Neck blog series part 2: Cervical Radiculopathy

What is Cervical Radiculopathy?

A product of pathology affecting the cervical nerve root or its dorsal horn ganglion (McKenzie & May, 2006). Causing one or more nerves not to work properly through some sort of compression (trapped nerve), often causing arm pain and even pins and needles, numbness and weakness.

How much of a problem is Cervical Radiculopathy?

Cervical Radiculopathy (trapped nerve causing arm symptoms) occurs in 3.3 people in every 1000 per year. It affects men and women equally and C6/7 and C5/6 are 90% of all cases. It is most common between the age of 30 and 50 years of age (Constantoyannis et al, 2002).

What are the common symptoms of Cervical Radiculopathy?

May present as pain, motor dysfunction, sensory deficits or a change in tendon reflexes (Williams & Hoving, 2004).

Quality of radicular pain is normally severe/lancinating/shooting whereas non radicular pain (somatic referred pain) is often a vague/dull ache. However nervi nervorum (small nerve filaments innervating the sheath of a larger nerve) can produce somatic type pain. So this isn’t a definitive rule.

It can be associated with other signs and symptoms of root compression, such as:

Muscle weakness/wasting

Reduced or absent reflexes

Areas of pins and needles or numbness

Pain or dysaesthesia (distortion of any sense) can be felt anywhere in the affected dermatome (area of skin supplied by a nerve root level in the spine) as a continuous line or as patches/spots of pain.

Motor and sensory abnormalities are not always present so be aware.

Sensory disturbances, when present, are usually found in the distal (furthest away from body) part of the affected dermatome, e.g. C6=thumb/index finger, C7=middle/ring fingers & C8=little finger.

Cervical radicular pain patterns show considerable variation between individuals and there can be no clear distinction between nerve roots and their proximal (close to the body) pain pattern.

Pain can follow an inflammatory pattern - i.e. it is usually worse at night and in the morning, but eases about 30 minutes after rising.

What causes Cervical Radiculopathy?

Most commonly caused by lateral canal stenosis and cervical disc herniation (only 25% of cases are due to disc herniation - unlike the lumbar spine) (Jellad et al, 2009).

Lateral canal stenosis is caused by narrowing of the intervertebral foramen by osteophytes (bone spikes) from the vertebral body or facet joint or ligamentum flavum hypertrophy. Cervical disc herniation results in disc material moving into the intervertebral foramen. Both of these phenomena cause nerve root irritation and result in nerve root pain and dysfunction

Due to compression of a previously damaged nerve root in the cervical spine, or compression of the dorsal root ganglia (Bogduk, 1997).

Could also be due to chemical irritation of a nerve root (Bogduk, 1997)

How do you diagnose Cervical Radiculopathy?

Often diagnosed by pain pattern and accompanying paraesthesia and/or muscle weakness.

Diagnostic tests are inconsistently reliable.

The Spurlings test is 93% for ruling in & 95% for ruling out of a lateral cervical disc prolapse (Cleland & Koppenhaver 2005).

Numbness is accurate to help diagnose Cervical radiculopathy to a probability of 79% (Cleland & Koppenhaver 2005).

Palpation to the facet joints in the neck is accurate to help diagnose neck injury to a probability of 82% (Cleland & Koppenhaver 2005).

MRI scans can be performed to help to diagnose but are rarely required.

So what can help?

Any movement which will cause narrowing of the intervertebral foramen - particularly cervical extension, and ipsilateral (to the same side) rotation and lateral flexion can increase symptoms.

However if the pain is due to a soft disc herniation, the symptoms could ease with repeated movements into extension, ipsilateral rotation and lateral flexion.

If the radiculapathy is due to lateral canal stenosis then flexion-based activities or movements should ease the pain.

Manual therapy, cervical traction, and deep neck flexor muscle strengthening - 85 -90% success (Cleland et al, 2007).

Manipulation, MET, neural mobilisation, over-the-door-traction, cervical stabilisation exercises and epidural steroid injection can be effective treatments (Murphy et al, 2006).

Traction, specific physical therapeutic exercise, oral anti-inflammatory medication, and patient education - 24 out of 26 patients in the study improved (Saal et al, 1996).

An arm support together with an alternative mouse may prevent work-related musculoskeletal disorders of the neck & shoulder (Hoe et al 2012).

Use of epidural steroids in the management of Cervical radiculopathy was inconclusive (Boswell et al, 2003).

Surgical decompression is required only if conservative treatment fails!

What is my prognosis?

It is very common to take a long time to recover and it tends to re-occur time and again. Studies suggest that at least 40% of people with neck pain will have a history of relapse and future episodes (McKenzie and May, 2006).

Radiculopathy is usually benign, meaning not serious, so don’t worry if you have the symptoms.

Intermittent pain has better prognosis with conservative therapy, whereas the need for surgery is more likely if the pain is constant & accompanied by neurological signs & symptoms.

If you need any further information or would like to book an appointment then call Hawkes Physiotherapy on 01782 771861 or 07866195914

Stay tuned for the next neck series blog article, part 3, coming soon!

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