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Pinched Nerves in the Neck

 

 

 

Degeneration of the cervical spine can result in several different conditions that cause problems. These are usually divided between problems that come from mechanical problems in the neck and problems which come from nerves being irritated or pinched. A cervical radiculopathy is a problem that results when a nerve in the neck is irritated as it leaves the spinal canal. This condition usually occurs when a nerve root is being pinched by a herniated disc or a bone spur.

The purpose of this information is to help you understand:

  • The anatomy of the cervical radiculopathy
  • The signs and symptoms of cervical radiculopathy
  • How the condition is diagnosed
  • The treatments available for treatment of the condition

Cervical Radiculopathy ("Pinched Nerve"):

When a nerve root leaves the spinal cord and the cervical spine it travels down into the arm. Along the way each nerve supplies sensation (feeling) to a part of the skin of the shoulder and arm. It also supplies electrical signals to certain muscles to move part of the arm or hand. When a nerve is irritated or pinched - by either a bone spur or a part of the intervertebral disc - it causes problems in the nerve and the nerve does not work quite right. This shows up as weakness in the muscles the nerve goes to, numbness in the skin that the nerve goes to and pain where the nerve travels. In the neck, this condition is called cervical radiculopathy. Let's look at the different causes of cervical radiculopathy.

Pinched nerve from an herniated disc:

Bending the neck forward and backward, and twisting left and right, places many kinds of pressure on the vertebrae and disc. The disc responds to the pressure from the vertebrae by acting as a shock absorber. Bending the neck forward compresses the disc between the vertebrae. This increased pressure on the disc may cause the disc to bulge toward the spinal canal and the nerve roots.

Injury to the disc may occur when neck motion puts too much pressure on the disc. One of the most painful injuries that can occur is a herniated disc. In this injury, the tear in the annulus potion of the intervertebral disc is so bad that part of the nucleus pulposus squeezes out of the center of the disc. The annulus can tear or rupture anywhere around the disc. If it tears on the side next to the spinal canal, when the nucleus pulposus squeezes out, it can press against the spinal nerves. Pressure against the nerve root from a herniated disc can cause pain, numbness, and weakness along the nerve. There is also evidence that the chemicals released from the ruptured disc may irritate the nerve root, leading to some of the symptoms of a herniated disc - especially pain.

Herniated discs are more common in early middle-aged adults. This condition may occur when too much force is exerted on an otherwise healthy intervertebral disc. An example would be a car accident where your head hit the windshield. The force on the neck is simply too much for even a healthy disc to absorb and injury is the result. A herniated disc may also occur in a disc that has been weakened by the degenerative process. Once weakened, less force is needed to cause the disc to tear or rupture. However, not everyone with a ruptured disc has degenerative disc disease. Likewise, not everyone with degenerative disc disease will suffer a ruptured disc.

Pinched nerve from degeneration and bone spurs:

In middle aged and older people, degenerative disc disease can cause bone spurs to form around the nerve roots. This usually occurs inside the foramen - the opening in the cervical spine where the nerve root leaves the spine to travel into the arm. If these bone spurs get big enough they may begin to rub on the nerve root and irritate the nerve root. This causes the same symptoms as a herniated disc. The irritation causes pain to run down the arm, numbness to occur in the areas the nerve provides sensation to and weakness in the muscles that the nerve supplies.

Symptoms:

A cervical radiculopathy causes symptoms that radiates out away from the neck. What this means is that although the problem is in the spine, the symptoms may be felt in the shoulder, the arm, or the hand. The symptoms will be felt in the area where the nerve that is irritated travels. By looking at where the symptoms are, the spine specialist can usually tell which nerve is involved. The symptoms include pain, numbness and weakness. The reflexes in the upper arm can be affected.

When you are suffering from a cervical radiculopathy, there is usually also neck pain and headaches in the back of your head. These are sometimes referred to as occipital headaches because the area just about the back of the neck is called the "occiput".

Diagnosis:

Finding the cause of neck pain begins with a complete history and physical examination. After the history and physical examination, Dr. Cady will have a good idea of the cause of your pain. To make sure of the exact cause of your neck pain, Dr. Cady can use several diagnostic tests. These tests are used to find the cause of your pain -- not make your pain better. Regular x-rays, taken in the doctor's office, are usually a first step in looking into any neck problem and will help determine if more tests will be needed.

Complete History:

A "complete history" is usually two parts. One part is written; a form that you fill out while you wait to see the doctor. While you fill out the form, take time to think about everything you can remember that relates to your neck pain and write it down. The more you can tell him, the faster he can diagnose the cause and help relieve your pain. The second part of your history will be answering questions. Your doctor will ask you describe when your neck pain began and the type of pain you are having.

For example, he may ask:

  • When did the pain first begin?
  • Have you increased your activity level?
  • Have you had an injury, or surgery, to your neck at any time?
  • Does the pain go down into your arms or legs?
  • What causes your neck to hurt more or less?
  • Have you had any problems with your bowels or bladder?

Physical Examination:

Once most of the information is gathered, your doctor will give you a thorough physical exam. During the exam your doctor will look at your neck to find out how well your neck is functioning. This includes:

  • How well you can bend your neck and roll your head in all directions?
  • How well you can twist your neck?
  • If there is tenderness around the neck?
  • If there are muscle spasms around the neck and shoulders?
  • Tests that examine the nerves that leave the spine are also important.
  • Testing for numbness in the arms and hands
  • Testing the reflexes
  • Testing the strength of the muscles in the arms, hands, and legs
  • Testing for signs of nerve irritation

X-rays:

X-rays show the bones of the cervical spine. Most of the soft tissue structures of the spine, such as the nerves, discs, and muscles, do not show up on x-ray. X-rays can show problems that affect the bones, such as infection, fractures, or tumors of the bones. X-rays may also give some idea of how much degeneration has occurred in the spine. X-rays alone will not show a herniated disc. The X-rays will be useful in showing how much degeneration and arthritis are affecting the neck. Narrowing of the disc space between each vertebra and bone spurs do show up on X-rays.

Magnetic Resonance Imaging (MRI):

The MRI is the most commonly used test to evaluate the spine because it can show abnormal areas of the soft tissues around the spine. The MRI is better than x-ray because in addition to the bones, it can also show pictures of the nerves and discs. The MRI is done to find tumors, herniated discs, or other soft-tissue disorders. The MRI is painless and lasts about 90 minutes. During the MRI, very detailed computer images of sections of the spine are taken. Unlike most other tests which use x-rays, the MRI uses magnetic fields and radio waves to see the structures of the neck. Pictures can also be taken in a cross section view. The MRI allows the doctor to clearly see the nerves and discs without using special dyes or needles. In many cases, the MRI scan is the only special test that needs to be done to find what is causing your neck pain. Dr. Cady can order an MRI if needed to diagnose your problem.

Treatment:

Treatment for any spine condition should include two main goals:

Relieve pain & reduce the risk of re-injury

Conservative Treatment:

Spinal Manipulation and physical therapy modalities are extremely important in the reduction of swelling which removes the irritation of the pressure on the nerves, resulting in less pain. Therapy will likely consist of ultrasound, ice, gentle stretches and exercises combined with gentle spinal manipulation. A cervical collar may be necessary in some cases to provide support and limit motion while an injured neck is healing.

Exercises and Stretches:

Dr. Cady may work on an exercise program developed just for you. He will teach you ways to prevent further injury to your neck. Many problems in the cervical spine can be improved greatly with a good exercise program and good education on neck mechanics.

Cervical Pillow:

A special pillow may help your pain at night and allow you to sleep better. These cervical pillows are specially designed to place the right amount of curvature in the neck while you sleep and decrease the amount of irritation on the nerve roots. The pillows are available at our office.

Referrals:

In some cases, Dr. Cady may need to refer you to an orthopedist or neurologist for a second opinion if you are not responding as well as expected to treatment. In those cases, we work with your medical doctor to provide the best possible care.

Call us at 408-739-2273 to make an appointment today.