Cervical Radiculopathy: More Than Just A Pinched Nerve?

What is Cervical Radiculopathy?

Cervical radiculopathy is a clinical term describing neural symptoms which originate from the cervical spine (neck). Informally it is known as a ‘pinched nerve’. This condition occurs when the nerve becomes compressed by a bulging disc or bony changes such as stenosis (narrowing) or osteophytes (bone spurs). Once compressed, the nerves become irritated and send unusual signals down the nerve path.

What are the symptoms?

Symptoms usually include pain in the neck and down the arm, as well as weakness, numbness, tingling and pins and needles from the shoulder to the hand and fingers. Many report that their arm feels heavier to raise, feel that their grip is weaker than usual or that their fingers are slower to move (such as when typing on a computer). The area of the neck, shoulder, arm and hand/fingers that people feel these symptoms can indicate which nerve is being affected. For example, pain/numbness/pins and needles felt down the middle of the front of the arm and into the 1^st, 2^nd and/or 3^rd fingers indicate that the nerve root originating from C7-C8 is affected. This is the most commonly irritated nerve root as the canal at C7-C8 is the narrowest found in the cervical spine.

How is it diagnosed?

Immediate scans are often not required with cervical radiculopathy. An assessment conducted by a physiotherapist is often enough to identify which nerve is affected. Your physiotherapist would likely assess your neck movement, strength, sensation and reflexes in order to commit to a definitive diagnosis.

What are the treatment options?

Physiotherapy

This should always be the first line of treatment when dealing with a cervical radiculopathy. There are many techniques that your physiotherapist can incorporate to help not only your symptoms but the source of your symptoms. Treatment can be broken down into 3 phases:

• Reduction: It is important to reduce the pain you are feeling in the acute stage which tends to be inflammatory in nature. This can be done with manual techniques and identifying movements and exercises that are relieving. Treatment techniques may include massage, dry needling, cervical traction, mobilisations and exercises to help offload the structures which may be compressing the nerve.
• Maintenance: As the pain begins to settle, it is usually recommended to continue the exercises for a few more weeks. It is important to maintain good posture and avoid aggravating movements/positions during this time.
• Recovery & Prevention: Once the acute symptoms have subsided, it is important that other factors that may have contributed to the onset of your cervical radiculopathy are identified and rectified. This may include poor muscle activation, poor posture or poor work setup.

Medication

Your doctor may provide you with medication to help reduce the inflammation and irritability.

Injections

When oral medications are not helpful in reducing inflammation, steroid epidural injections can be used to reduce pain in the short-term with long lasting relief in some cases.

Surgery

This is the last resort and only for those patients suffering from significant neurological symptoms who have failed all conservative methods of treatment. The most common surgical procedure is Anterior Cervical Disc Fusion. Another option for surgery includes Posterior Cervical Laminectomy while Anterior Disc Replacements are becoming more common. Surgery aims to offload the nerve when there is bony spurs and/or significant disc herniation.

If you have been experiencing one or more symptoms mentioned above, get in contact with the team here at Invigorate Health and Performance to help manage your symptoms and get you back on track!

Nicholas Dimos (Physiotherapist)