Definition and discussion

Compression of the cervical nerve roots resulting in various neurologic findings. The human body consists of seven cervical vertebrae and 8 cervical nerve roots.

Aetiology

Cervical radiculopathy is much less common than lumbar radiculopathy. Potential causes:

  • In younger patients: disc herniation, acute injury causing foraminal impingement, sports injuries such as forced extension, lateral bending and rotation mechanisms
  • In older patients: IVF narrowing from osteophyte
  • Being over 40 years of age decreases the chance of herniation as the IVD become fibrous with age (nucleus and annulus), but degenerative bulging may occur
  • Due to spinal canal stenosis with age, small disc lesions in the elderly may have greater clinical

Risk factors:

  • Heavy manual labour requiring lifting more than 25 pounds (approximately 3 kg) (especially repetitive activity)
  • Driving or operating vibrating equipment
  • Collision sports such as rugby
  • Prior injuries (RTA, whiplash), DUD (OA)

History, signs and symptoms

  • May be a history of multiple episodes of previous neck pain
  • Patient may describe deep aching to burning neck pain and radicular upper limb pain (numbness, tingling, sharp, shooting, electric) that may follow an acute injury or be of insidious onset (dermatomal in distribution)
  • Patient may complain of muscle weakness in the upper limb
  • Patient may state symptomatic reef occurs when the shoulder is abducted with the hand held on top of the head
  • Bilateral symptoms in the upper or lower extremity may indicate spinal cord compression
  • On observation, the patient may tilt their head away from the side of injury and holds their neck stiffly
  • On palpation, tenderness along the cervical paraspinal muscles may be present, usually more pronounced on the same side of the affected nerve root
  • Muscle tenderness may be present along muscles where symptoms are referred such as medial scapula, proximal arm and lateral elbow
  • Associated muscle hypertonicity
  • Active range of motion may be particularly limited in extension, rotation and lateral bending either towards or away from the affected nerve root
  • Increased pain with lateral bending away from the affected side causes stretching of the IVD and opening of the IVF taking pressure off the nerve root
  • Lateral bending towards the side of injury may cause increased pain, numbness, tingling or shooting electrical pain
  • Ipsilateral pain suggests an impingement of the nerve root at the side of the IVF
  • On neurological testing motor weakness may be present in the muscles innervated by the compressed nerve root and sensory changes such decreased sensation as well as pins and needles and numbness

Home management

  • Rest, heat when painful
  • Passive (stretching) and active ROM exercises to be performed in a pain free range
  • Avoid, prolonged compression and flexion positions, heavy lifting or
  • Maintain neck in a neutral position during sleep and limit head positions that cause narrowing of the IVF
  • Medications such as NSAIDs and analgesics for pain control and muscle relaxants

Prognosis

Prognosis is very good with proper treatment. 90% of patients can be treated with conservative treatment; patients should show progressive improvement over the first 6-8 weeks. If there is no significant improvement or worsening of symptoms within the first 6 weeks, referral to a neurologist or neurosurgeon is warranted.