Cervical Radiculopathy/Radiating Neck Pain

Cervical radiculopathy happens when a pinched nerve in the neck (cervical spine) causes pain.

Radicular pain can extend beyond the neck and radiate down:

• The shoulders
• Arms
• Fingers

This type of nerve compression also causes:

• Weakness
• Numbness
• Tingling
• Reflex problems

The neck consists of 8 pairs of nerves that control several motor (strength) and sensory (feel) functions.

The cervical nerve roots at the top send movement and feeling signals to the head and neck, and the nerves at the bottom enable motor and sensory function to the arms and hands.

 

If one or more of the spinal nerves in the neck gets pinched, it can disturb its ability to function correctly.

This radiates pain in the neck and other areas of the body.

This condition can affect anyone but usually affects middle-aged adults.

Men also tend to develop cervical radiculopathy more than women.

Causes

The natural aging process on the spine is what usually causes cervical radiculopathy.

The spine goes through the aging process just like the rest of the body and even more as it is the basis of our structure.

This process can lead to several degenerative spinal disorders that include:

• Cervical spondylosis (osteoarthritis)
• Spinal stenosis
• Herniated discs

When nerve passageways begin to narrow, intervertebral discs begin to protrude,  and bone spurs caused by these disorders can pressure the nerves in the neck.

A traumatic injury can also cause the condition to the neck like whiplash or sports injury.

Rarely is it caused by an infection or spinal tumor.

 

Symptoms

The primary symptom is pain radiating from the neck down to the:

• Shoulders
• Arms
• Hands
• Fingers

The above is an example of sensory function related to feeling.

In addition to sensory symptoms, radiculopathy can also cause motor dysfunction.

Motor dysfunction relates to muscles and movement.

Reflex changes in the neck and upper body and weakness are examples of motor dysfunction.

Diagnosis

A spine specialist/chiropractor has several tools to diagnose cervical radiculopathy.

First and foremost, your medical history will be reviewed, and then will be:

• Asked to describe symptoms

A physical exam will be conducted to recreate the pain in a controlled manner in the:

• Neck
• Shoulder
• Arms

Example: Spurling’s maneuver gently rotates the head while applying gentle pressure.

Once the information from the medical history and physical exam is done,  imaging tests such as an MRI may be ordered so they can pinpoint the location of the nerve compression.

MRI scans show the soft tissues in the spine, including the nerves.

The doctor may request a pair of diagnostic tests called electromyogram (EMG) and nerve conduction exam if there are significant upper nerve arm and neck pain.

These tests help understand if there is nerve damage, the cause and if the symptoms are related to the nerve damage.

EMG and nerve conduction tests are usually performed together to help in the diagnosis.

Emergency Symptoms

Once the spine specialist confirms the diagnosis, they will develop a treatment plan to relieve the nerve compression or prevent it from worsening.

Most cases are taken care of with non-surgical treatment; however, if the following occurs, you should contact your doctor:

• Neck pain does not improve with treatment in the time your doctor expects.
• Pain worsens regardless of treatment.

Or you develop new:

• Numbness
• Weakness in the
• Neck
• Arms
• Upper body
• Develop fever

If you experience symptoms in the lower body like:

• Weakness in the leg
• Difficulty walking
• Lack of bowel/bladder function, then seek medical attention immediately.

These symptoms may indicate cervical myelopathy, a more severe condition.

Cervical myelopathy is the compression of the spinal cord.

When the spinal cord gets compressed, it can generate widespread spine issues and usually requires surgery.

Treatment Cervical Radiculopathy

Like most types of spine pain, a doctor will recommend trying one or more conservative treatments first.

Conservative treatments are nonsurgical means.

It’s important to understand that just because a treatment is considered conservative does not mean it is ineffective.

In fact, it’s quite the opposite. Most people with nerve compression in their neck respond well to conservative therapies.

Though research on the efficacy of conservative treatments for cervical radiculopathy has produced mixed results, findings show that these therapies help eliminate pain and other nerve-related symptoms (like numbness and muscle weakness) in 40-80% of people.

 

The following are the most common conservative treatments:

• Over-the-counter medications, like acetaminophen (Tylenol) or nonsteroidal anti-inflammatory medications (ibuprofen, Motrin)
• Prescription medications, like steroids (prednisone), neuropathic agents (gabapentin, pregabalin), and muscle relaxants (baclofen, cyclobenzaprine)
• Wearing a neck brace
• Physical therapy and exercise to strengthen the neck muscles and improve motion
• Cervical spinal traction can be performed during physical therapy
• Avoiding strenuous activity, but don’t avoid all activity, as too much rest can exacerbate the injury and extend the recovery time

These conservative treatments can go on for 6 to 8 weeks. If there is no improvement or it worsens, a doctor may want to step you up to the next level.

This may include steroid injections.

Spinal Injections

Cervical epidural steroid injections are considered a second-line treatment for radiculopathy that is not responding to conservative therapy. These injections send a dose of anti-inflammatory medicine into specific nerve roots that can relieve pain.

The number of injections differs from patient to patient. A doctor will make recommendations based on the condition and response to the first injection.

If the first injection reduces the pain and symptoms, a second or third injection might not be necessary unless symptoms recur.

If more than one is needed, they are given 3 weeks between each injection.

Injections can help manage pain and inflammation but cannot strengthen or improve the flexibility of the cervical muscles.

Because of this, a doctor may prescribe physical therapy, chiropractic, or an exercise program to condition the neck muscles.

Surgery Considered

When surgery is needed, it is considered a last resort option. This is not a guaranteed solution, and there are risks and complications.

Different types of surgical approaches are available. These procedures can be performed minimally invasively in a hospital or outpatient surgery center.

Discussing options with a doctor and whether you are a candidate for minimally invasive surgery or not, along with other types of surgery e.g. artificial disc, is a discussion that is different for everybody, as some patients have existing medical conditions that can increase risks and complications.

Anterior cervical discectomy and fusion (ACDF)

This approach is the most widely used surgical approach.

The surgeon makes an incision through the front of the neck, removes the damaged intervertebral disc, fills the space with spacers to restore the height, and attaches spinal instrumentation (plate, screws) for stabilization.

A bone graft is packed into and around the body spacers for bone ingrowth and healing.

Posterior cervical foraminotomy

Here, the surgeon accesses one or more levels of the cervical spine with an incision in the back of the neck.

Foraminotomy decompresses the nerve root by removing whatever is compressing the nerve, like a bone or soft tissue.

The procedure opens/widens the neural foramen or the nerve passageway where the nerve exits the spinal canal.

Cervical artificial disc replacement (C-ADR)

Here an artificial disc device is implanted in the empty disc space.

C-ADR is like a shock absorber and enables healthy movement like an actual disc.

Conclusion

A compressed nerve in your neck can lead to radiating pain. This pain can make it almost unbearable to do simple tasks, even moving the neck from side to side or just opening a jar. Conservative treatment like chiropractic and exercise can ease the pain of this condition and restore function. Fortunately, surgery is rarely necessary.

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Chiropractic Care Neck Pain Treatment

 

 

Alfonso J. Ramirez, now retired, found follow-up treatment with Dr. Alex Jimenez for his neck pain. Mr. Ramirez experienced chronic pain and headaches, but after receiving chiropractic care, he found relief from his symptoms. Since then, Mr. Ramirez has continued to maintain the alignment of his spine with Dr. Jimenez. Mr. Ramirez is grateful for the chiropractic care he’s received for his neck pain and for his shoulder and knee pain. Mr. Ramirez recommends Dr. Jimenez as the non-surgical choice for neck pain.

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NCBI Resources

Approximately two-thirds of the population is affected by neck pain at any time throughout their lives. Pain that originates in the cervical spine, or upper spine, can be caused by numerous other spinal health issues. Joint disruption in the neck can generate a variety of other common symptoms, which include headaches, head pain, and migraines. According to statistics, neck pain affects about 5 percent of the global population.