Usually, when something hurts, you don't have to look far to find the source of the pain. But an injury near the root of a nerve could result in pain at the end of the nerve, where sensation is felt. For example, an injury to the vertebrae or disks in your neck (your cervical vertebrae) could result in pain, numbness or weakness in your shoulder, arm, wrist or hand. That's because the nerves that extend out from between the cervical vertebrae provide sensation and trigger movement in these areas, this condition is called cervical radiculopathy (ra-dick-you-lop'-a-thee).
Causes of cervical radiculopathy
Several conditions can put pressure on nerve roots in the neck. The most common causes for cervical radiculopathy are:
- Herniated cervical disk. In this situation, the outer layer (annulus) of the disk cracks and the gel-like center (nucleus) breaks through. This causes the disk to protrude, putting pressure on the nerve that exits the spinal column at that point.
- Spinal stenosis. Sometimes, the space in the center of the vertebrae narrows and squeezes the spinal column and nerve roots.
- Degenerative disk disease. As we age, the water content in our body cells diminishes and other chemical changes occur that can cause the disk to shrink. Without sufficient cushioning, the vertebrae may begin to press against each other, pinching the nerve, or to form bony spurs.
Diagnosis and treatment
Your physician will give you a careful examination and ask about your symptom history. You may be asked to extend and rotate your neck and/or arm to reproduce the pain symptoms. An X-ray will usually show any degenerative disk problems. Sometimes your physician may request an MRI (magnetic resonance image) or a CT scan (computed tomography) using a colored dye to outline the nerves. Initial treatment is usually conservative and aims to reduce the pain by easing the pressure on the nerves. The treatment consists of three parts: rest, medication and physical therapy.
- Rest. You may have to take it easy for a few days or wear a soft cervical collar to limit motion and relieve irritation on the nerves.
- Medication. Your doctor may prescribe a non-narcotic pain medicine and anti-inflammatory drugs to relieve any swelling.
- Physical therapy. After muscle spasms subside, your orthopaedic surgeon may prescribe a cervical traction device or other types of physical therapy such as heat or cold therapies, electrical stimulation, or isometric and stretching exercises.
If conservative treatment doesn't relieve your pain over the course of 6 to 12 weeks, surgery may be an option. The surgical procedure will depend on the underlying condition. Your orthopaedic surgeon will discuss the options with you. In most cases, surgery not only relieves the pain, but also improves functioning and movement of the affected areas.
American Academy of Orthopaedic Surgeons. "Cervical Radiculopathy". August 2000. < http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=179&topcategory=Neck >.
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