Do you sometimes feel a sharp pain or numbness that radiates from your neck down your arm? It's like you've been electrocuted. You may also have a pinched nerve in your neck. Don't worry, this is a common condition. Today, we'll talk about it in more detail.
Simply put, what is cervical radiculopathy?
This is what we usually call a "pinched nerve in the neck." To be precise, this is a condition in which one or more of the nerve roots that run through the vertebrae in your neck (let's call them your cervical spine) become compressed and inflamed. When these nerves become compressed, you start to experience various types of nerve problems, such as pain that goes from your neck down to your arms, numbness in your arms, or a slight loss of strength in your arms.
The word "cervical" comes from a Latin word meaning "neck." So in this case (Cervical Radiculopathy), the problem is in your neck, not the cervix, which is a narrow passageway like a "neck." That's why it's called that.
Let's learn a little about our cervical spine.
Your spine is a flexible column of interconnected bones (called vertebrae ) that runs from the back of your head to your buttocks. It protects your spinal cord . The part of this spine in your neck is called the cervical spine. It has seven vertebrae (C1-C7).
These vertebrae are what protect your spinal cord from injury. Between these vertebrae, like a jelly doughnut, are round cushions with a soft jelly-like center and a slightly harder outer shell. We call these "disks." These disks are what give your vertebrae good cushioning and give you the flexibility to turn your neck back and forth.
Your spinal cord is like a highway. It connects nerves throughout your body to your brain. It allows your brain to send signals and communicate throughout your body. A nerve root is the first part of a nerve that comes out of your spinal cord. These nerve roots are the ones that send nerves to other parts of your body. Different nerve roots along your spine connect to different parts of your body. So, if one nerve root is compressed, it affects the other nerves that are connected to it. That's why when a nerve in your neck is compressed (cervical radiculopathy), the pain feels like it's going down your arm.
Who is most likely to get this condition?
In fact, anyone can develop cervical radiculopathy, but it is more common among adults.
Typically, this condition, which is caused by a herniated disc, is most common in people under the age of 50. Similarly, this condition, which is caused by disc degeneration, most commonly affects people between the ages of 50 and 60.
The main cause of this condition in people aged 70 and over is foraminal narrowing due to arthritis . "Foramen" are the bony openings between the vertebrae through which nerve roots pass. When these narrow, nerves can become compressed.
How common is this situation?
This condition (Cervical Radiculopathy) is actually quite common. Statistically, it affects about 85 out of every 100,000 people. More than half of these cases affect the C7 nerve root. Also, about a quarter of cases affect the C6 nerve root.
What could be the symptoms of this?
The nerves that connect to your cervical spine extend to your shoulders, arms, upper chest, and upper back. Therefore, nerve symptoms caused by a pinched nerve in the neck (cervical radiculopathy) can radiate from the neck to one or more of these body parts, depending on which nerve root is pinched.
Cervical Radiculopathy usually affects only one side of the body. For example, it is rare for both arms to be affected at the same time, rather than just your right arm.
Symptoms of nerve problems that extend from the neck down include:
- Pain: This is the main symptom.
- Numbness: The hand may feel numb.
- A pins and needles sensation: Like the feeling you get when your limbs fall asleep.
- Muscle weakness: You may feel weak in your arms and find it difficult to lift heavy objects.
- Weak reflexes: This can be detected during an examination by a doctor.
The way this condition (Cervical Radiculopathy) affects each person can vary. You may have one, several, or just one of these symptoms.
How does this pain feel?
People with cervical radiculopathy usually describe the pain as sharp or burning. The pain may increase when you move your neck in different directions, especially when you bend your neck backward (extending), or when you strain your neck (straining).
But surprisingly, some people find that raising their arms above their heads relieves some of the pain . This is because it relieves some of the pressure on the compressed nerve root.
What are the main reasons for this?
This condition (Cervical Radiculopathy) occurs, as mentioned earlier, when a nerve root in your cervical spine becomes compressed and inflamed. There are two main causes of this compression:
- Degeneration and changes in your spine as you age: This is what we call "Cervical Spondylosis." Simply put, degeneration of the vertebrae in the neck.
- A herniated or bulging disc in the neck.
Age-related changes (Cervical Spondylosis) and nerve compression
Most often, the cause of cervical radiculopathy is a condition called "Cervical Spondylosis." This refers to the wear and tear and changes that occur in our cervical spine as we age . This can cause symptoms such as neck pain and stiffness. This is sometimes called arthritis of the neck.
As you age, the discs between your vertebrae lose height and start to bulge out. They also lose their jelly-like consistency and become harder. This causes the spaces between the discs to shrink and the discs to lose height.
When the discs lose height, your vertebrae move closer together. The body responds by growing new bone around the disc to strengthen it. These are called "bone spurs" or "osteophytes." In Sinhala, they are like bone spurs . These bone spurs can narrow the small holes called "foramen" where the nerve roots come out. This is called "foraminal stenosis." That's when the nerve root becomes compressed (cervical radiculopathy).
Herniated Disc and Nerve Compression
Whether due to aging or an accident, the outer covering of one of the discs between your vertebrae can weaken and develop a herniated disc. A "herniated disc" is when the "jelly" inside the disc bulges out through the gap.
Cervical radiculopathy occurs when material that has come out of a disc in the neck presses on nearby spinal nerves.
There are several reasons why a cervical disc may protrude in this way (cervical herniated disc). These are:
- Aging.
- Doing work that requires frequent neck movements (e.g., in some jobs)
- Not exercising regularly.
- Poor posture: The way you hold your neck, especially when working with a computer or using your phone.
- Lifting or twisting incorrectly: This can put extra pressure on the neck.
- Neck injuries.
As mentioned earlier, this condition (Cervical Radiculopathy), which is caused by a herniated disc, is most commonly seen in people under the age of 50.
How does a doctor diagnose this?
If your neck pain and arm numbness do not subside with simple home treatments (e.g., rest, taking a painkiller), you should definitely see a doctor.
A doctor will first ask you about these things:
- Your medical history.
- Your general health.
- About any accidents or injuries you have had in the past.
- What are your current symptoms ?
Next, the doctor will examine your neck, shoulders, arms, and hands. They will look for muscle weakness, changes in reflexes, and ask about any sensations you are experiencing (numbness, pain). Because this condition (cervical radiculopathy) usually affects only one side of your body (it is unilateral), the doctor will compare what you feel on one side of your body with what you feel on the other side.
Also, the doctor may ask you to move your neck and arms in different ways to see if your symptoms reappear or decrease.
In fact, it can sometimes be a little difficult to diagnose this condition (Cervical Radiculopathy). This is because many other nerve-related conditions, such as "neuropathy", can cause this type of pain and numbness. Therefore, your doctor may ask you to do some special imaging tests to confirm whether this is truly Cervical Radiculopathy.
What tests are being done for this?
In addition to a physical examination, doctors use these tests to diagnose cervical radiculopathy or to rule out other causes of your symptoms:
- Spine X-rays: This is the most common test done for neck and upper arm pain. By taking X-rays from different angles (views), they can detect things like reduced disc space and narrowing of the foraminal openings (stenosis).
- MRI (Magnetic Resonance Imaging): This uses a large magnet, radio waves, and a computer to take detailed pictures of the inside of your body. An MRI scan is the best imaging method to check for radiculopathy. It allows your doctor to see clearly any abnormalities in the soft tissues, such as herniated discs and compressed nerves.
- CT scan (Computed Tomography): A CT scan uses X-rays and a computer to take pictures of structures inside the body. Doctors usually use a CT scan to confirm symptoms of cervical radiculopathy after a traumatic injury.
- EMG (Electromyography): An EMG test measures the response, or electrical activity, of a muscle when a nerve stimulates it. This test helps determine whether a nerve is functioning properly.
What are the treatments for this? (Treatment)
There is good news! More than 85% of these (Cervical Radiculopathy) conditions resolve within 8 to 12 weeks without any specific treatment. This means that most of the time, they get better on their own.
However, if your symptoms persist, there are several treatment options for this condition (Cervical Radiculopathy). Since it affects everyone differently, the treatment plan you receive will be specific to your condition.
These are possible treatment options:
- Neck immobilization: This means using devices to help keep the neck still.
- Medication.
- Physical therapy.
- Cervical epidural steroid injection.
- Surgery.
Doctors usually start with nonsurgical treatments to treat this condition (Cervical Radiculopathy). About 90% of people with this condition get good or very good results with nonsurgical treatments.
Only if non-surgical treatments fail will a doctor suggest you have surgery.
Neck immobilization (Immobilization)
To control and reduce symptoms in the short term, your doctor may recommend that you wear a soft cervical collar (which is similar to a belt). This helps to reduce the amount of movement in your neck, reducing pressure and irritation on the nerve root. A soft cervical collar is a padded ring that wraps around your neck and secures with Velcro.
Doctors generally do not recommend wearing this "cervical collar" for more than a week or two, as this can cause muscle atrophy, which is the loss of muscle strength in your neck.
Medication
In some cases, certain medications can help reduce the symptoms of Cervical Radiculopathy. Some of them include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as aspirin, ibuprofen, and naproxen, help reduce pain and inflammation, or swelling. They provide relief by reducing swelling in the affected nerve root. You can get these medications over the counter at a pharmacy without a prescription.
- Oral corticosteroids: When taken short-term, oral corticosteroids can help reduce swelling and inflammation around the pinched nerve and relieve pain. You will need a prescription from a doctor to get these medications.
Physical Therapy
Physical therapy and specific exercises that strengthen and stretch the muscles in your neck can be very helpful in treating this condition (Cervical Radiculopathy). But remember, the physical therapy regimen you receive will be specific to you. It will depend on several factors, such as the area of your neck that is affected, your overall physical health, and your abilities.
Typically, a physical therapy program for this condition (Cervical Radiculopathy) will take you through different phases as your pain decreases. You will start with gentle range-of-motion exercises. Then, as acute symptoms subside, strength and conditioning exercises are added.
Your physical therapy may also include learning how to maintain good posture and ways to do your job safely and comfortably.
Cervical Epidural Steroid Injections
A "Cervical Epidural Steroid Injection" (Cervical ESI) is an injection of an anti-inflammatory medication – either a steroid or a corticosteroid – into the "epidural space" around the spinal nerves in your neck. The main purpose of this injection is to help control pain caused by irritation and swelling of the spinal nerve roots in your neck.
These (Cervical ESI) injections do not relieve pressure on the nerve, whether caused by a narrow foramen or a bulging or herniated disk. However, they can reduce swelling and provide pain relief while the affected nerve has time to heal.
Between 40% and 84% of people who receive this (Cervical ESI) vaccine experience some degree of pain relief. However, some people may not experience any pain relief.
Important: This (Cervical ESI) vaccine can cause serious side effects and complications. Therefore, it is very important to carefully discuss the pros and cons of getting this vaccine with your doctor.
Surgery
If you have tried nonsurgical therapy for 6 to 12 weeks, but you still have severe and persistent pain, or if the neurological issues caused by Cervical Radiculopathy become severe, your doctor may recommend surgery.
There are several different surgical procedures to treat this condition (Cervical Radiculopathy). The type of surgery your doctor recommends will depend on many factors, including your symptoms, your overall health, and the location of the affected nerve root.
Can this be completely cured? (Curable?)
While non-surgical treatment options can usually successfully control the symptoms of Cervical Radiculopathy, there is no permanent cure for the degenerative changes that occur with age in your cervical spine that cause it. This means that the underlying cause cannot be completely eliminated, but the symptoms can be controlled and you can live a normal life.
How do you try to avoid this situation? (Prevention)
Although this condition (Cervical Radiculopathy) cannot always be prevented, there are several things you can do to reduce your risk of developing it. These are:
- Maintaining a healthy weight.
- Being physically fit.
- Practice good posture: Be mindful of how you hold your neck, especially when sitting and working.
- Do stretching exercises to keep your muscles strong and flexible.
Here are some specific risk factors that can contribute to the development of this condition (Cervical Radiculopathy):
- Manual labor involving lifting weights and/or operating vibrating equipment.
- Having a history of chronic smoking.
- Having a previous lumbar radiculopathy.
- Playing golf. (This may come as a surprise to some, but golf is also considered a risk factor because it puts some pressure on the neck.)
If any of these risk factors apply to you, it is very important to talk to your doctor about specific things you can do to protect yourself from this condition (Cervical Radiculopathy).
What will happen in the future? (Prognosis/Outlook)
The prognosis of this condition (Cervical Radiculopathy), that is, what it will be like going forward, depends on several factors. These are:
- Which spinal nerve is affected?
- What is the cause of this condition (Cervical Radiculopathy).
- How severe your symptoms are.
- Your overall health.
In most cases, those who receive nonsurgical treatment have a better prognosis and symptoms resolve. In fact, many people with cervical radiculopathy can recover at home with time and rest.
However, after initial recovery, about one-third of people may experience a recurrence of symptoms of cervical radiculopathy. If your symptoms return, you should definitely talk to your doctor.
When should we definitely see a doctor?
If you have symptoms of this (Cervical Radiculopathy), which means pain that radiates from the neck down the arm, and does not subside after about a week of rest, you should definitely see a doctor.
If you have more serious symptoms, for example, if you feel like your arm muscles are weakening or your hand reflexes are weak, see a doctor as soon as possible.
Also, if you experience neck pain after an accident, such as a fall, you should see a doctor immediately or go to the nearest hospital.
Finally, the most important things you need to remember (Take-Home Message)
This condition called "Cervical Radiculopathy / Pinched Nerve" can be really uncomfortable and annoying. But the best thing is that most of the time, this condition gets better with rest at home and over time.
If your symptoms persist for more than a week, be sure to talk to a doctor. There are several nonsurgical therapies available to treat this condition (Cervical Radiculopathy).
Ask your doctor about ways to avoid these situations as much as possible and keep your spine healthy. Remember, your neck is very valuable to you! So take care of it.
Don't worry, this condition can be well controlled with the right understanding and treatment.
` Cervical Radiculopathy, Pinched Nerve, Neck Pain, Hand Numbness, Cervical Spondylosis, Herniated Disc
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