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Degeneration
of the cervical spine can result in several different
conditions that cause problems. These are usually divided
between problems that come from mechanical problems in
the neck and problems which come from nerves being irritated
or pinched. A cervical radiculopathy is a problem that
results when a nerve in the neck is irritated as it leaves
the spinal canal. This condition usually occurs when a
nerve root is being pinched by a herniated disc or a bone
spur.
The
purpose of this information is to help you understand:
-
The anatomy of the cervical radiculopathy
-
The signs and symptoms of cervical radiculopathy
- How
the condition is diagnosed
- The
treatments available for treatment of the condition
Causes:
Cervical
Radiculopathy ("Pinched Nerve"):
When
a nerve root leaves the spinal cord and the cervical spine
it travels down into the arm. Along the way each nerve
supplies sensation (feeling) to a part of the skin of
the shoulder and arm. It also supplies electrical signals
to certain muscles to move part of the arm or hand. When
a nerve is irritated or pinched - by either a bone spur
or a part of the intervertebral disc - it causes problems
in the nerve and the nerve does not work quite right.
This shows up as weakness in the muscles the nerve goes
to, numbness in the skin that the nerve goes to and pain
where the nerve travels. In the neck, this condition is
called cervical radiculopathy. Let's look at the different
causes of cervical radiculopathy.
Pinched
nerve from an herniated disc:
Bending
the neck forward and backward, and twisting left and right,
places many kinds of pressure on the vertebrae and disc.
The disc responds to the pressure from the vertebrae by
acting as a shock absorber. Bending the neck forward compresses
the disc between the vertebrae. This increased pressure
on the disc may cause the disc to bulge toward the spinal
canal and the nerve roots.
Injury
to the disc may occur when neck motion puts too much pressure
on the disc. One of the most painful injuries that can
occur is a herniated disc. In this injury, the tear in
the annulus potion of the intervertebral disc is so bad
that part of the nucleus pulposus squeezes out of the
center of the disc. The annulus can tear or rupture anywhere
around the disc. If it tears on the side next to the spinal
canal, when the nucleus pulposus squeezes out, it can
press against the spinal nerves. Pressure against the
nerve root from a herniated disc can cause pain, numbness,
and weakness along the nerve. There is also evidence that
the chemicals released from the ruptured disc may irritate
the nerve root, leading to some of the symptoms of a herniated
disc - especially pain.
Herniated
discs are more common in early middle-aged adults. This
condition may occur when too much force is exerted on
an otherwise healthy intervertebral disc. An example would
be a car accident where your head hit the windshield.
The force on the neck is simply too much for even a healthy
disc to absorb and injury is the result. A herniated disc
may also occur in a disc that has been weakened by the
degenerative process. Once weakened, less force is needed
to cause the disc to tear or rupture. However, not everyone
with a ruptured disc has degenerative disc disease. Likewise,
not everyone with degenerative disc disease will suffer
a ruptured disc.
Pinched
nerve from degeneration and bone spurs:
In
middle aged and older people, degenerative disc disease
can cause bone spurs to form around the nerve roots. This
usually occurs inside the foramen - the opening in the
cervical spine where the nerve root leaves the spine to
travel into the arm. If these bone spurs get big enough
they may begin to rub on the nerve root and irritate the
nerve root. This causes the same symptoms as a herniated
disc. The irritation causes pain to run down the arm,
numbness to occur in the areas the nerve provides sensation
to and weakness in the muscles that the nerve supplies.
Symptoms:
A
cervical radiculopathy causes symptoms that radiates out
away from the neck. What this means is that although the
problem is in the spine, the symptoms may be felt in the
shoulder, the arm, or the hand. The symptoms will be felt
in the area where the nerve that is irritated travels.
By looking at where the symptoms are, the spine specialist
can usually tell which nerve is involved. The symptoms
include pain, numbness and weakness. The reflexes in the
upper arm can be affected.
When
you are suffering from a cervical radiculopathy, there
is usually also neck pain and headaches in the back of
your head. These are sometimes referred to as occipital
headaches because the area just about the back of the
neck is called the "occiput".
Diagnosis:
Finding
the cause of neck pain begins with a complete history
and physical examination. After the history and physical
examination, Dr. Cady will have a good idea of the cause
of your pain. To make sure of the exact cause of your
neck pain, Dr. Cady can use several diagnostic tests.
These tests are used to find the cause of your pain --
not make your pain better. Regular x-rays, taken in the
doctor's office, are usually a first step in looking into
any neck problem and will help determine if more tests
will be needed.
Complete
History:
A
"complete history" is usually two parts. One
part is written; a form that you fill out while you wait
to see the doctor. While you fill out the form, take time
to think about everything you can remember that relates
to your neck pain and write it down. The more you can
tell him, the faster he can diagnose the cause and help
relieve your pain. The second part of your history will
be answering questions. Your doctor will ask you describe
when your neck pain began and the type of pain you are
having.
For
example, he may ask:
-
When did the pain first begin?
- Have
you increased your activity level?
- Have
you had an injury, or surgery, to your neck at any time?
- Does
the pain go down into your arms or legs?
- What
causes your neck to hurt more or less?
- Have
you had any problems with your bowels or bladder?
Physical
Examination:
Once
most of the information is gathered, your doctor will
give you a thorough physical exam. During the exam your
doctor will look at your neck to find out how well your
neck is functioning. This includes:
-
How well you can bend your neck and roll your head in
all directions?
- How
well you can twist your neck?
-
If there is tenderness around the neck?
-
If there are muscle spasms around the neck and shoulders?
-
Tests that examine the nerves that leave the spine are
also important.
-
Testing for numbness in the arms and hands
-
Testing the reflexes
-
Testing the strength of the muscles in the arms, hands,
and legs
-
Testing for signs of nerve irritation
X-rays:
X-rays
show the bones of the cervical spine. Most of the soft
tissue structures of the spine, such as the nerves, discs,
and muscles, do not show up on x-ray. X-rays can show
problems that affect the bones, such as infection, fractures,
or tumors of the bones. X-rays may also give some idea
of how much degeneration has occurred in the spine. X-rays
alone will not show a herniated disc. The X-rays will
be useful in showing how much degeneration and arthritis
are affecting the neck. Narrowing of the disc space between
each vertebra and bone spurs do show up on X-rays.
Magnetic
Resonance Imaging (MRI):
The
MRI is the most commonly used test to evaluate the spine
because it can show abnormal areas of the soft tissues
around the spine. The MRI is better than x-ray because
in addition to the bones, it can also show pictures of
the nerves and discs. The MRI is done to find tumors,
herniated discs, or other soft-tissue disorders. The MRI
is painless and lasts about 90 minutes. During the MRI,
very detailed computer images of sections of the spine
are taken. Unlike most other tests which use x-rays, the
MRI uses magnetic fields and radio waves to see the structures
of the neck. Pictures can also be taken in a cross section
view. The MRI allows the doctor to clearly see the nerves
and discs without using special dyes or needles. In many
cases, the MRI scan is the only special test that needs
to be done to find what is causing your neck pain. Dr.
Cady can order an MRI if needed to diagnose your problem.
Treatment:
Treatment
for any spine condition should include two main goals:
Relieve
pain & reduce the risk of re-injury
Conservative
Treatment:
Spinal
Manipulation and physical therapy modalities are extremely
important in the reduction of swelling which removes the
irritation of the pressure on the nerves, resulting in
less pain. Therapy will likely consist of ultrasound,
ice, gentle stretches and exercises combined with gentle
spinal manipulation. A cervical collar may be necessary
in some cases to provide support and limit motion while
an injured neck is healing.
Exercises
and Stretches:
Dr.
Cady may work on an exercise program developed just for
you. He will teach you ways to prevent further injury
to your neck. Many problems in the cervical spine can
be improved greatly with a good exercise program and good
education on neck mechanics.
Cervical
Pillow:
A
special pillow may help your pain at night and allow you
to sleep better. These cervical pillows are specially
designed to place the right amount of curvature in the
neck while you sleep and decrease the amount of irritation
on the nerve roots. The pillows are available at our office.
Referrals:
In
some cases, Dr. Cady may need to refer you to an orthopedist
or neurologist for a second opinion if you are not responding
as well as expected to treatment. In those cases, we work
with your medical doctor to provide the best possible
care.
Call us at 408-739-2273 to make an appointment
today.
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