Cervical Radiculopathy: Understanding Pinched Nerves in the Neck
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on September 6, 2024
Cervical radiculopathy is a condition caused by the compression of a nerve root in the neck, often due to herniated discs, bone spurs, or spinal degeneration. This compression can lead to symptoms like pain, numbness, or weakness that radiate into the shoulder, arm, or hand. The condition affects about 83 per 100,000 people annually, with a higher prevalence in individuals aged 40 to 60 years. Cervical radiculopathy can significantly impact daily activities and work, leading to reduced physical function and quality of life.
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Definition of cervical radiculopathy
Cervical radiculopathy
A condition where a nerve root in the neck is compressed or irritated, often due to issues like herniated discs or bone spurs. This compression disrupts nerve function, causing pain, numbness, or weakness that radiates into the shoulder, arm, or hand.
Radiculopathy
Meaning "root disease," affecting nerve roots as they exit the spine. In the cervical region, it specifically involves nerve roots in the neck. The term "pinched nerve" describes this compression, which leads to the symptoms of radiculopathy.
Anatomy of the cervical spine
Cervical vertebrae structure
The cervical spine comprises seven vertebrae (C1 to C7) in the neck. These vertebrae are smaller and more flexible, with central bodies, vertebral arches, and transverse processes that protect the spinal cord and support movement.
Cervical nerve roots and functions
Nerve roots exit the spinal cord through openings between the vertebrae, extending to the shoulders, arms, and hands. They are responsible for transmitting sensory and motor signals between the spinal cord and upper body.
Cervical radiculopathy
Cervical radiculopathy occurs when these nerve roots are compressed by herniated discs, bone spurs, or other issues, leading to pain, numbness, or weakness in the areas served by the affected nerve.
Causes of cervical radiculopathy
Herniated disc: Occurs when the soft inner gel of a disc protrudes through its outer layer, compressing nearby nerve roots. It's a common cause of radiculopathy.
Degenerative disc disease: Age-related wear and tear on discs can reduce their height and elasticity, leading to nerve root compression.
Bone spurs (Osteophytes): Bony growths that form on the vertebrae due to arthritis can encroach on nerve roots, causing radiculopathy.
Spinal stenosis: Narrowing of the spinal canal can compress nerve roots, leading to symptoms of radiculopathy.
Trauma or injury: Accidents or injuries to the neck can damage discs, vertebrae, or ligaments, potentially causing nerve root compression and radiculopathy.
Signs and symptoms of cervical radiculopathy
Neck pain: Typically sharp or aching, often localized in the neck and can worsen with movement or certain positions.
Radiating arm pain: Pain often travels from the neck down the arm, following the path of the affected nerve root, which can vary depending on the specific nerve involved.
Numbness and tingling: Usually felt in the arm, hand, or fingers, often in a specific pattern related to the affected nerve root.
Weakness: May affect specific muscle groups in the arm or hand, such as grip strength or the ability to lift objects, depending on the nerve root involved.
Changes in reflexes: Diminished or absent reflexes in the arm can indicate nerve root involvement and dysfunction.
Risk factors
Age-related changes: As people age, spinal discs lose elasticity and height, increasing the risk of conditions like herniated discs and degenerative disc disease.
Occupational factors: Jobs involving repetitive neck movements, heavy lifting, or prolonged sitting can increase the risk of cervical radiculopathy.
Genetic predisposition: A family history of spinal disorders can make individuals more susceptible to cervical radiculopathy.
Lifestyle factors: Smoking, obesity, and a lack of exercise can contribute to spinal degeneration and increase the risk of developing cervical radiculopathy.
Diagnosis of cervical radiculopathy
Physical examination: Doctors assess neck pain, range of motion, and neurological symptoms like muscle weakness, reflex changes, and sensory loss.
Neurological tests: These tests evaluate nerve function, including muscle strength, reflexes, and sensation to identify affected nerves.
Imaging studies:
X-ray: Shows bone structure and can detect degenerative changes but has limited detail on soft tissues.
MRI: Provides detailed images of soft tissues, including discs and nerves, to identify herniations or nerve root compression.
CT scan: Used when MRI is not available or suitable; provides detailed images of bone and can help identify bony abnormalities.
Electrodiagnostic tests:
EMG (Electromyography): Measures electrical activity in muscles to assess the function and identify abnormalities in muscle function.
NCS (Nerve conduction studies): Measures the speed and strength of electrical signals traveling through nerves to evaluate nerve function and identify compression or damage.
Prevention strategies for cervical radiculopathy
Proper posture techniques: Maintain a neutral spine position while sitting, standing, and working to reduce strain on the neck. Use ergonomic chairs and adjust screens to eye level.
Ergonomic adjustments: Ensure your workspace is set up to support good posture—adjust chair height, desk position, and keyboard placement to minimize neck strain.
Neck-strengthening exercises: Incorporate exercises like neck stretches, chin tucks, and shoulder shrugs to strengthen neck muscles and improve flexibility. Regular exercise can enhance spinal support and reduce injury risk.
Lifestyle modifications: Avoid smoking, maintain a healthy weight, and engage in regular physical activity to support overall spinal health and reduce the risk of cervical radiculopathy.
Treatment options for cervical radiculopathy
Conservative approaches
Rest and activity modification: Limit activities that exacerbate symptoms and use supportive neck braces if recommended to reduce strain and promote healing.
Medications: Include nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief and inflammation reduction. Muscle relaxants and analgesics can also be used, with precautions regarding potential side effects and interactions.
Physical therapy: Focuses on exercises to strengthen neck muscles, improve posture, and increase flexibility. Techniques such as manual therapy and modalities like heat or cold therapy may also be used to alleviate symptoms.
Advanced treatments
Epidural steroid injections: Involves injecting steroids into the epidural space to reduce inflammation and pain. It can provide temporary relief and improve function.
Surgical interventions: Considered when conservative treatments fail or severe symptoms persist. Options include discectomy (removal of a herniated disc), laminectomy (removal of part of a vertebra), or spinal fusion (joining vertebrae together). Surgery is typically considered when there is significant nerve compression or persistent functional impairment.
Physiotherapy's effectiveness for cervical radiculopathy
Benefits of physiotherapy
Physiotherapy can help alleviate pain, improve neck function, and enhance overall quality of life for those with cervical radiculopathy. It focuses on reducing symptoms, restoring mobility, and preventing future episodes.
Specific techniques used
Manual therapy: Includes techniques such as joint mobilization and manipulation to relieve nerve root compression and improve neck mobility.
Therapeutic exercises: Strengthening and stretching exercises target neck and upper back muscles to support the spine and improve posture.
Traction: Involves applying a gentle pulling force to the cervical spine to alleviate pressure on nerve roots.
Modalities:
TENS (Transcutaneous Electrical Nerve Stimulation): Uses electrical impulses to reduce pain.
Ultrasound: Applies sound waves to promote tissue healing and reduce inflammation.
Expected outcomes and typical recovery timeline
Physiotherapy can lead to significant symptom relief and functional improvement. Recovery varies but often starts within a few weeks, with more substantial progress typically seen within 6 to 12 weeks of consistent therapy.
Research supporting physiotherapy
Key studies have shown that physiotherapy can effectively manage cervical radiculopathy symptoms and improve functional outcomes. For instance, a study by Jang et al. (2014) demonstrated that physical therapy significantly reduces pain and disability in cervical radiculopathy patients. Another study by Kuehnel et al. (2018) highlighted the effectiveness of manual therapy and exercise in improving neck function and reducing symptoms.
Self-care tips
Home exercises
Chin tucks: Gently tuck your chin to your chest and hold for 5-10 seconds. Repeat 10 times. This helps strengthen neck muscles and improve posture.
Neck stretch: Tilt your head towards one shoulder, hold for 20-30 seconds, and switch sides. Repeat 2-3 times per side to stretch tight neck muscles.
Shoulder shrugs: Lift your shoulders up towards your ears, hold for a few seconds, then release. Repeat 10 times to relieve tension.
Pain management strategies
Ice application: Apply an ice pack to the neck for 15-20 minutes to reduce inflammation and numb pain. Use several times a day as needed.
Heat application: Apply a warm compress or heating pad for 15-20 minutes to relax muscles and alleviate stiffness. Use several times a day.
Posture tips: Maintain a neutral neck position while sitting and using screens. Use ergonomic chairs and keep screens at eye level.
Ergonomic adjustments
Sleep: Use a supportive pillow that maintains a neutral neck position. Avoid sleeping on your stomach.
Work: Adjust your chair, desk, and monitor height to support good posture. Keep your feet flat on the floor and your arms at a comfortable angle.
Daily activities: Use proper lifting techniques and avoid carrying heavy bags on one shoulder to reduce neck strain.
When to seek professional help
Red flags
Seek medical attention if you experience severe pain, progressive weakness in the arms or hands, or changes in bladder or bowel function.
Importance of early intervention
Early diagnosis and treatment can prevent symptoms from worsening and avoid chronic issues.
Choosing the right healthcare provider
Consult a healthcare provider experienced in treating cervical radiculopathy, such as a physiotherapist, neurologist, or orthopedic specialist, for appropriate evaluation and treatment.
Conclusion
Cervical radiculopathy involves the compression or irritation of nerve roots in the neck, leading to pain, numbness, and weakness that can impact daily life. Key causes include herniated discs, degenerative disc disease, bone spurs, spinal stenosis, and trauma. Symptoms typically include localized neck pain, radiating arm pain, and changes in sensation or muscle strength.
Proper diagnosis through physical examination, neurological tests, and imaging studies is crucial for effective treatment. Physiotherapy plays a significant role in managing cervical radiculopathy, offering techniques such as manual therapy, therapeutic exercises, traction, and various modalities to relieve symptoms and improve function.
Proactive management, including self-care tips and lifestyle adjustments, can help reduce the risk of worsening symptoms. If you experience symptoms of cervical radiculopathy, consult a physiotherapist or healthcare provider for a comprehensive evaluation and targeted treatment plan to address your specific needs and prevent long-term complications.
References:
Caridi, J. M., Pumberger, M., & Hughes, A. P. (2011). Cervical Radiculopathy: A Review. HSS Journal ®, 7(3), 265–272. https://doi.org/10.1007/s11420-011-9218-z
Mansfield, M., Smith, T., Spahr, N., & Thacker, M. (2020). Cervical spine radiculopathy epidemiology: A systematic review. Musculoskeletal Care, 18(4). https://doi.org/10.1002/msc.1498
Related links:
Understanding Neck Pain and Conditions: Causes, Types, and Effective Treatments
Acute Neck Pain: Causes, Signs, and Effective Treatment Options
Understanding Neck-Related (Cervicogenic) Headaches: Causes, Symptoms, and Effective Treatments
Understanding Chronic and Recurrent Neck Pain: Causes, Treatment, and Management
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.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.