12 May Cervical Radiculopathy (Pinched Nerve)
By Steven Tran –Sydney CBD Chiropractor
Getting pin and needles or burning sensation that travels down your arm? Pain that radiates into the shoulder and down the hand? You may be suffering from cervical radiculopathy.
For a quick summary on cervical radiculopathy, watch the video below by Sydney CBD Osteopath Dr Abbey Davidson.
What is Cervical Radiculopathy (Pinched Nerve)?
Cervical radiculopathy or pinched nerve is defined as cervical nerve root compression. This occurs when there is inflammation or damage of the nerve root possibly due to a herniated disc, spondylosis (bone spurs), trauma, instability and more rarely, tumour.
Why do I get numbness or burning sensation down my arm?
The cervical spine contains 7 cervical vertebrae, running through the vertebral column you have your spinal cord which have 8 pairs of cervical nerve root that branches out and exits both sides of the spinal canal through an intervertebral foramen (small bony opening between the adjacent vertebrae). These nerves then branch out further to supply muscles to enable function of the shoulders, arms, hands and fingers. They also carry sensory fibres to the skin that provide sensation.
- Neck and radiating arm pain which can travel all the way down into the fingers (pins and needles or burning sensation)
- Pain that is accompanied by sensory disturbances (loss of sensation)
- Weakness and/or loss of muscle function in more severe cases
- Headaches, Neck pain and Scapular pain
How do I know if I have Cervical Radiculopathy?
It is important to seek out a qualified Chiropractor, Osteopath or Physiotherapist to screen the extent of your cervical radiculopathy injury and treat it accordingly. Your therapist will use various assessments to objectively determine the probability and location that you have cervical radiculopathy.
If you are unsure that you may have cervical radiculopathy, here are some modified self-administered tests that may be helpful for you to determine if you may have cervical radiculopathy. According to Wainner and colleagues, if 3 of the 4 test are positive, there is a 65% of cervical radiculopathy. If 4 of the 4 test are positive, the probability jumps to 90%. It is important to note if you are suffering with severe pain or if the pain takes a long time to go away, BE GENTLE with the assessment and if once you feel the symptoms come on, STOP it’s a positive test.
1 . Cervical Rotation:
Rotate your head in the direction to the side of your symptoms. Limited neck rotation of less than 60 degrees is considered a positive test.
2 . Upper Limb Nerve Tension Test:
This test aims to add a traction force to the nerve root, which typically aggravates symptoms if presents. With your affected arm keep your shoulder down, stick your arm out forward at 90 degrees with your palm facing in. Follow this with extending your wrist back. Next, gently bring your arm out to the side. Be sure to move slowly as this movement can recreate or worsen your symptoms, it’s a positive test if symptoms worsen.
3 . Cervical Distraction Test:
This test aims to decompress the nerve root in your cervical spine by opening up the intervertebral foramen.
4 . Spurling’s Test:
This test aims to add further compression to the nerve root, by closing down the intervertebral foramen in your cervical spine. By tilting your head back and side bend towards the side of your pain. You will need to determine if this position reproduces your neck/arm symptoms? If yes, this is a positive. If no, gently apply over pressure with your opposite hand. If this test recreates your symptoms, it’s also considered a positive test.
What can I do to reduce my pain?
No one single intervention has been shown to be more effective than another. Thus, a multimodal approach incorporating manual therapy and therapeutic exercises in addition to education has shown to be the most effective approach to treat cervical radiculopathy. The chiropractor, osteopath or physiotherapist may use many different modalities for treatment including manual mobilisation and/or manipulation, cervical traction, soft tissue manipulation and dry needling. These hands on therapy will focus on assisting in calming pain and inflammation, increasing mobility and strength.
To reduce symptoms:
- Anti-inflammatory cream or medication
- Gentle range of motion exercises and stretches
Avoid those things that aggravate your pain:
- Instead of turning your neck, turn your body!
- Position your work station (computer screen and other objects of interest) on the opposite side of your symptoms.
- Instead of looking up with your neck, use your eyes or thoracic spine to look up.
Do I need a MRI to diagnose cervical radiculopathy?
No. Your chiropractor, osteopath or physiotherapist will perform a series of specific assessment to determine if you suffer with a cervical radiculopathy. In some cases, especially if signs and symptoms have not been subsiding with conservative treatment, your therapist may request advanced diagnostic techniques, such as:
- Magnetic resonance imaging (MRI) is the most common imaging study used when checking for cervical radiculopathy because it shows nerves and other soft tissue, such as herniated discs.
Wainner, R., Fritz, J., Irrgang, J., Boninger, M., Delitto, A. and Allison, S. (2003). Reliability and Diagnostic Accuracy of the Clinical Examination and Patient Self-Report Measures for Cervical Radiculopathy. Spine, 28(1), pp.52-62.