Introduction
Degeneration of the cervical spine can result in several different conditions
that cause problems. These are usually divided between problems that come from
mechanical problems in the neck and problems which come from nerves being
irritated or pinched. A cervical radiculopathy is a a problem that results when
a nerve in the neck is irritated as it leaves the spinal canal. This condition
usually occurs when a nerve root is being pinched by a herniated disc or a bone
spur.
The purpose of this information is to help you understand:
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The anatomy of the cervical radiculopathy
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The signs and symptoms of cervical radiculopathy
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How the condition is diagnosed
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The treatments available for treatment of the condition
Causes
Cervical Radiculopathy ("Pinched Nerve")
When a nerve root leaves the spinal cord and the cervical spine it travels down
into the arm. Along the way each nerve supplies sensation (feeling) to a part
of the skin of the shoulder and arm. It also supplies electrical signals to
certain muscles to move part of the arm or hand. When a nerve is irritated or
pinched - by either a bone spur or a part of the intervertebral disc - it
causes problems in the nerve and the nerve does not work quite right. This
shows up as weakness in the muscles the nerve goes to, numbness in the skin
that the nerve goes to and pain where the nerve travels. In the neck, this
condition is called cervical radiculopathy. Let's look at the different causes
of cervical radiculopathy.
Pinched nerve from an herniated disc
Bending the neck forward and backward, and twisting
and right, places many
kinds of pressure on the vertebrae and disc. The disc responds to the pressure
from the vertebrae by acting as a shock absorber. Bending the neck forward
compresses the disc between the vertebrae. This increased pressure on the disc
may cause the disc to bulge toward the spinal canal and the nerve roots.
Injury to the disc may occur when neck motion puts too much pressure on the
disc. One of the most painful injuries that can occur is a herniated
disc. In this injury, the tear in the annulus potion of the
intervertebral disc is so bad that part of the nucleus pulposus squeezes out of
the center of the disc. The annulus can tear or rupture anywhere around the
disc. If it tears on the side next to the spinal canal, when the nucleus
pulposus squeezes out, it can press against the spinal nerves. Pressure against
the nerve root from a herniated disc can cause pain, numbness, and weakness
along the nerve. There is also evidence that the chemicals released from the
ruptured disc may irritate the nerve root, leading to some of the symptoms of a
herniated disc - especially pain.
Herniated discs are more common in early middle-aged adults. This condition may
occur when too much force is exerted on an otherwise healthy intervertebral
disc. An example would be a car accident where your head hit the windshield.
The force on the neck is simply too much for even a healthy disc to absorb and
injury is the result. A herniated disc may also occur in a disc that has been
weakened by the degenerative process. Once weakened, less force is needed to
cause the disc to tear or rupture. However, not everyone with a ruptured disc
has degenerative disc disease. Likewise, not everyone with degenerative disc
disease will suffer a ruptured disc.
Pinched nerve from degeneration and bone spurs
In middle aged and older people, the degenerative disc disease can cause bone
spurs to form around the nerve roots. This usually occurs inside the foramen -
the opening in the cervical spine where the nerve root leaves the spine to
travel into the arm. If these bone spurs get big enough they may begin to rub
on the nerve root and irritate the nerve root. This causes the same symptoms as
a herniated disc. The irritation causes pain to run down the arm, numbness to
occur in the areas the nerve provides sensation to and weakness in the muscles
that the nerve supplies.
Symptoms
A cervical radiculopathy causes symptoms that radiates out away from the neck.
What this means is that although the problem is in the spine, the symptoms may
be felt in the shoulder, the arm, or the hand. The symptoms will be felt in the
area where the nerve that is irritated travels. By looking at where the
symptoms are, the spine specialist can usually tell which nerve is involved.
The symptoms include pain, numbness and weakness. The reflexes in the upper arm
can be affected. When you are suffering from a cervical radiculopathy, there is
usually also neck pain and headaches in teh back of your head. These are
sometimes referred to as occipital hdeadaches because the area just about the
back of the neck is called the "occiput".
Diagnosis
Finding the cause of neck pain begins with a complete history and physical
examination. After the history and physical examination, Dr. Tarrabain will
have a good idea of the cause of your pain. To make sure of the exact cause of
your neck pain, Dr. Tarrabain can use several diagnostic tests. These tests are
used to find the cause of your pain -- not make your pain better. Regular
x-rays, taken in the doctor's office, are usually a first step in looking into
any neck problem and will help determine if more tests will be needed.
Complete History
A "complete history" is usually two parts. One part is written; a form that you
fill out while you wait to see the doctor. While you fill out the form, take
time to think about everything you can remember that relates to your neck pain
and write it down. The more you can tell him, the faster he can diagnose the
cause and help relieve your pain. The second part of your history will be
answering questions. Your doctor will ask you describe when your neck pain
began and the type of pain you are having.
For example, he may ask:
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when did the pain first begin?
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have you increased your activity level?
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have you had an injury, or surgery, to your neck at any time?
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does the pain go down into your arms or legs?
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what causes your neck to hurt more or less?
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have you had any problems with your bowels or bladder?
Physical Examination
Once most of the information is gathered, your doctor will give you a thorough
physical exam. During the exam your doctor will look at your neck to find out
how well your neck is functioning. This includes:
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how well you can bend your neck and roll your head in all directions
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how well you can twist your neck
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if there is tenderness around the neck
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if there are muscle spasms around the neck and shoulders
Tests that examine the nerves that leave the spine is also important. This
includes:
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testing for numbness in the arms and hands
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testing the reflexes
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testing the strength of the muscles in the arms, hands, and legs
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testing for signs of nerve irritation
X-rays
X-rays show the bones of the cervical spine. Most of the soft tissue structures
of the spine, such as the nerves, discs, and muscles, do not show up on x-ray.
X-rays can show problems that affect the bones, such as infection, fractures,
or tumors of the bones. X-rays may also give some idea of how much degeneration
has occurred in the spine. X-rays alone will not show a herniated disc. The
X-rays will be useful in showing how much degeneration and arthritis are
affecting the neck. Narrowing of the disc space between each vertebra and bone
spurs do show up on X-rays.
Magnetic Resonance Imaging (MRI)
The MRI is the most commonly used test to evaluate the spine because it can show
abnormal areas of the soft tissues around the spine. The MRI is better than
x-ray because in addition to the bones, it can also show pictures of the nerves
and discs. The MRI is done to find tumors, herniated discs, or other
soft-tissue disorders. The MRI is painless and lasts about 90 minutes. During
the MRI, very detailed computer images of sections of the spine are taken.
Unlike most other tests which use x-rays, the MRI uses magnetic fields and
radio waves to see the structures of the neck. Pictures can also be taken in a
cross section view. The MRI allows the doctor to clearly see the nerves and
discs without using special dyes or needles. In many cases, the MRI scan is the
only special test that needs to be done to find what is causing your neck
pain. Dr. Tarrabain can order an MRI if needed to diagnose your problem.
Treatment
Treatment for any spine condition should include two main goals:
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relieve pain
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reduce the risk of re-injury
Conservative Treatment
Spinal Manipulation and physical therapy modalities are extremely important in
the reduction of swelling which removes the irritation of the pressure on the
nerves, resulting in less pain. Therapy will likely consist of
ultrasound, ice, gentle stretches and exercises combined with gentle spinal
manipulation. A cervical collar may be necessary in some cases to provide
support and limit motion while an injured neck is healing.
Exercises and Stretches
Dr. Tarrabain may work on an exercise program developed just for you. He will
teach you ways to prevent further injury to your neck. Many problems in the
cervical spine can be improved greatly with a good exercise program and good
education on neck mechanics.
Cervical Pillow
A special pillow may help your pain at night and allow you to sleep better.
These cervical pillows are specially designed to place the right amount of
curvature in the neck while you sleep and decrease the amount of irritation on
the nerve roots. The pillows are available at our office.
Referrals
In some cases, Dr. Tarrabain may need to refer you to an orthopedist or
neurologist for a second opinion if you are not responding as well as expected
to treatment. In those cases, we work with your medical doctor to provide
the best possible care.