the shoulder, arm or hand, other possible symptoms include:

• Altered reflexes in the upper arm
• Headaches in the back of the head (occipital headaches)
• Neck (cervical) pain
• Numbness and weakness in the shoulder, arm or hand.

Certain movements, such as extending the neck or turning the head, can worsen cervical radiculopathy symptoms. Often, placing the hand on the head and stretching the shoulder improves symptoms.

Treatment of Cervical Radiculopathy Pain

Mild cervical radiculopathy often improves on its own, even without treatment. However, persistent symptoms of arm pain or weakness require medical attention.

Your doctor will most likely prescribe non-steroidal anti-inflammatories (NSAIDs) to treat cervical radiculopathy pain, although stronger drugs may also be considered. These medications help to control:

• Inflammation
• Muscle spasms
• Pain
• Sleep problems.

Other treatment options include:

• Chiropractic care to help with back or neck (cervical) pain
• Physical therapy to improve neck muscle flexibility and strength
• Soft cervical collars to limit neck motion and rest neck muscles, to decrease pinching of nerve roots with movement. (These should only be worn for short periods of time to avoid loss of muscle strength.)
• Traction or spinal decompression.

If other treatments don't work, a nerve block (steroid injection) may help decrease cervical radiculopathy pain and swelling, allowing the nerve to heal. However, this treatment doesn't always work and is often a last-resort option before surgery.

If other treatments don't work or radiculopathy symptoms become severe, surgery may be necessary to relieve the cause of the nerve compression.

Preventing Cervical Radiculopathy

Although you may not be able to prevent the causes of cervical radiculopathy, you can reduce your risk by:

• Avoiding high-risk situations that can lead to injury
• Avoiding improper lifting or repetitive strenuous activities
• Following good health practices, such as good nutrition, regular exercise and not smoking to slow down spinal degeneration
• Using good body mechanics and posture.

Resources

American Academy of Orthopaedic Surgeons (AAOS) Staff. (2010). Cervical radiculopathy (pinched nerve). Retrieved March 29, 2010, from the AAOS Web site: http://orthoinfo.aaos.org/topic.cfm?topic=A00332

Malanga, G.A. (2009). Cervical radiculopathy. Retrieved March 29, 2010, from the eMedicine Web site: http://emedicine.medscape.com/article/94118-overview

University of Maryland Spine Program Staff. (n.d.). A patient's guide to cervical radiculopathy. Retrieved March 29, 2010, from the University of Maryland Medical Center Web site: http://www.umm.edu/spinecenter/education/cervical_radiculopathy.htm