Cervical radiculopathy is often referred to as a pinched nerve in the neck. It is characterized by radiating pain from the neck to the shoulder, scapula, arm, or hand. Weakness and lack of coordination in the arm and hand may also occur. The disease affects an average of 85 in 100,000 people, most commonly in people in their 50s. Athletes, heavy workers, and workers using vibration machines are commonly affected. People who sit for a long time or people with arthritis in the neck area can also be affected. Conservative treatment, including physical therapy, can help relieve symptoms. A physical therapist can help relieve acute neck and hand symptoms resulting from this condition, as well as improve overall strength and function. In most cases, cervical radiculopathy resolves with physical therapy and does not require surgery.
What is cervical radiculopathy?
Cervical radiculopathy occurs when the nerve root is compressed by the spinal cord. Compression can occur for a variety of reasons. In young people, this can happen with a herniated disc caused by trauma. In older people, this usually occurs spontaneously as a result of arthritis or a reduction in the height of the discs in the neck.
The cervical spine consists of 7 cervical vertebrae (bones that form the cervical spine). Each vertebra is separated by a gelatinous disk. Discs pad the spine. The spinal cord runs through a canal in the cervical vertebrae. The roots of the spinal nerves originate in the spinal cord and branch out at specific points in the arm. The spinal nerves send signals to our muscles to move, as well as the sensations we feel throughout our arm. The spinal cord is like a tree trunk, and the spinal nerves are like the tree branches. If an impingement or abnormal pressure is placed on a branch near the trunk, everything along that branch will be affected.
Spinal nerves can be impinged by:
· Arthritis or disc wear-and-tear with age
· Herniated or bulging discs from trauma or degeneration
· Spinal stenosis, which is a narrowing of the spaces in which the nerves travel
· Tumor, which can be benign or malignant, impinging the nerve root
When the spinal nerves are impinged, they cannot properly send messages to the muscles from the brain, nor receive proper sensation from the specific arm location the nerve travels. Everywhere the spinal nerve travels will be affected. That is why a pinched nerve in the neck can cause pain, weakness, and loss of sensation in the arm, even though the pinch is in the cervical region.
How is it?
Symptoms of cervical radiculopathy vary depending on the nerve root involved and usually occur on the same side of the body as the affected nerve. Symptoms may include:
Pain in the neck, shoulder blade, shoulder, upper chest, or arm that may radiate down the affected nerve root to the fingers.
Pain described as “sharp,” “tingling,” or “popping” in the neck area.
Generalized dull pain or numbness anywhere along the nerve course.
· Weakness in the shoulder, arm, or hand.
· Pain that worsens with certain neck movements.
· Pain that improves when the arm is lifted over and behind the head (relieving tension on the spinal nerve).
These symptoms may also be specific to the nerve root involved:
· C5 nerve root (between cervical vertebrae C4-C5): weakness in the deltoid muscle (front and side of the shoulder) and upper arm; shoulder pain and numbness
· C6 nerve root (between cervical vertebrae C5-C6): weakness in the bicep muscle (front of the upper arm) and wrist muscles; numbness on the thumb side of the hand
· C7 nerve root (between cervical vertebrae C6-C7): weakness in the triceps muscle (the back of the upper arm and wrist); numbness and tingling in the back of the arm and the middle finger of the affected hand
· C8 nerve root (between vertebrae C7-T1): weakness with hand grip; numbness in the little finger
The most common nerve root levels for this condition are C6 and C7.
How Is It Diagnosed?
If you ask a physiotherapist for help, the physiotherapist will conduct a comprehensive assessment and ask you questions about your pain and your daily activities. These may include:
· How and when did the pain begin: was the pain spontaneous or was there trauma or popping in the neck area?
· Where are the symptoms located and have their location or intensity changed since onset?
What makes symptoms better or worse?
· What do you do for a living?
· What hobbies or household chores do you regularly do?
Your physical therapist will carefully monitor your neck and arm movements. The therapist will check your tendon reflexes and strength, and perform specific tests on your neck and upper limbs to determine which spinal roots may be involved and rule out other disorders. Your family doctor can work with an orthopedist or other healthcare provider to make a definitive diagnosis. The orthopedist may order additional tests such as magnetic resonance imaging (MRI) or electromyography (EMG). An MRI can show soft tissues, including the spinal cord and nerve roots. This test can determine what’s causing the nerve compression, including a bulging or herniated disc. EMG measures the function of nerves and muscles. This test can determine how well your spinal nerves are communicating with your muscles.
How can a physical therapist help?
Physiotherapy is an effective treatment for cervical radiculopathy and in many cases completely eliminates the symptoms. Based on the results of your initial examination, your physiotherapist will create an individual treatment plan. The treatment plan may include:
Pain Relief. The first goal is to reduce pain and inflammation in that area. Ice packs applied to the neck and shoulder blade area for the first 24 to 48 hours after the pain begins will help reduce inflammation. After this time, moist heat can be used to relax the surrounding muscles. Your physical therapist may advise you to wear a soft neck collar from time to time during the day to allow your neck to relax. A neck pillow may be recommended for proper neck support and a more comfortable sleep.
Your physical therapist can teach chiropractic techniques such as B. Use manual cervical traction to relieve pressure in the cervical (neck) area. This procedure can provide immediate relief from pain and numbness radiating down the arm. A light massage can also be performed on the muscles of the cervical spine and shoulder blade region. This method helps muscles relax and improves blood flow to the area, promoting healing and relieving pain.
Posture training is an important part of rehabilitation. Your physical therapist can suggest adjustments to your workplace and work habits to ensure correct posture and protect your neck. In the early stages of recovery, this may mean sitting for only 15 to 20 minutes at a time. You’ll also receive instruction on how to bend, extend, and lift throughout the day in safe positions that put minimal pressure on your spinal discs.
Range of Motion Exercises
Your physical therapist will show you how to perform gentle cervical mobility exercises to relieve your symptoms and allow you to return to normal movements. In the early stages of recovery, it is important that none of these exercises increase the pain that radiates down the arm. It’s important to accurately report your symptoms to your physical therapist. When you spend long hours at your desk during your workday, your neck can become stiff. Your therapist will teach you how to stretch your neck to reduce the strain on your neck from long periods of sitting and improve your mobility.
Your physical therapist will help you decide which muscle groups to strengthen based on which spinal nerves are affected in your particular situation. When the pain stops radiating down the arm, more aggressive strengthening exercises can begin. Neck stability exercises (strengthening exercises) are also performed. You will receive a home exercise program to strengthen your neck, shoulder, arm and upper back long after your formal physical therapy is over.
As your symptoms improve, your physical therapist will work on functional exercises to help you return to work, sports, or other daily activities. For example, if your job tasks require you to reach up, push, pull, and sit for long periods of time, you will be taught how to perform those tasks to reduce excessive strain on your neck.
Can this injury or illness be prevented?
Your physical therapist will talk to you about the best ways to prevent cervical radiculopathy from coming back, including:
Maintaining good posture. Use a supportive pillow and maintain proper posture when seated at a desk or in the car.
· Workplace adjustment to minimize stress on the spine. You may be advised to use a speakerphone or adjust your computer monitor to avoid excessive twisting or stretching of your neck in repetitive directions throughout your workday.
· Continued regular exercise. to maintain the flexibility and strength of the spinal muscles, including the upper body, mid-back and core muscles.
Maintain a healthy weight to minimize unnecessary stress on the spine.