"Living With Cervical Radiculopathy: Tips for Managing the Condition"

Overview

Cervical radiculopathy, or "pinched nerve," happens when compression and inflammation of any of the nerve roots in your neck cause radiating pain, muscle weakness and/or numbness down your arm.

Cervical radiculopathy is a condition that results in radiating pain, muscle weakness and/or numbness down your arm. It's caused by compression and inflammation of any of the nerve roots in your neck.

What is cervical radiculopathy (pinched nerve in the neck)?

Cervical radiculopathy (also known as “pinched nerve”) is a condition that results in neurological dysfunction caused by compression and inflammation of any of the nerve roots of your cervical spine (neck). Neurological dysfunction can include radiating pain, muscle weakness and/or numbness.

“Cervical” comes from the Latin word “cervix,” which means “neck.” In the case of cervical radiculopathy, the issue is in your neck, not your cervix. (The cervix, the narrow passage forming the lower end of the uterus, is called so because it’s a neck-like passage.)

What is the cervical spine?

Your spine (backbone) is the long, flexible column of bones that protects your spinal cord. It begins at the base of your skull and ends in your tailbone at your pelvis. Your cervical spine is the neck region of your spine. It consists of seven bones (C1-C7 vertebrae).

Vertebrae help protect your spinal cord from injury. Between your vertebrae in your spine are round cushions called disks. They have soft, gel-like centers and a firmer outer layer, like a jelly doughnut. These disks provide cushioning for your vertebrae and flexibility for you.

Your spinal cord acts like a highway that connects the nerves located all over your body to your brain so that your brain can send signals and communicate with the rest of your body. A nerve root is the initial segment of a nerve that leaves your spinal cord. It’s the root for the nerves that extend out to other parts of your body. Different nerve roots along your spine extend to different parts of your body.

When a nerve root becomes pinched, it can affect the nerves that are attached to it. This is why a pinched nerve (cervical radiculopathy) in your neck can cause pain that radiates down your arm.

Who does cervical radiculopathy affect?

Anyone can get cervical radiculopathy, but it’s more common in adults.

Cervical radiculopathy caused by a herniated disk is more common in people up to 50 years old. And cervical radiculopathy caused by disk degeneration is more common in people in their 50s and 60s.

People in their 70s or older tend to get cervical radiculopathy from foraminal narrowing as a result of arthritis. The foramen is the bony hollow opening between vertebrae through which spinal nerve roots travel.

How common is cervical radiculopathy?

Cervical radiculopathy is somewhat common. Cervical radiculopathy affects approximately 85 out of 100,000 people. In over half of cervical radiculopathy cases, the C7 nerve root is affected. Approximately a quarter of cases affect the C6 nerve root.

Symptoms and Causes

What are the symptoms of cervical radiculopathy?

The nerves that connect to your cervical spine (neck) extend out to your following body parts:

• Shoulders.
• Arms.
• Chest.
• Upper back.

Because of this, the neurological symptoms that result from cervical radiculopathy can radiate down from your neck to any one of or a combination of these body parts, depending on which nerve root is affected. Cervical radiculopathy typically only affects one side of your body — for example, your right arm, not both arms.

Neurological symptoms from cervical radiculopathy that can radiate down from your neck include:

• Pain.
• Numbness.
• Tingling or a “pins and needles” feeling.
• Muscle weakness.
• Weakened reflexes.

Cervical radiculopathy affects people differently. You may have any combination of the above neurological symptoms or only one.

What does cervical radiculopathy pain feel like?

People with cervical radiculopathy typically describe the pain as sharp or burning. Moving your neck in certain ways, like extending or straining it, may increase the pain.

Some people with cervical radiculopathy notice that their pain decreases when they place their hands on top of their head. This may temporarily relieve pressure on the affected nerve root.

What causes cervical radiculopathy?

Cervical radiculopathy happens when a nerve root in your neck (cervical spine) becomes compressed (pinched) and inflamed.

This compression has two main causes:

• Degenerative changes that happen in your spine as you age (cervical spondylosis).
• A herniated (bulging) disk in your neck.

Cervical spondylosis and cervical radiculopathy

The majority of cases of cervical radiculopathy are due to cervical spondylosis.

Cervical spondylosis is a general term for age-related wear and tear (degenerative changes) in your cervical spine (neck) that can lead to neck pain, neck stiffness and other symptoms. Sometimes, this condition is called arthritis or osteoarthritis of the neck.

As you age, the disks in your spine between your vertebrae lose height and begin to bulge. They also become less jelly-like and become stiffer. This problem causes the collapse of the disk spaces and loss of disk space height.

As the disks lose height, your vertebrae move closer together. Your body responds to the collapsed disk by forming more bone — called bone spurs (osteophytes) — around the disk to strengthen it. These bone spurs can narrow the foramen — the small openings on each side of your spinal column where the nerve roots exit — and pinch the nerve root. This is called foraminal stenosis. The pinched nerve root causes cervical radiculopathy.

Herniated disks and cervical radiculopathy

Through aging or an injury, the outer layer of a vertebra disk can weaken and crack. A herniated disk happens when the inner “jelly” substance of the disk pushes through the crack.

A herniated disk causes cervical radiculopathy when the leaked material from a disk in your neck presses on nearby spinal nerves.

Several factors can contribute to a cervical herniated disk, including:

• Aging.
• Repetitive neck motions.
• Lack of regular exercise.
• Poor posture.
• Incorrect lifting or twisting, causing additional stress on your neck.
• Injury to your neck.

Cervical radiculopathy caused by a herniated disk is more common in people up to 50 years old.

Diagnosis and Tests

How is cervical radiculopathy diagnosed?

You’ll want to visit your healthcare provider about your pinched nerve if it’s not responding to conservative treatment at home.

Your healthcare provider will ask about your:

• Medical history.
• General health.
• History of injuries or accidents.
• Symptoms.

They’ll then examine your neck, shoulder, arms and hands. They’ll look for muscle weakness, check for changes in reflexes and ask about the different sensations you’re feeling. Since cervical radiculopathy almost always affects one side of your body (is unilateral), your healthcare provider will compare the sensations you feel on one side of your body to your other side.

Your healthcare provider may also ask you to perform certain neck and arm movements to try to recreate and/or relieve your symptoms.

Cervical radiculopathy can be difficult to diagnose, as many other neurological conditions, such as neuropathy, can cause pain and numbness. Because of this, you may need to undergo certain imaging tests so your healthcare provider can confirm a cervical radiculopathy diagnosis.

What tests will be done to diagnose cervical radiculopathy?

Aside from a physical exam, healthcare providers use the following tests to diagnose cervical radiculopathy or to rule out other possible causes of your symptoms:

• Spine X-rays: X-rays of your cervical spine are the most common imaging tests for evaluating neck and upper extremity pain. Different views or angles can reveal different issues, such as disk space narrowing and foraminal narrowing (stenosis).
• Magnetic resonance imaging (MRI): MRI uses a large magnet, radio waves and a computer to produce detailed images of the inside of your body. An MRI scan is the imaging method of choice for evaluating radiculopathy. MRI allows your healthcare provider to see soft tissue abnormalities, including herniated disks and compressed nerves.
• Computed tomography (CT) scan: A CT scan shows structures inside of your body by using X-rays and computers to produce images. Healthcare providers typically use a CT scan for the diagnosis of traumatic injuries that result in cervical radiculopathy symptoms.
• Electromyography (EMG): An electromyography (EMG) test measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle. This test can help determine if a nerve is working normally.

Management and Treatment

How is cervical radiculopathy treated?

Fortunately, over 85% of cervical radiculopathy cases resolve (get better) without any specific treatments within eight to 12 weeks.

If your symptoms persist, cervical radiculopathy has several treatment options. As the condition affects everyone differently, your treatment plan will be unique to your situation.

Treatment options include:

• Immobilization.
• Medication.
• Physical therapy.
• Cervical epidural steroid injection.
• Surgery.

Healthcare providers almost always start with nonsurgical therapies to treat cervical radiculopathy. About 90% of people with cervical radiculopathy have good to excellent outcomes with nonsurgical therapy.

If nonsurgical treatment isn’t working, your healthcare provider may recommend surgery.

Immobilization for cervical radiculopathy

For short-term management and to alleviate symptoms, your healthcare provider may recommend wearing a soft cervical collar (neck brace) to minimize neck movement and reduce nerve root irritation. A soft cervical collar is a padded ring (collar) that wraps around your neck and is held in place with Velcro®.

Healthcare providers typically don’t recommend wearing a cervical collar for more than one to two weeks because it can lead to muscle atrophy (muscle loss) in your neck.

Medication for cervical radiculopathy

In some cases, certain medications can help alleviate (relieve) symptoms of cervical radiculopathy, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as aspirin, ibuprofen and naproxen, can provide both pain relief and anti-inflammatory effects for cervical radiculopathy. They provide relief by targeting the inflammation at the affected nerve root(s). You can buy these medications without a prescription at a pharmacy.
• Oral corticosteroids: A short course of oral (taken by mouth) corticosteroids may help relieve pain by reducing swelling and inflammation around the pinched nerve. You’ll need a prescription from your healthcare provider for these medications.

Physical therapy for cervical radiculopathy

Physical therapy and specific exercises focused on strength training and stretching your neck muscles can help treat cervical radiculopathy. Again, your physical therapy regimen will be unique to you and depend on several factors, such as which area of your neck is affected and your overall physical health and abilities.

In general, a physical therapy regimen for cervical radiculopathy will progress you through different stages as your pain improves, beginning with gentle range-of-motion exercises and adding strengthening and conditioning activities once the acute (severe and sudden) symptoms fade.

Your physical therapy may also include learning ways to have good posture and perform your job safely and comfortably.

Cervical epidural steroid injections for cervical radiculopathy

A cervical epidural steroid injection (cervical ESI) is an injection of anti-inflammatory medicine — a steroid or corticosteroid — into the epidural space around your spinal nerves in your neck. The main goal of cervical epidural steroid injections for cervical radiculopathy is to help manage pain caused by irritation and inflammation of the spinal nerve roots in your neck.

Although cervical ESIs don’t relieve the pressure on the nerve caused by a narrow foramen or by a bulging or herniated disk, they may lessen the swelling and relieve the pain long enough to allow the affected nerve to recover.

Approximately 40% to 84% of people who receive a cervical epidural steroid injection experience at least partial pain relief. But some people don’t experience any pain relief.

Cervical ESIs have potentially serious side effects and complications. Be sure to ask your healthcare provider about the benefits and risks of getting a cervical ESI.

Surgery for cervical radiculopathy

Your healthcare provider may recommend surgery if you’re experiencing severe and persistent pain despite trying nonsurgical therapy for at least six to 12 weeks or if you’re experiencing severe or worsening neurological issues due to cervical radiculopathy.

Several different surgical procedures can treat cervical radiculopathy. The procedure your healthcare provider recommends will depend on many factors, including what symptoms you have, your overall health and the location of the affected nerve root.

Is cervical radiculopathy curable?

While nonsurgical treatment options usually successfully treat the symptoms of cervical radiculopathy, there isn’t a cure for the degenerative changes (age-related wear and tear) in your cervical spine that can cause cervical radiculopathy.

Prevention

How can I prevent cervical radiculopathy?

While you can’t always prevent cervical radiculopathy, there are certain things you cando to lower your risk of developing this condition:

• Maintain good posture.
• Exercise regularly and strengthen the muscles in your neck and upper back.
• Take frequent breaks if you work at a desk or use a computer for long periods of time.
• Avoid activities that strain your neck, such as carrying heavy objects on one side of your body.
• Use proper lifting techniques to prevent injury.
• Quit smoking, as smoking can increase the risk of cervical spondylosis.
• Seek treatment for any underlying medical conditions that may contribute to the development of cervical radiculopathy, such as arthritis or spinal stenosis.