Updated: Sep 2, 2021
As the sun beams down on our mid-summer countryside, it’s easy to become lost in warm days and daydreams. But for some, the reverie is broken by pain. A literal pain in the neck, possibly accompanied by an uncomfortable arm. Neck soreness, a tingling arm, shooting pain, clumsiness, muscle weakness, or reduced sensation can take hold. Turning your head from side to side or gazing upwards at the beauty of our majestic red oak trees could trigger electricity to belt down your arm… If this sounds familiar, you might have what’s known as “cervical radiculopathy”. Cervical what-was-that? To explain, let’s first look at the anatomy of the cervical spine. In doing so, you will better understand how this problem can arise. And, importantly, what effective treatment for cervical radiculopathy might involve. Anatomy of the cervical spine (neck) The cervical spine is incredible. Complex, beautiful, and perfectly designed; as are all parts of your body. The seven spine bones of the neck sit stacked one on top of another. The uppermost vertebra is called the C1 or atlas. The second uppermost vertebra is called the C2 or axis. Then follows C3 down to C7, in numerological order. Each one is separate but acts as an integral team member, effecting and supporting the others. Together they enable motion, absorb shock, and protect the spinal cord that passes through it and the spinal nerves that exit from it. Because there are anatomical differences, let’s start from the bottom and work our way up… C3 - C7 vertebrae C3 to C7 are similar to one another. They each have a vertebral body, a kidney-shaped building block. Stacked on top of each other, these strong bony elements bear the bulk of the weight of the neck. From the individual bodies, bone extends backwards on each side before re-connecting to create a robust semicircle. Near each vertebra’s bony back, there are pairs of facet joints; like click-together flooring that connects each vertebra with its direct neighbors. They guide and limit motion so your head can only turn as far as is safe. After all, owl-like rotary ability in a human would be damaging! Between each vertebrae (except the occiput and C1, and C1 and C2) is an intervertebral cervical disc. Made from strong, rubbery tissue, they allow movement and absorb shock. But why does this all matter? The back of the bodies and the intervening disc for a virtual floor. The back of the posterior semi-circles form the roof. But at each level there are side exits, like small doorless alleyways. This is where the spinal nerves exit. These nerves innervate the muscles that enable you to move your head, neck, arms, and fingers, breathe, and remain upright. They produce sensation, so you can experience touch. It’s here — in these doorless passageways, that cervical radiculopathy tends to present. To visualize how this works, let’s consider a hug-worthy story… Imagine bear hugging a loved one and clasping your hands behind their torso. Your body represents the vertebral bodies and discs. Your arms represent the posterior bony elements that form the sides and roof of the spinal column (like a biological tunnel). Their body represents the spinal cord. Below the armpits a smaller space is created where the spinal nerves pass through. C1 and C2 vertebrae
C2 is a unique spinal bone. It has facet joints at its lower half like the vertebrae below it. But it has a prong on top. This projection pokes upwards and into C1. C1 is shaped like a ring so C2’s prong projects into its inner aspect. This quirky design allows rotational movement so you can look left and right. Because of the increased movement required here, these two bones are held together by a strong ligament rather than an intervertebral disc. To visualize how this works… Make a circle with your left thumb and forefinger, then place your right thumb inside, pressed gently against where the two digits join. Notice how you can rotate the “circle” around the “prong”? This is akin to how C1 and C2 move together. These differences between the anatomy of the lower and upper cervical vertebrae are why, in part, radiculopathy is more common in the lower regions. Regardless of the level, though, together the cervical spine creates a protected tunnel that enables the spinal cord to pass from the brain and skull, through the neck, and into the thoracic spine and onwards… While still providing the necessary exit points for the cervical spinal nerves. Now that we’ve covered the basic anatomy, why does this matter for neck and arm pain, and cervical radiculopathy? What is cervical radiculopathy? In scientific terms, Cervical refers to “neck”. Radiculopathy refers to “Any disease of the spinal nerve roots and spinal nerves.” So, cervical radiculopathy denotes a condition that affects the spinal nerves of the neck. How common is this condition? Before we look at how cervical radiculopathy can occur, it’s important to realize this condition is rare. Estimates vary, but the average likelihood of affliction is around 0.0008%! Still, if you’re one of the unlucky ones, prevalence statistics offer no respite. The incidence is more common during the fourth and fifth decades, in Caucasians, males, those who smoke cigarettes, people who’ve had a similar problem in the lower back (lumbar radiculopathy), and those who’ve experienced a physically traumatic event like a motor vehicle accident. How might cervical radiculopathy occur? Occasionally, the spaces we discussed earlier lose their spaciousness and become too narrow. Sometimes the spinal nerves becomes damaged or inflamed. For some people, injury or illness results in pressure on a nerve. Rarer still, infection or tumor could trigger compression. When a cervical spinal nerve is in some way hurt, this condition can result. Aging As we age, the spine may degenerate. This can lead to bony spurs called osteophytes and a loss of disc height. Both of these changes can reduce the space through which the spinal nerves travel. This is termed foraminal stenosis because the foramina or “hole” becomes stenosed or “narrowed”. This is the most common cause for cervical radiculopathy. Injury A cervical disc can become herniated. That is, a portion of the disc can abnormally protrude. It may poke into the foramina or onto the spinal nerve and trigger this condition. Mind you, this is rare. Inflammation Nerve tissue is exquisitely sensitive to inflammation. Whether caused by degenerative changes or injury, the inflammatory process may irritate spinal nerves in the absence of direct compression. This irritation can change how well the nerve is able to function. As a result of the nerve damage, symptoms can occur. What symptoms might develop? As each cervical nerve supplies or “talks to” different tissues, symptoms depend on the side of involvement and the body part being supplied. For example, if the nerve is squashed or inflamed on the right, the neck pain and any arm pain will be on the right. Note: It is possible for a problem to be large enough to effect the foramina on both sides but this is unusual. As another example, if the C6 nerve is involved, the biceps might be weak and the thumb side of the forearm might feel strange because these parts are innervated by this spinal nerve. With this in mind, symptoms can include: - Neck pain - Scapular pain (discomfort around the shoulder blade area) - Arm soreness that travels into a specific area. It may feel like burning pain, pins and needles, or an electrical sensation - Loss of sensation in part of the arm or hand (related to the nerve involved) - Muscle weakness (related to the nerve involved) - Worsening of the pain when the neck is tilted backwards and to the involved side (because this reduces the size of the involved foramina) - Relief when the arm is raised over and behind the head (because this can lessen traction on the involved nerve) Does this sound familiar? If so, you should seek professional advice. While some people with cervical radiculopathy will recover with time, some won’t. Plus, recovery may be hastened and made more comfortable with the right advice and treatment. Treatment for cervical radiculopathy Once you have received an accurate diagnosis, treatment can begin. The most common recommendations include conservative, non-invasive care. Here are five important suggestions… 1. Activity modification may calm symptoms. If there are particular actions that exacerbate the pain, avoiding them may help. 2. Ice or heat therapy or a combination of both might offer respite. 3. Cervical traction can be therapeutic. One study found that, “Cervical traction appears to be a major contribution in the rehabilitation of [cervical radiculopathy] particularly if it is included in a multimodal approach of rehabilitation.” 4. Manual therapy together with prescribed exercises have been shown to increase function and range of motion, while reducing disability and discomfort. 5. Chiropractic care can improve joint function and deliver pain relief. Appropriately adjusting the thoracic spine for example, that is, any subluxated vertebrae in the mid-section of your back, has been shown to offer relief for cervical radiculopathy. While this may at first seem strange, we at Flemington Chiropractic Center are happy to share why this is. Ask us! The cervical radiculopathy takeaway If you are experiencing neck or arm pain, or both… If the symptoms in this article jump out at you… If you have already been diagnosed with this condition and are looking for a safer, non-surgical option, we’d love to meet you and offer our expertise. Whether your condition is caused by a prolapsed cervical disc, an aging stenosed foramina, or another reason, we will begin by pinpointing the cause. Then we will determine the most appropriate course of treatment given your exact problem, your preferences, and your needs. Respite is possible. We look forward to helping get you firmly back on track. There is no reason to relinquish gazing upward at our beautiful oaks and enjoying our lovely warm summer! It’s time to experience a pain-free, happy life!
Disclaimer: This Website offers advice designed for educational purposes only and is not intended to replace the advice, treatment, or diagnosis of a healthcare professional. We recommend consulting with a registered health professional before implementing any advice.