Cervical Radiculopathy

Cervical radiculopathy can develop after an injury or as the result of a chronic condition. Some common causes of cervical radiculopathy include:

• • • Spinal stenosis, or the narrowing of the space where the spinal cord lies (individually, these are called the vertebral foramen)
    • A herniated disc, which causes the nerve material (called nucleus pulposus) between the vertebrae to become compressed
    • A spinal fracture or trauma
    • Degenerative disc disease
    • Spinal tumors, or tumors that are pressing on structures near the cervical spine
    • Infections impacting the spine or larger bodily systems
    • Sarcoidosis, which causes lumps on organs

Cervical radiculopathy can be diagnosed by undergoing an exam with a licensed physician. Their doctor will usually start by asking them about their symptoms, past medical history, and previous surgeries. This is then followed up by a physical exam, which involves your doctor checking the range of motion and sensation in the arms, including the hands, shoulders, and fingers.

Your doctor may also test your reflexes in the upper body to determine the extent of the symptoms. This physical exam usually includes your doctor asking you to assume certain positions and then pressing down on the arms to see how your body responds. They will also facilitate specific orthopedic tests to reproduce pain that is indicative of a positive cervical radiculopathy diagnosis.

Doctors often rely on imaging to assist in diagnosing cervical radiculopathy. This means they may recommend imaging exams such as x-rays, magnetic resonance imaging (MRIs), and computed tomography (CT) scans. Each of these allow the doctor a slightly different view of the structures near the cervical spine so they can determine what the root cause of your symptoms are.

X-rays allow doctors to more clearly see the bones in the spine, so they can check whether they have narrowed or are fractured. MRIs and CT scans give doctors a picture of the spinal nerves and tissues near the spine, which allows them to see if and where there is nerve compression.

Another test that more definitively diagnoses cervical radiculopathy is electromyography, also known as an EMG. An EMG is used to test how cervical nerve roots are working by monitoring muscle contractions in the upper body (specifically the arms, hands, and fingers). This involves small needles being placed in the skin that measure the nerve signals that are coming from certain parts of the body.

Depending on where the cervical nerve root is being pinched, people may have various symptoms of Cervical Radiculopathy. Some cases of cervical radiculopathy impact the neck and shoulders, while other people will experience issues with their entire arm (down to the hands and fingers). Symptoms of cervical radiculopathy include:

• • • Pain in the shoulder, arm, elbow, hand, and fingers (pain can be either dull, sharp, or burning)
    • Neck pain
    • Impaired ability to recognize touch on the arms, also known as loss of sensation
    • Feelings of numbness and tingling, also known as pins and needles
    • Muscle weakness
    • Generalized fatigue
    • Headaches
    • Long-term nerve damage, in some instances

For most spinal conditions, the first line of treatment is nonsurgical, including physical therapy and chiropractic care. Physical therapists and chiropractors work with people who have cervical radiculopathy to alleviate pressure on the cervical nerve root.

This may include joint mobilization focused on the cervical spine, manipulation, and myofascial release to ease tension in stiff upper back and neck muscles. Stretching and strengthening exercises serve to restore joint motion and build up the muscles around the cervical spine.

Professionals will also provide patients with an exercise program to help relieve symptoms and strengthen the body outside of therapy sessions. This helps stop the progression of degrative changes while relieving pain. Individuals may also find relief from wearing a cervical collar, which gives the neck some stability and can ease neck pain.

In some instances, physical therapy and chiropractic care may not work. This usually happens for more severe cases. If this does occur, the next recommendation is an anti-inflammatory steroid injection (also known as an epidural steroid injected into the base of the spine).

An epidural steroid assists with managing the pain that cannot be resolved otherwise. Your doctor may also wish to do a repeat MRI to further assess the status of the affected nerve and soft tissues of the spine. From there, they may recommend surgery.

One option is a microdiscectomy, which involves removing part of the intervertebral disc (located between individual spinal vertebrae). This eliminates the damaged part of the nerve and eases any areas that may be compressed. Another potential surgery is spinal fusion, which is considered a last resort.

This is particularly helpful for people whose cervical radiculopathy stems from spinal fractures or severe degenerative changes. Spinal fusion involves surgically combining two or more vertebrae that are injured beyond the point of repair. Most surgeons utilize an anterior approach, which involves making an incision on the front of the neck to access the anterior cervical spine and the nerves of the upper spine.

If you are experiencing symptoms of cervical radiculopathy, including issues with the arms and hands or neck and arms, you should consult your doctor for medical advice. They can complete an assessment to determine what is the best way to address the issues.