Cervical radiculopathy, commonly called a “pinched nerve in the neck” occurs when a nerve exiting the spine in the neck is compressed or irritated. This can cause pain in the neck or shoulder, radiating pain into the arm with tingling, numbness and or weakness in the pattern of that particular nerve. Some patients experience pain at the lower tip of the shoulder blade rather than in the actual neck. Sometimes neck movements increase the symptoms. At times pain can be better if one holds their hand on top of their head.
Our spine is a series of bones stacked on top of each other. In between the bones is a structure called a disc. A disc is built like a jelly doughnut, there is a tough outer wall called the annulus and jelly on the inside called the nucleus. A disc rupture (or herniation) is when the outer wall tears and the jelly inside the disc escapes. Next to each disc is a nerve. A ruptured disc can pinch on a nerve, this is most common in a younger patient. As we age, the discs dry, they become narrowed and develop bone spurs. All of this can narrow the bone canals where the nerves exit. Typically pinched nerves after age 40-50 are due to these degenerative changes.
Often people live with a chronic level of neck pain. When new symptoms in the arm develop, it is easy to assume that the problem must be originating in the spine. Any person over the age of 40 will have disc bulges in the neck on MRI, so again it is easy to assume everything is coming from the neck. However, rotator cuff and shoulder issues can also cause neck and scapular pain. Numbness in the upper extremity can be due to nerve compression at either the wrist (carpal tunnel syndrome) or the elbow (cubital tunnel syndrome). Sometimes there is a combination of issues present. This makes an accurate diagnosis more difficult, and even more important for appropriate treatment.
Diagnosis of a pinched nerve is made by a combination of history, physical examination, cervical X-ray, cervical MRI or CT scan, and an EMG study.
- DO NOTHING -
Often mother nature will resolve the problem. If a pinched nerve is due to a disc rupture, the jelly inside the disc is 80% water which can be reabsorbed over time. This can make a large disc rupture into a smaller over time. Please seek medical attention prior to doing nothing. There is risk of nerve damage if a serious condition is ignored. The longer there is pressure on the nerve, the greater the risk of permanent nerve damage.
- SURGERY -
The most extreme intervention, done when there is significant pathology such as spinal cord compression, instability, or severe nerve compression.
- STEROIDS -
These reduce the swelling of the pinched nerve. Options are either steroid pills, or a steroid epidural injection which is a cortisone injection into the spine under x-ray. There are potential risks of both the medication and injections. Cervical epidural injections have the remote risk of a spinal cord injury.
- TRACTION -
Spinal traction temporarily opens the nerve canals while the patient is on the machine. This temporarily relieves the pressure on the inflamed nerve and allows natural healing to occur. Traction and spinal decompression are the same thing. If traction is done through physical therapy, it is typically paid for by health insurance companies. If traction is helpful, there are home traction units that allow patients to do traction several times a day home, thus reducing the cost of treatment even further. Traction, unfortunately, does not make bone spurs disappear, it does not make disc protrusion smaller, nor can it rehydrate a dry degenerative disc.
- HANDS ON THERAPY -
Soft tissue work and modalities can reduce muscle spasm, exercise can improve range of motion. High-velocity adjustments should be avoided in the presence of a cervical radiculopathy, as these can irritate a pinched nerve and make a small disc rupture larger.
Neck and arm problems can be due to a number of issues, which can mimic one another, making it difficult to determine if the problem is coming from the neck, the shoulder, or problems further in the arm. At times a combination of issues is present. Accurate diagnosis is important for appropriate treatment.
To schedule an appointment with Dr. Katharine Leppard, please call her office at 719-575-1800.