What is Cervical Radiculopathy?
Cervical radiculopathy explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors
The term radiculopathy refers to the damage, irritation, or compression of nerves resulting in symptoms of pain, weakness, numbness, or even difficulty with muscle control. Cervical radiculopathy refers to nerve damage occurring specifically within the cervical region or neck area.
The underlying source of nerve damage is typically found at the root of the nerve, which is located along the spine. However, it is not uncommon for patients to report that their pain radiates to other parts of the body. Patients with cervical radiculopathy typically experience pain in the neck and other upper extremities, motor problems, weakening of the muscles, loss of sensory sensation in various regions of the upper body, and numbness or tingling sensations in the fingers, hands, or skin.
Causes of Cervical Radiculopathy
In general, the pain associated with cervical radiculopathy can be traced to a compressed, irritated, or pinched nerve. In some cases, the nerve may be working ineffectively due to a loss of blood flow to the area. This compression or pinching of spinal nerves can occur from structures surrounding the nerve itself. For instance, nerves can become compressed or pinched by nearby bones, muscle, cartilage, or even tendons.
A common cause of cervical radiculopathy is herniation of a cervical disc. This condition occurs when the intervertebral disc bulges out beyond the intervertebral space and places pressure on the surrounding nerves. Other conditions such as spondylarthrosis, arthritis, nerve injury, tumor, and infection in the spine can also be linked with symptoms related to cervical radiculopathy.
Cervical radiculopathy can also be the result of an injury, heavy lifting, a car accident, a tumor, or even diabetes. Individuals who smoke are believed to be at significant risk for developing complications with regard to cervical radiculopathy.
Diagnosing cervical radiculopathy can be done through a variety of methods. Magnetic resonance imaging (MRI) and electromyography may be used to assist clinicians with ruling out other possible conditions. Further, the shoulder abduction test (SAT), the Spurling test (ST), and the upper limb tension test (ULTT) have been increasingly used in the diagnosis of cervical radiculopathy. The goal of these tests is to assess for nerve root pain, underlying cervical radiculopathy.
Treatment for Cervical Radiculopathy
There are a number of treatment options to manage the pain of cervical radiculopathy. It is generally recommended that the initial intervention attempts focus primarily on relieving the symptoms of pain and inflammation. Patients may wish to begin by taking over-the-counter pain relievers, such as ibuprofen or acetaminophen, and applying a cold compress. Cervical collars that provide patients with support for the neck region are also available. Cervical pillows are beneficial at night to ensure that the head and neck are held in a neutral position, thereby reducing the risk for sleeping in a position that may exacerbate the condition.
For intractable cervical radiculopathy pain, the patient may wish to undergo a trial of stronger pain medications. For instance, opioids such as morphine, oxycodone, and codeine, are highly effective in relieving moderate to severe instances of pain, particularly with regard to pain that has not responded to even high doses of traditional pain medication. There are risks associated with the use of opioids though, and their use should only be considered in the short-term. Prolonged reliance on opioids for pain management increases the potential for drug dependence, abuse, and possible overdose. Patients receiving opioid treatment as part of their pain management plan should be closely monitored for use. Alternative options should always be considered should the patient’s pain persist or reemerge while using opioids.
Another highly effective treatment option available for cervical radiculopathy pain is steroid injections. There are two types of injections that are specifically appropriate for cervical radiculopathy pain. These are the cervical injection and the epidural injection. Using very similar techniques, medication is injected into the region of the affected nerve root. In terms of the cervical injection, the corticosteroid is administered between the vertebrae of the neck region. In terms of the general epidural injections, the injection site may be in many different locations, such as the middle back, lower back, or side of the spinal vertebrae. For both procedures, the anti-inflammatory properties of the corticosteroids are believed to be responsible for the elimination of pain. Further, these procedures are relatively brief and can be done on an outpatient basis. Some patients have reported almost immediate pain relief following the injection. There are very few risks associated with these injections. Of note, there is a possibility that nerve damage can occur during the injection. Other minor risks from the injection itself include minor bleeding, infections, and headaches. Some patients experience a reaction to the medication itself.
Nerve blocks are another treatment option for cervical radiculopathy. Similar to steroid injections, the procedure for a nerve block requires a needle to be inserted into the affected regions in the area of the damaged nerve. Rather than using this needle to administer a pain-relieving steroid or other anesthetic, an agent is used to destroy the nerve tissue. This form of treatment is more long-term as it involves disintegrating the damaged nerve. There are risks involved with the nerve block procedure. They include possible injury to nearby tissue such as arteries, veins, or other undamaged nerve roots during insertion. The use of imaging technology, such as fluoroscopy, ultrasounds, or computed tomography (CT), however, has significantly reduced these risks.
Nerve root damage owing to inflamed and compressed cervical nerves characterizes cervical radiculopathy. Patients with cervical radiculopathy report difficulty with regard to symptoms of muscle weakness, loss of sensory sensation, motor difficulties, and numbness or tingling within the affected area. These symptoms generally occur within the neck region, however, many individuals report experiencing pain or discomfort in other areas of the upper body.
There are a number of known causes for cervical radiculopathy. It is generally recommended that patients first attempt to manage their pain with anti-inflammatory medications or injections, non-steroidal treatments, and physical therapy. Nonetheless, some patients experience difficulties with regard to symptoms that do not remit in response to typical intervention. In these instances, short-term use of opioids may be recommended. Other procedures include cervical or epidural steroid injections, and nerve blocks. These procedures are relatively quick and can be done on an outpatient basis. Many patients report rapid pain relief as well in response to these therapies.
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