Severe neck pain with pain radiation into the arm and hand is usually the result of a herniated disc or a traumatic injury causing the nerve exit to be compromised, compressing the nerve. Most commonly affected are the C6 nerve in 25% of cases and the C7 nerve in 60%. About 25% of arm pains are from an acute prolapsed disc. In older people the cause is more likely to be narrowing of the exit channel from bony outgrowths, disc bulging, ligament infolding and arthritic enlargement of the facet joints. Physiotherapists routinely assess and treat this kind of neck pain.
Risk factors for this type of neck pain and arm pain include smoking, lifting heavy weights regularly (e.g. 12kg, 25 pounds) and driving or operating vibrating equipment. Overall cervical radiculopathy is uncommon and much more so than lumbar disc syndromes such as sciatica. The discs between the vertebrae from C2 to C7 transmit loads down through the spine and dissipate some of the forces applied to it. At the side of the vertebrae are the nerve exits or foramina and the nerve takes up to a third of the exit space normally. Degenerative changes in any of the structures which surround and form the walls of the exit can compromise the exit channel itself and compress the nerve.
There can be many reasons for the onset of nerve root neck pain or it can come on slowly without clear reason. If the neck is moved backwards, tipped to one side and rotated to the same side this can sharply narrow the nerve exit space and injure the nerve, occurring in a traumatic accident or a sporting injury. The opposite can occur with a quick side bend, combined with flexion or extension, tractioning the nerve and causing injury. Sudden loading of the neck in any posture can cause disc prolapse. There may be degenerative changes in an older group and with repetitive or sustained neck postures an osteophyte can impinge the nerve and give a slower development of arm pain.
The onset of cervical radiculopathy can be insidious without obvious cause or after an incident. During sport or trauma like a fall the neck can be extended back, bent to one side and rotated, suddenly narrowing the exit for the nerve and compressing it, causing an injury. Or a sudden bend to the opposite side with either cervical flexion or extension can traction the nerve on the one side with consequent injury again. If there is a sudden load on the cervical spine, in any position, it’s possible for a disc prolapse to occur. If there are osteophytes present in an older person, sustaining or repeating extension with rotation may cause nerve irritation with a slower onset.
Typically the pain comes on slowly and steadily with neck and arm discomfort, ranging from dull ache to a severe pain. Initially the complaint is shoulder pain, progressing to scapular, upper arm, lower arm and hand pain as the syndrome worsens. Changes in sensibility and motor power can also be present, in some cases without significant pain.
A postural abnormality is often present with the neck held side flexed or rotated away from the painful side. Examination by the physiotherapist includes recording any muscle spasm, checking reflexes, sensibility and muscle power, any combined movements which might aggravate the pain and any easing factors such as manual traction. Acupuncture and cervical epidural injections of steroids may be useful if physiotherapy cannot reduce the pain sufficiently.
Posture is usually abnormal with the head tilted away from the painful side and the neck held stiffly with reduced ranges of movement. The physio notes the muscle spasm and tests the muscle power to determine which nerve root is affected, looks for sensory and reflex loss and notes which combination of movements are provocative and if manual traction reduces symptoms.
In the sub-acute phase restoration of neck range of movements and strength is encouraged with isometric neck exercises with a progression to isotonic and multiple muscle groups. To prevent further problems, a long term exercise regime of aerobic fitness, stretching and strengthening may be helpful.
If you would like to make a comment, please fill out the form below.
