What Is A Cervical Radiculopathy?
Cervical radiculopathy (CR) is a condition resulting from compression or irritation of the cervical nerve roots. The clinical presentations are variable and can include neck and upper limb pain, pins and needles that radiate into your shoulder and/or arm, motor deficits, reduced reflexes, or any combination of these (Iyer & Kim, 2016).
CR typically occurs due to degeneration of the cervical spine, compression from the spinal discs or less commonly as a result of trauma. One of the most common causes of CR is cervical spondylosis. This refers to degenerative changes that occur in the cervical spine, leading to decreased intervertebral disc height and reduced diameter of the intervertebral foramen (where the nerve passes through the spine), contributing to nerve root compression.
Physiotherapy assessment for cervical radiculopathy.
The incidence of CR generally peaks in those over 40 (Iyer & Kim, 2016). The diagnosis is primarily based on clinical signs and symptoms. Magnetic resonance imaging (MRI) of the cervical spine usually indicates the radiculopathy is caused by spondylosis (vertebral disc degeneration) or a herniated disc (Kuijper et al., 2009).
Relevant Anatomy
The cervical spine is composed of seven vertebrae and eight nerve roots that originate from the spinal cord. Each nerve root exits the spine through the intervertebral foramen, each bordered by joints that can be subject to degeneration and inflammation. This can cause compression of the spinal nerves resulting in the common symptoms of CR, such as neck pain radiating to the arm and fingers. The varying clinical presentations correspond to the spinal level of injury. Where you experience your symptoms depends on which spinal level is irritated and thus, which nerve root is affected. The most commonly affected areas of the neck are a C6 or C7 radiculopathy.
Treatment
If you begin to experience any neck pain radiating to the arm, the team here at Keilor Road Physiotherapy are specialists in performing a comprehensive physical examination to confirm your diagnosis. This will include which structures are involved in your injury and the expected timeframe to return to doing what you love.
Cervical radiculopathy treatment.
Following your assessment, your physiotherapist here at Keilor Road Physiotherapy will discuss a thorough and individualised management plan. This will include personalised goals, factors contributing to your injury, a timeframe to expect a full recovery from your neck pain and the various cervical radiculopathy treatment techniques that will be utilised in your management.
Initial management will aim to address the presenting symptoms and pain. This may be achieved with soft tissue techniques, patient education and relevant pain management strategies. Successful treatment of CR involves various modes of treatment. Recent national guidelines for the non-operative management of CR support the use of patient education, non-steroidal anti-inflammatory medication, individualised physical activity, motor control exercise and manual therapy (Kjaer, Kongsted, & Hartvigsen, 2017).
Medications
As there is often an inflammatory cause for the pain experienced with CR, non-steroidal anti-inflammatory drugs (NSAIDs), e.g. Voltaren and Nurofen, can be useful in reducing symptoms. Reducing inflammation and therefore compression of the nerve root can aid a quicker resolution of pain and recovery. Please ensure you seek professional advice from your GP and pharmacist.
Manual Therapy
Physiotherapists can apply manual therapy techniques especially in the acute stage of treatment. Manual therapy can reduce neck pain, neural sensitivity and improve cervical spine range of motion. Commonly used techniques include soft tissue massage, mobilisations and manual traction. It is important that manual therapy is complimented with appropriate exercise therapy for a comprehensive management plan.
Exercises
Strengthening exercises are important in the management of CR. Our expert physiotherapists can work with you to identify the most appropriate and effective exercises for your presentation. Strengthening can assist in recovery and address contributing factors of your neck pain. Tailored exercises to address not only the symptoms but target the underlying cause of the injury can assist in preventing re-injury. Common areas of focus include the muscles acting on your neck, shoulder and back, such as the cervical extensors, deep neck flexors and upper trapezius muscles.
Neural tissue mobilisations may also be used as part of your treatment. They can reduce inflammation and pain and lead to improved movement and function. The type of neural tissue mobilisations used depend which spinal level and nerve is affected.
Surgery
Evidence highlights favourable outcomes for conservative management, however, surgery is an option. Surgery is considered if pain persists following 6-12 weeks of conservative treatment or if there is progression of neurological impairments (Fehlings et al., 2017).
If you are experiencing any neck pain or pain referring into your arm, book an assessment with one of our expert physiotherapists. Niddrie, Essendon, Airport West, Keilor & Melbourne’s Northern suburbs for over 40 years, you can book with one of our expert physiotherapists below or call 93794557 to speak to one of our admin superstars.
Related links
References
Iyer, S., Kim, H.J. Cervical radiculopathy. Curr Rev Musculoskelet Med 9, 272–280 (2016). https://doi.org/10.1007/s12178-016-9349-4
Kuijper B, Tans JT, Schimsheimer RJ, van der Kallen BF, Beelen A, Nollet F, de Visser M. Degenerative cervical radiculopathy: diagnosis and conservative treatment. A review. Eur J Neurol. 2009 Jan;16(1):15-20. doi: 10.1111/j.1468-1331.2008.02365.x. PMID: 19087147.
Kjaer, P., Kongsted, A., Hartvigsen, J. et al. National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. Eur Spine J 26, 2242–2257 (2017). https://doi.org/10.1007/s00586-017-5121-8
Fehlings MG, Tetreault LA, Riew KD, Middleton JW, Aarabi B, Arnold PM, Brodke DS, Burns AS, Carette S, Chen R, Chiba K, Dettori JR, Furlan JC, Harrop JS, Holly LT, Kalsi-Ryan S, Kotter M, Kwon BK, Martin AR, Milligan J, Nakashima H, Nagoshi N, Rhee J, Singh A, Skelly AC, Sodhi S, Wilson JR, Yee A, Wang JC. A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression. Global Spine J. 2017 Sep;7(3 Suppl):70S-83S. doi: 10.1177/2192568217701914. Epub 2017 Sep 5. PMID: 29164035; PMCID: PMC5684840.
Article by
John Keller | Clinical Director
Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.