Cervical radiculopathy occurs when the nerve is irritated or compressed (pinched) as it passes through the tunnel on its path to the arm. The nerve is often irritated by inflammation from neighbouring joints or the disc. The size of the tunnel may be reduced in height as a factor of ageing, but that alone will not pinch the nerve. Another factor is usually present. The tunnel may be further narrowed by some bony outgrowth from a neighbouring joint or by a fragment of disc that has split away. The resulting inflammation of the nerve is often the cause of pain.
When a nerve is truly pinched, there may be pain in the neck and shoulder region, but the worst pain is commonly felt in the arm. It is also common to feel sensations of pins and needles in the fingers or parts of the arm. There may be some numbness in the tip of the thumb, or one or two fingers, depending on which nerve is involved. Muscles in the arm or hand may also become weak. Symptoms are often quite severe and it is difficult to find positions of relief. It is often difficult to sleep.
The most notable symptom is the rather-severe ‘nerve pain’ in the arm. It is often a shooting, or burning type pain that is difficult to obtain relief from. The diagnosis is made from consideration of the nature of the pain and other symptoms, as well as an examination of the neck and neurological examination, which involves testing of reflexes, muscle strength and sensation in the arm. An X-ray or MRI may help confirm the clinical diagnosis.
Acute phase
In the acute stage (first 1–6 weeks), the treatment is a combination of pain-relieving medication for nerve pain prescribed by your GP, gentle physiotherapy and rest. Physiotherapy methods that have proven helpful to help ease the pain include gentle manual therapy and other treatment techniques. In addition, individualised education about the pain is provided, as well as instruction on best sleeping and working positions and how to care for the neck.
Subacute phase
Once the severe pain has reduced, your physiotherapist will progress treatment to include manual therapy to gently mobilise both the joints and nerves of the neck to further decrease residual pain. Gentle exercises are added to ensure that the nerves can move normally with day-to-day movement of the arms, and to ensure return of good control of your neck by the neck muscles. Exercises are progressed when pain has reached minimal levels to ensure return of normal muscle strength of your neck and shoulder girdle. Advice and education are provided on self-care methods for your neck to prevent recurrent episodes.
Persistent phase
Some people have intermittent but lesser pain in the arm that persists for several weeks or even months. In these cases, physiotherapy methods, such as manual therapy for the joints of the neck and nerve structures can be helpful in addition to education about pain, self-care methods and lifestyle features. A comprehensive exercise program is an important aspect of management.
Usually physiotherapy is the first treatment approach, but if severe pain is not easing and the muscles are becoming weaker, neck surgery may be considered. Studies that have investigated those who do and do not have surgery show that there is no difference in the final result some two years later.
Cervical radiculopathy is a very unpleasant condition and quick cures are rare to non-existent. The conservative management methods used by physiotherapists help progressively ease the symptoms of cervical radiculopathy. The time for recovery is highly variable and it may take many months before symptoms completely go away. Some people will have surgery if the level of pain is not tolerable and activities are severely limited. However, it has been shown that the outcome after one to two years is similar for those who do and do not have surgery.
When the arm pain is severe, the first thing is to find positions of the neck or arm that ease the pain. Some rest is helpful. Try different heights of pillows in bed or support the arm on a pillow. Consult your GP, as often some type of pain killer is necessary to help sleep. Sometimes, sitting tall and undertaking a few repetitions of an exercise, in which you gently draw your chin back may assist, but do not do these exercises if they make the pain worse. As the arm pain eases, some gentle exercises for the neck and arm can be commenced with care.
The time for recovery is variable and ranges from several weeks to several months. For some individuals, it may take up to a year or even two for all symptoms to go away. During this period, it is important to provide the neck with a balance of rest and normal activity.
