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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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Cervical Radiculopathy (Arm Pain)

Cervical radiculopathy is the term used to describe radiating nerve pain that begins in the neck region and runs down the shoulder, arm, forearm, and into the hand, and is associated with a neurologic deficit such as numbness or weakness. The term radiculitis indicates that there is only pain, without associated numbness or weakness, shooting down the arm into the hand and fingers. Although radiculopathy and radiculitis can be used to describe the above-mentioned signs and symptoms in the arms or legs, many people often used the term sciatica when referring to lower extremity and back problems.

Causes of Cervical Radiculopathy (Arm Pain)

There are numerous conditions that can cause cervical radiculopathy, but the most common is a herniated disc (herniated nucleus pulposus). When an intervertebral disc is injured and protrudes into the spinal canal, it can impinge on the spinal cord and nerves and cause pain. The pain may be in the neck or arms(s), or both. If the pain radiates into the arms(s), it is called radiculopathy. Other conditions may also cause radiculopathy, such as a bone spur (osteophyte) pinching a spinal nerve, or more rarely a tumor or infection. Conditions affecting the brachial plexus and nerves in the shoulder or the median, ulnar, and radial nerves in the arm and wrist can also cause neurologic dysfunction similar to cervical radiculopathy.

Symptoms of Cervical Radiculopathy (Arm Pain)

Radiculopathy is typically present in one arm only, but occasionally occurs in both arms. The arm and hand symptoms may manifest as a shooting electricity pain down the shoulder, arm, forearm, hand, and into specific fingers. The radicular pain may also have a component of numbness, tingling (parasthesia), and/or weakness. Patients may have difficulty turning their head because of the pain. Shoulder pain that arises from within the shoulder joint, particularly with abduction and raising the arm and shoulder generally indicates a shoulder problem such as bursitis or a rotator cuff injury. This type of pain is called referred pain, when the pain of a nearby joint causes the entire region or extremity to be painful.

Physical Findings of Cervical Radiculopathy (Arm Pain)

Since the majority of patients with cervical radiculopathy have the underlying diagnosis of a herniated disc, the physical findings are usually the same. Patients with cervical radiculopathy may have decrease cervical (neck) range-of-motion, especially rotation (looking from side to side). There may be significant weakness in one or more muscle groups and numbness in a specific dermatomal distribution. Patients with longstanding nerve compression and muscle weakness may demonstrate atrophy (decreased size) of the affected muscle(s), and this may be quite noticeable when comparing it with the opposite arm. Deep tendon reflexes may be diminished or absent for the particular spinal nerve that is affected.

Investigation for Cervical Radiculopathy (Arm Pain)

An MRI of the spine is most useful to evaluate a patient with cervical radiculopathy. An MRI utilizes a powerful magnet and computer system to generate images in three dimensions of all structures, including the intervertebral disc, spinal cord and nerves, muscles, bone, and other soft tissues. Regular x-rays are most useful to evaluate fractures, instability, or arthritis changes of the spine. However, x-rays do not allow one to visualize the soft tissues of the spine such as disc, nerves, or muscles, and usually will not identify the cause of sciatica symptoms.

Diagnosis of Cervical Radiculopathy (Arm Pain)

The diagnosis of radiculopathy is typically made by taking a detailed patient history alone. Physical examination can further clarify the diagnosis. However, an MRI of the cervical spine will often be required to confirm the actual cause of the radicular pain. It is important for the clinician to conduct a thorough history and clinical examination prior to formulating the final diagnosis so as not to misdiagnose this condition.

Treatment Options for Cervical Radiculopathy (Arm Pain)

The natural history of a cervical herniated disc and radiculopathy is favorable, meaning that the majority of patients improve with conservative treatments and do not require surgery. Quite often, patients with cervical radiculopathy will quickly improve with a few days of rest, use of a soft cervical collar, and oral anti-inflammatory medications and pain medications. Muscle relaxant medications can also be used for severe pain and muscle spasms. Cervical epidural steroid injections and/or nerve root blocks may also be utilized for severe pain or moderate pain that is no longer responding to other conservative measures. Surgical options, such as anterior cervical discectomy and fusion or microscopic posterior cervical foraminotomy may be recommended for patients who fail conservative treatments. These surgical treatments, when indicated, demonstrate a high rate of success in relieving pain and restoring function, and often a rapid return to normal activities.

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