26/07/2020
PHYSIOTHERAPY MANAGEMENT OF CERVICAL RADICULOPATHY (CR)
Cervical radiculopathy is often referred to as a pinched nerve in the neck.
In other words, it occurs when a nerve root coming off the spinal cord becomes compressed. The compression can occur for various reasons. In younger people, it may occur when a cervical disc herniates due to trauma. In older individuals, it commonly occurs spontaneously as a result of arthritis or decreased disc height in the neck region.
It is characterized by radiating pain from the neck to the shoulder, scapula, arm, or hand. Weakness and lack of coordination in the arm and hand can also occur in severe cases. The condition affects an average of 85 out of 100,000 people most often individuals in their 50s. People who sit for long periods of time, or individuals with arthritis in the cervical (neck) region can also be affected. Conservative care, including Physiotherapy, can help reduce symptoms. A Physiotherapist can help alleviate the acute neck and arm symptoms that result from the condition, as well as improve general strength and function. Most cases of CR are resolved with physiotherapy management and may not require surgical procedures.
The cervical spine however, consists of 7 cervical vertebrae (the bones that form the neck region). Each vertebra is separated by a gel-like disc. The discs provide shock absorption for the spine. The spinal cord travels through a canal in the cervical vertebrae. Spinal nerve roots extend from the spinal cord and branch off going to specific locations in the arm. The spinal nerves send signals to our muscles for movement as well as sensations that we feel in the entire arm. The spinal cord is like a tree trunk, and the spinal nerves are like the tree branches. If an impingement or abnormal pressure is placed on a branch near the trunk, everything along that branch will be affected.
SYMPTOMS
Symptoms of CR vary depending on the nerve root involved, and commonly occur on the same side of the body as the affected nerve. The symptoms may include:
☆ Pain in the neck, shoulder, scapula (shoulder blade), upper chest, or arm, with pain possibly radiating into the fingers following the path of the involved nerve root.
☆Pain described as "sharp" or "pins-and-needles" or popping sensation in cervical region.
☆General dull ache or numbness anywhere along the pathway of the nerve especially the fingers.
☆Weakness in the shoulder joint, arm, forearm and fingers.
☆Pain that worsens with certain neck movements.
☆Pain that improves when the arm is lifted over and behind the head (relieving tension on the spinal nerve).
These symptoms may also be specific to the nerve root involved as follows:
~ C5 nerve root (between cervical vertebrae C4-C5): weakness in the deltoid muscle (front and side of the shoulder) and upper arm; shoulder pain and numbness
~ C6 nerve root (between cervical vertebrae C5-C6): weakness in the bicep muscle (front of the upper arm) and wrist muscles; numbness on the thumb side of the hand
~ C7 nerve root (between cervical vertebrae C6-C7): weakness in the triceps muscle (the back of the upper arm and wrist); numbness and tingling sensation in the back of the arm and the middle finger of the affected hand
~ C8 nerve root (between vertebrae C7-T1): weakness with hand grip; numbness in the little finger.
It's important to note that the most common nerve root levels for this condition are C6 and C7.
MANAGEMENT
Physiotherapy is an effective treatment for cervical radiculopathy, and in many cases, it completely resolves symptoms. Your Physiotherapist will develop an individual treatment plan based on the findings of your initial evaluation.
There are several intervention strategies for managing cervical radiculopathy, with *physical therapy and surgical interventions being the most common.*
However, Physiotherapists' goals include the following, before you begin with the management approaches :
¤ Pain relief
¤ Reduced muscle tension
¤ Improved range of movement in the neck region
¤ Improved functional levels
¤ Reduced numbness
¤ Restoration of neurological functions
¤ Improved activities of daily living
¤ Prevention of reoccurrence, etc.
These are all possible goals and the management will depend on the outcome of both your subjective and objective examination.
NB: It's important to look for a licenced Physiotherapist for review and possible management of this condition following your symptoms as outlined above.
Again, talk to your doctor for referral to a reputable Physiotherapy clinic and experience indelible impact on your neck pain challenge.
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