The cervical (neck) spine has seven vertebrae (bones). Cervical radiculopathy, or pinched nerve, is damage to a nerve root near these vertebrae. The seventh and sixth nerve roots are most often affected. It’s a common problem, affecting most adult age groups. It’s less common in teenagers and children.
Anything that puts pressure on nerves where they leave the spine can cause symptoms. Causes include sudden injuries, pressure from ruptured (burst) disks, and degenerative bone changes (as in arthritis). Spinal instability and cancer are others. Younger people usually have disk herniations (bulges) or acute injuries. Older people often have degenerative bone changes.
Symptoms depend on which root is involved. The main symptom is pain spreading into the arms, neck, chest, or shoulders. Muscle weakness, numbness, tingling in fingers or hands, lack of coordination (especially in hands), and headaches are others. Reflexes in upper arm muscles are usually affected. Moving the neck can make pain worse.
The health care provider takes a careful history and does a physical and sensory examination. It’s important to know how long symptoms lasted and whether they’ve gotten worse. The health care provider tests deep tendon reflexes. Because about 80% of people improve without treatment, imaging isn’t often needed. However, if symptoms persist, the health care provider can order magnetic resonance imaging (MRI), the best study. X-rays, computed tomography (CT), provocative tests, and maybe electromyography (EMG) and selective diagnostic nerve root block (SNRB) can also be done to determine how severe the radiculopathy is.
Treatment depends on the cause but aims to reduce pain and inflammation (swelling). First, nonoperative measures such as immobilization (keeping the neck still) in bed, local icing, and soft neck collar are used. The collar is worn for 1–2 weeks. A cervical pillow at night can help position the neck. Physical therapy for pain and inflammation may include gentle cervical traction, mobilization, and neck-strengthening exercises. Traction relieves muscle spasms. Traction with weights, by using a head halter, is usually applied at home. Electrical stimulation can calm muscle spasms and pain. Acupuncture is another option. Drugs including steroids and the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen and naproxen sometimes help. Most people get better without surgery. If other treatments don’t work, surgery may be needed. Types of surgery include foraminotomy (making the passage for the nerve root bigger), discectomy (removing the disk where it presses against a nerve), and fusion (joining two or more bones into one).
For prevention and rehabilitation, certain activities (such as heavy lifting) are restricted and using proper sports technique (e.g., tackling in football) is important.
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Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.
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