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.
Causes of Cervical Radiculopathy
As disks age, they lose height and begin to bulge. They also lose water content and become stiffer.
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 foramen 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
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 actvities.
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.
Treatment of Cervical Radiculopathy
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 persistant symptoms and require evaluation and treatment for the arm pain or weakness.
If you are not getting better, our 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.
- Nonsteroidal anti-inflammatories (NSAIDS). These include drugs like aspirin and ibuprofen, and may be helpful if the arm symptoms are from nerve swelling.
- Narcotics. These medications are reserved for patients with severe pain that is not relieved by other options. Narcotics are usually prescribed for a limited time only.
- Spinal injections.Sometimes, an injection of anti-inflammatory medicine can be placed near where the nerve is being pinched. This takes advantage of the anti-inflammatory effects similar to oral medicines. The injection may be placed between the laminae (epidural injection), in the foramen (selective nerve injection), or into the facet joint.While 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.
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.