What Is Cervical Radiculopathy?
Cervical Radiculopathy
Cervical radiculopathy is compression or irritation of a nerve root in the neck as it leaves the spinal canal. These nerve roots exit through small openings between the vertebrae called foramina. When a nerve root is squeezed or irritated as it passes through one of these openings, it causes cervical radiculopathy. It can be extremely uncomfortable and painful. There are several possible causes, and in many cases, symptoms can be reduced without surgery.
Some neck and arm symptoms need urgent care. Get medical care right away if you have weakness in your arm or hand that is getting worse, clumsy hands or trouble with buttons or handwriting, trouble walking or balance problems, or new problems controlling your bladder or bowels. These can be signs of pressure on the spinal cord itself. Call 911 for neck pain with sudden severe headache, dizziness, vision changes, trouble speaking or weakness on one side of the body.
What Are the Symptoms of Cervical Radiculopathy?
Cervical radiculopathy usually causes pain and changes in sensation that follow a specific path down the arm. People often feel numbness or tingling in the part of the arm served by the irritated nerve, and these sensations can travel all the way to the wrist and hand. Moving the neck can cause neck pain that spreads into the shoulder, arm and hand. There is often a tender spot in the neck, and pressing on it may make the arm and hand symptoms worse. Some people also notice weakness in certain arm or hand muscles.
What Causes Cervical Radiculopathy?
Cervical radiculopathy happens when a nerve root is compressed near where it leaves the spinal column. A common cause is a herniated disc (1). A herniated disc can crowd the foramen, which contains nerves and blood vessels, causing pain, numbness and weakness.
Other causes include bone spurs (osteophytes), wear-and-tear changes in the spine called spondylosis, and, rarely, fractures or other conditions. In one large study, a herniated disc alone caused about 22% of cases, while about 68% came from a combination of disc and wear-and-tear changes (2).
The C6 and C7 nerve roots are the most commonly affected, and more than half of people also have pain around the shoulder blade or shoulder (1, 2).
How Common Is Cervical Radiculopathy?
Cervical radiculopathy affects about 83 out of every 100,000 people each year. It is most common in people in their 40s and 50s and affects men and women about equally. Physical exertion or injury triggers fewer than 15% of cases, and car accidents are involved in about 3% to 23% (1, 3, 2).
How Is Cervical Radiculopathy Usually Treated?
Most people with cervical radiculopathy improve without surgery. Non-surgical care can include spinal manipulation, traction, physical and occupational therapy, short-term use of a soft collar, steroid injections and medications. When there is severe degeneration, worsening weakness or pain that doesn’t respond to other care, surgery to relieve pressure on the nerve may be recommended. Research on manipulation and traction for cervical radiculopathy is encouraging, though more is needed (4).
How the NeuroRescue Program Can Help
Our care is designed to work alongside your physician and other providers, never in place of them. Please don’t change or stop any medication without talking with your prescriber.
Cervical radiculopathy often develops over time. Wear-and-tear changes in the spine are a common cause, and research suggests that how well the neck is stabilized by its muscles plays a role (5). Joints in the spine are held together by ligaments and connective tissue, and they rely on well-coordinated deep stabilizing muscles. Research has found that muscle function in the neck can be altered in people with cervical radiculopathy (6). Targeted manual therapies can help improve how these structures work (4).
Restoring spinal stability isn’t as simple as exercising the stabilizing muscles. Much of the work of the deep neck stabilizers happens automatically, guided in part by the vestibulospinal pathway, which carries signals from the inner ear down the spinal cord. This pathway helps steady the spine against gravity and during movement. The same inner ear signals also travel up to help control eye movements.
When the vestibular system is activated, it has a strong influence on the deep and surface muscles that stabilize the neck (7). The inner ear’s gravity sensors, called otoliths, help drive the stabilizing muscles that keep you upright against gravity. When these signals are impaired, spinal stability may be reduced (8). That’s why we include a careful evaluation of the vestibular system in our approach to the neck.
Other systems also affect neck muscle tone. Sound can influence spinal muscle activity (9), and the visual system fires neck muscles in response to eye movements, which helps coordinate your eyes and head (10). These eye, head and inner ear reflexes are often disrupted after whiplash injuries (11), which can also contribute to neck problems.
Because of this, we look not only at the spine and nerve roots, but also at the vestibular system, eye movements and balance.
Research suggests spinal adjustments may do more than move a joint. Studies using EEG, brain stimulation and brain imaging have found that adjustments can produce short-term changes in how the brain processes sensory and movement information, including in the prefrontal cortex and the areas that plan and control movement (12, 13, 14, 15). Researchers are still working to understand how long these changes last and how they relate to symptoms, but they help explain why we look at how your whole nervous system is working, not just your spine.
Depending on your needs and test results, your program may include:
Chiropractic adjustments and other specific manual therapies, used when appropriate and safe for you after a careful exam (16).
Eye-head coordination retraining (17) and vestibular rehabilitation, to support the reflexes that help stabilize your neck.
Electrical stimulation (18) and low-level laser therapy (19), which have been studied for nerve-related pain.
Transcranial magnetic stimulation (TMS), which has been studied for chronic pain (20). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it may be appropriate for you.
The therapies we recommend are always chosen based on your testing and exam findings.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions. Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems, including the nerves, reflexes and strength of your arms. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving function in the systems that need support and helping them work together. Our testing also helps us decide when to push and when to let you rest.
Our goal is to help calm the nerve, steady your neck and get you back to using your arm and hand with more comfort and confidence.
Your Next Step
Living with neck and arm pain can make everything harder, from sleeping to working to picking up your kids. You don’t have to keep pushing through it. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
It’s never too late to take the next step.
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