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Cervical Radiculopathy (Pinched Nerve)

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Some people have neck pain that may radiate into the shoulder and arm. This type of pain is often caused by an injury near the root of a spinal nerve. A nerve root injury is sometimes referred to as a “pinched” nerve. The medical term for this condition is cervical radiculopathy.

Understanding your spine and how it works can help you better understand cervical radiculopathy.

Causes of Cervical Radiculopathy (Pinched Nerve):

As the disks lose height, the vertebrae move closer together. The body sees the collapsed disk as a possible weak area and responds by forming more bone called spurs around the disk to strengthen it. The bone spurs that form also contribute to the stiffening of the spine. Bone spurs may also narrow the area of the forearm and pinch the nerve root.

The disk changes that occur with age are often called arthritis or spondylosis. It is important to keep in mind that all these changes are “normal” and they occur in everyone. In fact, if MRI scans were performed on all people aged 50 or older, nearly half of the scans would show worn disks and pinched nerves that do not cause painful symptoms. It is not known why some patients have symptoms and others do not.

Symptoms of Cervical Radiculopathy(Pinched Nerve):

Cervical radiculopathy pain travels down the arm in the area of the involved nerve. Pain is usually described as sharp. There can also be a “pins and needles” sensation or even complete numbness. In addition, there may be a feeling of weakness with certain activities.

Symptoms can be worsened with certain movements, like extending or straining the neck or turning the head. These symptoms are often made better by placing the hand on the head and stretching the shoulder.

Radiologic Investigation of Cervical Radiculopathy(Pinched Nerve):

X-rays

X-rays can show the alignment of bones along the neck. They can also show any narrowing of the foramen and disks.

Computed tomography (CT)

CT scans show the bones of the neck in finer detail. Bone spurs can be seen with CT, especially spurs near the foramen.

Magnetic resonance images (MRI)

An MRI of the neck can show if nerve compression is caused by soft tissue, such as a bulging disk and herniations. MRI can also show the appearance of the spinal cord and nerve roots.

Electromyelography

Electromyography and nerve conduction studies may be able to help show the difference between symptoms caused by pressure on spinal nerve roots and nerve damage caused by other ailments, such as diabetes.

Treatment of Cervical Radiculopathy (Pinched Nerve):

It is most important to note that the majority of patients with cervical radiculopathy get better with time and never need surgery, or even any treatment at all.

Some patients will have the pain go away quickly over days to weeks, while others take longer. It is also not uncommon for cervical radiculopathy to come back at some time in the future, but again, this problem usually gets better without any specific treatment. Some patients do develop persistent symptoms and require evaluation and treatment for the arm pain or weakness.

Nonsurgical Treatment

If you are not getting better, your surgeon will recommend a course of treatment. Treatment for radiculopathy starts with nonsurgical options.

Soft Collars. Soft collars allow the muscles of the neck to rest and limit neck motion. This can help decrease pinching of nerve roots with movement. Soft collars should only be worn for short periods of time, because long-term wear can decrease the strength of neck muscles.

Physical Therapy. Physical therapy can help with neck muscle stretching and strengthening. Sometimes, traction is also used.

Medications.

  • Nonsteroidal anti-inflammatories (NSAIDS). These include drugs like aspirin and ibuprofen, and may be helpful if the arm symptoms are from nerve swelling..
  • Spinal injections. Sometimes, an injection of steroids can be placed near where the nerve is being pinched. This takes advantage of the anti-inflammatory effects similar to oral steroids. The injection may be placed between the laminae (epidural steroid injection), in the foramen (selective nerve injection), or into the facet joint.While steroid injections do not take the pressure caused by a narrow foramen or herniated disk off the nerve, they may lessen the swelling and relieve the pain enough to allow the nerve to recover with more time.

Surgical Treatment

There are several surgical procedures for radiculopathy. The procedure that is right for you will depend on many factors, most importantly the type of problem you have.

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Nerve Injuries

Nerves are fragile and can be damaged by pressure, stretching, or cutting. Injury to a nerve can stop signals to and from the brain, causing muscles not to work properly, and a loss of feeling in the injured area.

Anatomy of Nerve

Nerves are part of the “electrical wiring” system that carries messages between the brain and the rest of the body. Motor nerves carry messages between the brain and muscles to make the body move. Sensory nerves carry messages between the brain and different parts of the body to signal pain, pressure, and temperature.

A ring of tissue covers the nerve, protecting it just like the insulation surrounding an electrical cable. Nerves are composed of many fibers, called axons. These axons are separated into bundles within the nerve. The bundles are surrounded by tissue layers, just like the outer tissue layer that surrounds the nerve.

Causes of Nerve Injuries

Pressure or stretching injuries can cause fibers within the nerve to break. This may interfere with the nerve’s ability to send or receive signals, without damaging the cover.

When a nerve is cut, both the nerve and the insulation are severed. Sometimes, the fibers inside the nerve break while the insulation remains intact and healthy. If the insulation has not been cut, the end of the fiber farthest from the brain dies. The end that is closest to the brain does not die. After some time, it may begin to heal. New fibers may grow beneath the intact insulating tissue until it reaches a muscle or sensory receptor.

If both the nerve and insulation have been severed and the nerve is not fixed, the growing nerve fibers may grow to form a painful nerve scar, or neuroma.

Treatment

Surgical Treatment

The insulation around both ends of the injured nerve is sewn together. The goal in fixing the nerve is to save the insulating cover so that new fibers can grow and the nerve can work again.

If a wound is dirty or crushed, surgery may be delayed until the skin has healed.

If there has been some loss, leaving a space between the ends of the nerve, it may be necessary to take a piece of nerve (nerve graft) from a donor part of the body to fix the injured nerve. This may cause permanent loss of feeling in the area where the donor nerve graft was taken.

Once the insulating covering of the nerve is repaired, the nerve generally begins to heal three or four weeks after the injury. Nerves usually grow one inch every month, depending on the patient’s age and other factors. With an injury to a nerve in the arm above the fingertips, it may take up to a year before feeling returns to the fingertips. The feeling of pins and needles in the fingertips is common during the recovery process. While this can be uncomfortable, it usually passes and is a sign of recovery.

Therapy

Several things can be done to keep up muscle activity and feeling while waiting for the nerve to heal.

Physical therapy will keep joints flexible. If the joints become stiff, they will not work, even after muscles begin to work again.

If a sensory nerve has been injured, care must be taken not to burn or cut fingers because there is no feeling in the affected area.

With a nerve injury, the brain may need to be “re-educated.” After the nerve has recovered, sensory re-education may be needed to improve feeling to the hand or finger. This involves physician therapy and the appropriate therapy based on the nature of the injury will be recommended by the physician.

Factors that may affect results after nerve repair include age, the type of wound and nerve, and location of the injury. Although nerve injuries may create lasting problems for the patient, care by a physician and proper therapy help two out of three patients return to more normal use.