Cervical Radiculopathy, What is it?
Cervical radiculopathy is more than simply a “pain in the neck.” More specifically, it is describing a condition involving the nerves within the neck that become irritated, inflamed, or compressed resulting in symptoms of pain, tingling, weakness, or numbness that extend into the upper extremity.
Necks are designed to withstand significant forces as well as normal everyday activity. It is the most mobile part of the spine as the structures allow for flexion (forward bending), extension (backward bending, or, looking up), rotation (side-to-side), and lateral flexion (side bending, or moving the ear toward the shoulder). It also is designed to accept the weight of the head.
Seven vertebrae, or bones, make up the cervical spine. Each is stacked upon one another which allows for mobility, stability, and protection for the spinal cord and nerves. They are named in order from top to bottom, C1 to C7.
The largest of the cervical bones, C7, is the bottom of the cervical spine. It takes on a significant amount of the weight of the head, has more muscles attached to it than any other cervical vertebrae, and its shape is slightly different so that it connects perfectly with thoracic spine.
Each of the cervical vertebrae gets smaller as it moves up the spine. C3-C6 are structured the same and function the same to help with neck movements and to protect the cord. C1 and C2 are different in their design as they sit just below the skull and the mechanics of movement are different than the other vertebrae. C2 is called the axis and has a hook that fits neatly into C1 which sits just above it.
C1 is called the atlas and is the connection point of the spine to the skull. It is also uniquely designed to fit perfectly with the back of the skull.
Many muscles, tendons, ligaments, and cartilage attach to and control what happens in the cervical spine. The soft tissue is meant to help with movement, stabilization, and cushioning the space between each vertebra. A fibrocartilage disc is the cushion, and is extremely important as it relates cervical radiculopathy and its effect on nerve roots.
A nerve root is where the nerve extends off the spinal cord, and exits in a space created by two vertebrae as they stack on top of each other. The spinal cord is the structure of nerves that exits from the skull and is surrounded by the vertebral bodies as protection Eight cervical nerve roots (C1-C8) are present. The name of the root relates to the vertebral level between which it exits. C8 extends out of the bottom of C7.
One of the primary causes of cervical radiculopathy relates to compression or impingement of a cervical nerve, and this can be more commonly referred to as a “pinched nerve.” If the cushion wears out or does not stay within its designed space (disc bulge or herniation), then a change in the space between the vertebrae may cause a nerve compression or impingement. A person may experience pain, numbness, tingling, or weakness in their upper back, shoulder area, arm, and/or hand if this is occurring.
What causes cervical radiculopathy?
Some things that can cause the symptoms of radiculopathy are more serious than others, and frequently, many are treatable with the help of a physical therapist. Among the factors that may cause cervical radiculopathy are:
- Bulging disc
- Degenerative joint changes or bone spurs
- Impact trauma (e.g. falling object that hits head)
- Poor posture
- Ruptured disc
- Spinal stenosis (narrowing of the spinal canal)
- Trauma (e.g. whiplash)
Symptoms of cervical radiculopathy
Symptoms often start as neck pain, and then can spread into the arm and upper back or sometimes the head. The symptoms of a pinched nerve (pain, numbness, tingling, and/or weakness) will can appear somewhere else in the body depending on what nerve, or nerves, are involved.
The lower levels of the cervical spine are more common as the source of pinched nerves.
A C5 nerve root impingement will cause shoulder blade (scapula) pain, possibly shoulder weakness, and the pain and weakness may radiate down the upper arm. However, C6 impingement is more common than C5. The symptoms of a C6 compression may include pain and possibly tingling and numbness down the front of the arm, to the wrist, thumb and index finger.
C7 root impingement is the most common for cervical radiculopathy. Pain and weakness may be felt down the back of the arm, to the wrist and middle finger. C8 impingement will show signs of symptoms on the inside of the arm, down to the wrist, and include the ring and pinky fingers. Commonly with C8 impingement, symptoms will include numbness and grip weakness.
Another condition many people are familiar with, carpal tunnel syndrome, results in similar symptoms of hand numbness, tingling, and weakness. Careful assessment of the cervical spine by a skilled physical therapist can differentiate one from the other and symptoms caused by carpal tunnel syndrome will not typically be affected by movements of the cervical spine.
C1-C2 impingement is rare, but if the nerve is irritated, it can cause sinus pain, eye pain, headaches, high blood pressure, and dizziness. Compressions at the levels of the C2, C3, and C4 nerve roots are less common and frequently produce symptoms in the upper back, neck, clavicle, and shoulder areas.
How is cervical radiculopathy diagnosed?
For those who suffer from neck pain, early diagnosis and treatment are critical to preventing the symptoms from progressing to a cervical radiculopathy. Most often, people live through neck pain, but wait until neurological symptoms appear before they seek treatment.
An appointment with a physical therapist can be an excellent place to begin. In all states, patients can see a PT first, without a physician’s order, however, specific guidelines may apply. Information for the requirements for each state is located on the American Physical Therapy Association’s website Physical Therapy Direct Access By State.
An evaluation by a physical therapist begins with a complete medical history and physical exam of the neck, upper back, arms, and hands. Posture, reflexes, strength, range of motion, and response to movement will all be assessed.
Based on the results of the evaluation, the PT will develop a treatment plan and goals together with the patient.
Treatment of cervical radiculopathy
Treatment selected to address cervical radiculopathy will depend on the cause and severity of symptoms, and benefits and risks of options will be discussed by the physical therapist. Every patient is unique, and the care plan for every patient is also unique.
Physical therapists treat conditions conservatively, meaning they do not do injections or surgeries. Physical therapists do not prescribe medications.
If the physical therapist feels the clinical findings warrant additional examination by a medical provider, the PT will refer the patient appropriately for ongoing care.
Early intervention to neck pain is key to returning to function and reducing pain.
Find A Clinic will help identify a PT that has excellent outcomes in treating neck pain including cervical radiculopathy.