Cervical radiculopathy is a neck problem that occurs when there is compression of the cervical nerve, which supplies the shoulder, arm, and hand. It is the most common neurological problem resulting from the compression of the nerve root as it exits through the cervical spine. This condition is primarily caused by wear and tear associated with aging. Clinical manifestations include neck pain, numbness, weakness, and tingling sensation in the affected parts. It can be unilateral or bilateral.
The cervical spine has eight cervical nerve roots for seven cervical vertebrae. Cervical radiculopathy most commonly affects the C7 vertebra in 60% of cases and the C6 vertebra in 25%. Additionally, it is less common than lumbar spine radiculopathy. The annual incidence of cervical radiculopathy in the USA is about 85/1000 cases. ¹

Cervical radiculopathy causing neck pain

What are the Causes of Cervical Radiculopathy?

The most common causes include cervical disc herniation, cervical foraminal stenosis, traumatic injuries, and cervical tumors.

Cervical Disc Herniation:

It is the most common cause of cervical radiculopathy, in which the inner part of the cervical disc bulges out and pinches the adjacent nerve roots. Herniation results from the wear and tear phenomenon. It is among the most common causes of cervical radiculopathy in younger ones.

Cervical Foraminal Stenosis:

Foramina is an opening in a bone through which the nerve root exits or passes. When this opening narrows and becomes smaller, it compresses the nerve root, which results in cervical radiculopathy. Furthermore, cervical foramen stenosis occurs due to the following :

Cervical osteoarthritis
Disc degenerative changes
Rheumatoid arthritis

It is another common cause of cervical radiculopathy.

Trauma to Cervical Vertebra:

Trauma to the vertebra may cause fracture of the bone resulting in instability in vertebral consistency and foraminal narrowing which impinges the adjacent nerve root. Additionally, These fractures are caused by:

Mechanical injuries
spondylolisthesis (slipping of the vertebrae)

Spinal Tumor:

The tumor is a space-occupying lesion, whether it is benign or malignant. However, tumors grow beyond their boundaries and impinge the nerve root.

Spinal Infection:

Infections in the spine may cause cervical radiculopathy by inducing an inflammatory response that damages the adjacent nerve root.

Spinal Sarcoidosis:

It is a rare systemic disease that causes lump formation in the body. The lump is a swelling that may compress the adjacent nerve root.

Risk Factors of Cervical Radiculopathy

Some possible risk factors increase the risk of getting cervical radiculopathy. These factors are:

Aging:

Aging is one of the most common and leading risk factors for cervical radiculopathy. The incidence of cervical radiculopathy increases as age progresses. It occurs due to progressive degenerative changes with aging. Moreover, Aging can cause cervical radiculopathy due to the following reasons:

Increase in degenerative disc changes
Osteoporosis
Osteopenia
Steroid abuse

Strenuous Exercise :

Healthy and low-impact exercises maintain your spine mobility. In comparison, a strenuous activity (heavy weight lifting) may stress your cervical spine, resulting in cervical radiculopathy.

Previous History of Lumbar Radiculopathy:

People with a positive history of prior lumbar radiculopathy are prone to have cervical radiculopathy at later ages.

Smoking:

Smoking may affect the ongoing process of disc degeneration. Due to this reason, smokers are at high risk of getting cervical radiculopathy.

Operating Vibratory Equipment/Vehicles:

Driving vibratory vehicles such as trucks can cause damage to your vertebra due to repetitive neck motion. These people are prone to these neurological problems.

What are the Symptoms of Cervical Radiculopathy?

Symptoms of cervical radiculopathy are most commonly unilateral but can be bilateral. Clinically it involves the neck, shoulder, arm, forearm, and hand. The appearance of the symptoms depends on the type of affected nerve root. Cervical nerve fibers provide both sensory and motor nerve supply. However, the symptoms may be associated with sensory or motor loss, depending on the type of fiber damaged by cervical radiculopathy. The most common neurological symptoms are :

Neck pain (moderate to severe)
Numbness
Tingling sensation (pins and needle sensation)
Weakness in the affected muscle
Autonomic areflexia (loss of hot and cold sensation)

As we have discussed, signs and symptoms of cervical radiculopathy depend upon the location of the affected nerve root. According to the site, cervical radiculopathy is subdivided into different types.

C1-C2 Radiculopathy:

C1-C2 radiculopathy is rare. It causes radiating pain to the back or upper part of the head, pain below the eyes and nose, neck-tongue syndrome (causing an abnormal sensation in the tongue), light sensitivity, dizziness, lethargy, and fatigue.

C3 Radiculopathy:

C radiculopathy causes neck pain and muscular pain in the trapezius muscles.

C4 Radiculopathy:

In C4 radiculopathy, there is winging of the scapula (shoulder blades) with pain and numbness at the base of the neck.

C5 Radiculopathy:

The signs and symptoms of C5 radiculopathy are pin-needles sensation or tingling, numbness, and pain that radiates into the neck, shoulder, arm, and thumb.

C6 Radiculopathy:

C6 radiculopathy causes a pin-needle sensation, numbness, and radiation of pain from the arm to the 2nd digit of the finger (index finger). Moreover, it can cause weakness of the biceps or wrist.

C7 Radiculopathy:

Numbness, tingling, and pain may be felt from the arm to the middle finger. In addition, weakness of the triceps may occur.

C8 Radiculopathy:

Numbness, tingling, and pain radiate through the arm into the little finger causing ulnar deviation (deviation of the little finger). Thus, Handgrip is reduced in this type of radiculopathy.

When to see your Doctor?

Since cervical radiculopathy may have serious complications, immediately book your appointment with your neuro physician when you feel persistent pain, tingling, numbness, and weakness in your arm, neck, fingers, or back.

How to Diagnose Cervical Radiculopathy?

Your Doctor will diagnose it by the following methods: ²

History
Physical examination
Provocative Tests
Imaging techniques

History:

The first step in diagnosing every medical illness is to take a proper patient history. In the patient’s history, your doctor will ask about the following:

Signs and symptoms and duration of the disease
Is there any previous history of radiculopathy t?
Family history
Trauma
Medical history
History of any systemic illness

Physical examination:

After taking a detailed history, your Doctor will evaluate you physically. In physical examination, your Doctor will check for:

Neck stiffness
Neck mobility
Tumors or swelling
Lymph nodes palpation
Tenderness
Muscle strength
Reflex
Power of muscles
The tone of the muscles

Provocative Tests:

In addition to lab investigations, some provocative tests help diagnose cervical radiculopathy. These tests include:

Spurling Test:

It is the best physical test for the confirmation of cervical radiculopathy. In this test, the Doctor extends the patient’s neck and rotates the head rotated towards the affected site, and exerts pressure on the head. In a positive Spurling test, pain may radiate to the affected area (reproducing the symptoms). Moreover, the Spurling test is highly specific, with a specificity of approximately 93%. This means that if the test is positive, it highly indicates cervical radiculopathy. However, its sensitivity is relatively low at around 30%, meaning that a negative test result does not rule out the possibility of cervical radiculopathy.

Manual Cervical Distraction:

In manual cervical distraction, the person lies supine, and the Doctor applies a gentle manual distraction. Besides its diagnostic benefit, this method relieves the symptoms of cervical radiculopathy.

Lhermitte Sign:

In this test, when the patient flexes his neck, he feels an electric shock-like sensation that radiates down toward the spine. It may be negative in patients with cervical radiculopathy.

Imaging Techniques:

Imaging modalities are the best way to confirm your diagnosis of cervical radiculopathy. The following imaging studies help diagnose cervical radiculopathy:

X-ray (Plain Radiography):

Plain radiography is the most common and first diagnostic test to confirm cervical radiculopathy. The American College of Radiography recommends plain radiography as the first and best initial test in patients with chronic neck pain. Moreover, Plain radiography offers multiple views, such as anteroposterior, lateral, and oblique views.
Plain radiography shows degenerative disc changes, foraminal stenosis, osteophyte formation, and the diameter of the spinal canal.

Image of an X-ray shoes lateral view of neck

CT Scan:

CT scan provides good visualization of the cervical vertebra. It helps provide details of the C6 and C7 vertebra, which can not be clearly seen on plain radiography. The accuracy of CT scans is 72-91% in disc herniation diagnosis.
Moreover, a CT scan with myelography has an accuracy of 96% in diagnosing disc herniation. CT scan with myelography is recommended over a plain CT scan when disc herniation is suspected.

MRI:

MRI is one of the best imaging techniques and is the modality of choice for diagnosing cervical radiculopathy. In comparison, it is superior to a CT scan because it can visualize soft structures that a CT scan can’t. Magnetic resonance imaging can detect disc and ligament disruption, which can not be visualized on a CT scan.
Furthermore, It is also a useful imaging technique for evaluating the amount of cerebrospinal fluid surrounding the spinal cord in patients with foraminal stenosis.

Other Studies:

Other studies which are used to diagnose are :

Electromyography:

Electrodiagnostic studies are used to identify nerve root abnormalities. However, it is a very useful test for the diagnosis of cervical radiculopathy, and its findings are correlated with other studies.

The Selective Diagnostic Nerve Root Block Studies:

It is a diagnostic and therapeutic study in which the nerve of the affected area is blocked to provide short-term pain relief. Moreover, This study unveils the origin of the affected nerve.

Treatment of Cervical Radiculopathy

There are different options for treatment that relieve it step by step. About 85% of cervical radiculopathy resolves without taking any specific treatment in 8-12 weeks of duration. However, if it does not resolve independently, the following are treatment approaches for cervical radiculopathy: ³

Nonsurgical treatment
Surgical treatment

Nonsurgical Treatment

Nonsurgical treatment includes:

1-Physiotherapy:

Physiotherapy is the best nonsurgical and non-medical technique to release the pain of cervical radiculopathy. Besides medical and surgical treatment, different physiotherapy exercises relieve this pain. The aim of these exercises is to:

Improve your postural awareness
Alleviate pain
Muscle reactivation

These exercises are :

Neck flexion
In this exercise, you must lie on your back with your neck fully supported with soft pillows. Flex your neck and maintain your position for 5 seconds. Repeat this exercise 5 times a day.

Neck Rotation
To perform the neck rotation exercise, firstly, assume the same position as mentioned earlier. Gradually and gently rotate your neck towards the left side, maintaining this posture for a duration of 5 seconds. It is recommended to repeat this movement at least five times a day to enhance flexibility and alleviate discomfort.
Resisted Neck Rotation
In the resisted neck rotation exercise, you will place one hand on the side of your head. Then, with controlled effort, try to move your head towards the same side while simultaneously opposing the resistance provided by your hand. This exercise aims to strengthen the neck muscles and promote stability.

Scapula Exercise
The sitting position is favorable for this exercise. In this exercise, you will sit straight and gently move your shoulder back and up. Hold them for 10 seconds and repeat this exercise 5 times a day.
Shoulder Girdle Exercise
Sitting and standing positions are both appropriate for this exercise. In this exercise, you will lift your shoulder, hold it for 10 seconds, and then relax. Repeat this exercise 5 times a day.
Hand Grip Strengthening Exercise
You can do this exercise in a sitting or standing position. Hold a tennis ball in your hand, gently press it, and hold it for 5-10 seconds. Repeat this exercise 5 times a day.

Supplementary Approaches

Additionally, other measures that help release the pain are:

Maintain your posture that minimizes your neck and arm pain
Stay active
Use soft pillows
Cervical support by cervical collar
Good sleep
Heating pads
Cooling pads
Gentle Massage
Avoid smoking
Avoid strenuous exercises

2-Medical treatment:

Medical treatment for cervical radiculopathy includes the use of painkillers or analgesics. These medications are prescribed by your doctor based on the severity of the condition. It should be noted that the first-line painkillers for cervical radiculopathy are Nonsteroidal anti-inflammatory drugs (NSAIDs).

In addition to NSAIDs, other medications can be beneficial in treating cervical radiculopathy. These may include opioids, muscle relaxants, gabapentin, pregabalin, and antidepressants. Each of these medications targets different aspects of the condition to help manage pain, reduce inflammation, relax muscles, and alleviate associated symptoms.

Your doctor will determine the most suitable treatment plan for you, which may involve a combination of these medications tailored to your specific needs. It is important to follow your doctor’s instructions and communicate any concerns or side effects experienced during the course of treatment.

Cervical Epidural Steroid Injection:
If the affected nerve root is identified by an imaging technique, an X-ray-guided steroid epidural injection is injected to overcome it.
Cervical Traction:
Cervical traction is a device that is applied over the affected area. Additionally, it provides traction and helps increase the space of the cervical canal to overcome nerve compression.

Surgical Treatment:

There are two surgical options to treat it. These are:

Cervical Discectomy and Fusion:

It is a small, minimally invasive surgery in which your surgeon removes the part of the disc that is causing compression. Moreover, This is the most commonly performed surgery nowadays to treat cervical radiculopathy.

Artificial Disc Replacement:

In this surgery, the neurosurgeons remove the part of the disc causing the problem and place an artificial disc for fusion. Moreover, the benefit of this surgery is it provides better neck mobility than cervical discectomy, in which fusion compromises neck mobility.

Conclusion:

To conclude, Cervical radiculopathy is a painful condition that affects your neck, shoulder, arm, and hand. Moreover, It most commonly occurs unilaterally, but it may occur bilaterally. MRI is the investigation of choice for it. Physiotherapy and medical therapy can resolve uncomplicated cervical radiculopathy. NSAIDs are first-line medications for it. Surgery is preferred in complicated cases.

Refrences

1
Meyler, Z., DO. (n.d.). Cervical Radiculopathy Treatment. Spine-health. https://www.spine-health.com/conditions/neck-pain/cervical-radiculopathy-treatment
2
Craig Forsthoefel MD Johns Hopkins University. (n.d.). Cervical Radiculopathy – Spine – Orthobullets. https://www.orthobullets.com/spine/2030/cervical-radiculopathy
3
Malanga, G. A., MD. (n.d.). Cervical Radiculopathy Treatment & Management: Acute Phase, Recovery Phase, Maintenance Phase. https://emedicine.medscape.com/article/94118-treatment#d10

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