Cervical radiculopathy is a condition that occurs when a nerve in your neck is irritated. It typically occurs when there is pressure on the nerve root or a narrowing of the space for the nerve to exit from the cervical spine. You will hear it commonly referred to as a “pinched nerve". Cervical Radiculopathy can produce neck pain in addition to pain that radiates into the arm. It can cause numbness, tingling, or weakness in various regions of the arm depending on where in the neck this has occurred. This is a common condition and has good success when it is diagnosed and treated by a physical therapist.
There are two common causes of cervical radiculopathy. There can be pressure on the nerve (from a disc irritation or injury) or there can be limited space for the nerve to move and function as it exits the cervical spine with age related changes. Traction (stretch) injuries are less common, but can cause increased tension on the nerve causing similar symptoms.
Cervical radiculopathy can affect everyone in all walks of life. It can occur with repetitive movements, sudden, heavy loads or movements, or when overall motion of the spine is limited leaving only a few areas available for movement. It is possible to have a history of cervical radiculopathy, and a new activity may aggravate symptoms.
The cause of radiating symptoms in the arm or hand from the neck is due to the compression or irritation of the nerve that supplies the arm and hand. These nerves begin in the neck and can be compressed by a ruptured or herniated disc, bone spurs or an irritated facet joint. This can occur from normal wear and tear, degenerative or arthritic changes, or from acute traumatic activities such as athletics or a whiplash type injury. Areas of stiffness above or below the problem area frequently lead to abnormal stress at the level of the nerve involvement.
Symptoms can include neck pain and pain into the arm. This is often paired with numbness, tingling, and/or weakness of a particular muscle group. Because cervical radiculopathy affects a particular segment or level of the neck, the radiating pain and numbness will usually follow a distinct pattern. Often times, it will be difficult to turn your head towards the arm that has been affected due to pain and stiffness, but other directions can be impacted, as well.
Cervical Radiculopathy symptoms can increase first thing in the morning or after prolonged periods of rest. It may feel better to rest your arm on the top of your head. This reduces tension on the nerve that has become painful.
Occasionally there is no neck pain associated with this condition and only arm or hand symptoms. Movement of the neck will reproduce the arm/hand symptoms in this case. The pain from this can be excruciating due to the involvement of the nerve. In more severe cases, significant weakness and/or numbness in the shoulder, arm or hand may occur.
Your physical therapist will assess your neck and arm pain to determine if it follows a particular pattern. Range of motion, sensation, strength, and reflexes will also be assessed. This will help your therapist determine what level your symptoms are coming from in your cervical spine for appropriate, targeted treatment.
A physical therapist, primary care physician, orthopedic physician, or neurologist can diagnose cervical radiculopathy with a thorough history and musculoskeletal and neurological assessment. If your symptoms are limiting your ability to move your neck or arm or complete day-to-day tasks, your physician will refer you to a physical therapist.
X-Rays and MRIs are typically only recommended if surgery is being considered or if you are having progressive, worsening neurological changes that include complete numbness, worsening strength, and absent reflexes.
A course of manual therapy in conjunction with mechanical or manual traction is found to be the most relieving and effective treatment for this condition. As the pressure begins to reduce on the nerve, treatment to the associated areas of muscle spasm and joint stiffness frequently helps reduce the remaining symptoms. As in all cases, the underlying muscle weakness and tightness is addressed with a specific exercise program to help reduce the likelihood of this condition returning. Exercise training to assist in returning to normal activity is the primary goal. Modalities such as ice and electrical stimulation are utilized to reduce the acute inflammation and pain as well.
Your physical therapist’s aim is to reduce pain and improve function. After a thorough assessment, you will be given advice on pain management and modifications you can make throughout your care with Results. These modifications can be specific to you and your goals.
Hands on, manual therapy techniques will be used to improve pain and stiffness in your neck, which will alleviate symptoms in the arm. Your therapist may recommend trigger point dry needling, taping techniques, and other pain relieving modalities to get you better, faster. Specific exercises will be prescribed to improve your ability to perform the tasks you need to do. Your therapist will also give you specific stretches and exercises to do at home to continue your recovery.
It is common for symptoms to begin to “centralize” throughout treatment. This means that the pain in your arm will reduce and will not travel as far into the arm as time passes. During recovery, you may see your arm pain reduce, but your neck pain to worsen. This can be normal and is a sign that the “pinched nerve” is regaining its function.
After your evaluation, your therapist will be able to discuss a timeline for recovery. Significant improvement is expected within the first few weeks of seeing a therapist. Full recovery is possible, but if this condition has persisted for several months or years, patients can expect a longer duration of care for management of this condition.
General strength and cardiovascular exercise can reduce risk for cervical radiculopathy. Smoking and tobacco use can increase the likelihood of this condition. Smoking also increases the intensity of pain from cervical radiculopathy by limiting blood flow to the affected nerve. Uncontrolled diabetes can also intensify symptoms of this condition by limiting nutrition to the affected nerve.
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