Cervical radiculopathy, commonly called a “pinched nerve”, occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal cord. This may cause pain that radiates into the shoulder. This may also present as muscle weakness and numbness that travels down the arm and into the hand.
Cervical radiculopathy is often caused by “wear and tear” changes that occur in the spine as we age, such as arthritis. In younger people, it is most often caused by a sudden injury that results in a herniated disk.
In most cases, cervical radiculopathy responds well to conservative treatment that includes medication and physical therapy.
Cervical radiculopathy most often arises from degenerative changes that occur in the spine as we age or from an injury that causes a herniated, or bulging, intervertebral disc.
Degenerative Changes. As the discs in the spine age, they lose height and begin to bulge. They also lose water content, begin to dry out, and become stiffer. This problem causes settling, or collapse, of the disk spaces and loss of disc space height. As the discs lose height, the vertebrae move closer together. The body responds to the collapsed disk by forming more bone (called bone spurs or osteophytes) around the disk to strengthen it. These bone spurs contribute to the stiffening of the spine. They may also narrow the foramen (the small openings on each side of the spinal column where the nerve roots exit) and pinch the nerve root.
Herniated disc: A disc herniates when its jelly-like center (nucleus) pushes against its outer ring (annulus). If the disk is very worn or injured, the nucleus may squeeze all the way through. When the herniated disc bulges out toward the spinal canal, it puts pressure on the sensitive nerve root, causing pain and weakness in the area the nerve supplies.
In most cases, the pain of cervical radiculopathy starts at the neck and travels down the arm in the area served by the damaged nerve. This pain usually presents as a constellation of symptoms called neuropathic pain. This can include burning, electric or sharp sensation. Certain neck movements, like extending or straining the neck or turning the head, may increase the pain. Other symptoms include:
- Tingling or the feeling of "pins and needles" in the fingers or hand
- Weakness in the muscles of the arm, shoulder, or hand
- Loss of sensation
Some patients report that pain decreases when they place their hands on top of their head. This movement may temporarily relieve pressure on the nerve root.
Initial treatment for cervical radiculopathy is nonsurgical. Nonsurgical treatment options include:
Soft cervical collar: This is a padded ring that wraps around the neck and is held in place with Velcro. Your doctor may advise you to wear a soft cervical collar to allow the muscles in your neck to rest and to limit neck motion. This can help decrease the pinching of the nerve roots that accompany movement of the neck. A soft collar should only be worn for a short period of time since long-term wear may decrease the strength of the muscles in your neck.
Physiotherapy: Specific exercises can help relieve pain, strengthen neck muscles, and improve range of motion. In some cases, traction can be used to gently stretch the joints and muscles of the neck.
Medications: In some cases, medications can help improve your symptoms.
Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, including Compound Topical Creams, ibuprofen, and naproxen, may provide relief if your pain is caused by nerve irritation or inflammation.These medications can irritate the stomach lining and cause internal bleeding. They should be taken with food. Consult with your doctor before taking over-the-counter NSAIDs if you have a history of ulcers or are taking blood thinning medication.
Injections can be very helpful for this condition and they may include:
- Cortisone (Corticosteroid)
- Platelet Rich Plasma (PRP)
- Trigger Point Injections
If after a period of time nonsurgical treatment does not relieve your symptoms, your doctor may recommend surgery. There are several surgical procedures to treat cervical radiculopathy. The procedure your doctor recommends will depend on many factors, including what symptoms you are experiencing and the location of the involved nerve root.