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    Cervical Radiculopathy

    What is cervical radiculopathy?

    • Cervical radiculopathy refers to nerve pain originating from the neck and causing pain, altered sensation or weakness in the arm.

    How common is cervical radiculopathy?

    • Relatively common.
    • It is estimated that approximately 6.3%-14.4% of people will develop symptoms of cervical radiculopathy at some point during their life (1, 2).

    Should I worry?

    • No.
    • Cervical radiculopathy is common and very rarely linked to any serious medical conditions.
    • Symptoms from cervical radiculopathy usually settle well within 6-12 weeks in most people.
    •  A small number of patients may require further treatment or surgical interventions.
    • With the right rehabilitation approach, you should recover well (3,4,5).

    Who is most likely to suffer form cervical radiculopathy?

    • Cervical radiculopathy is most common in those aged between 50-60 (2).
    • Being a smoker and being an ex-smoker are both identified as risk factors for this type of nerve pain.
    • Those in certain occupations may be more at risk (3).

    What are the common symptoms?

    • Neck pain with associated pain travelling down the arm and even into the hand.
    • Some people experience arm pain without significant neck symptoms.
    • Pain is often described as sharp and shooting.
    • Sometimes associated with altered sensations, often described as pins and needles, numbness or tingling in the arm.
    • In rarer cases, weakness of certain muscles might occur (2, 7).

    What can I do?

    • Remain active within your limitations.
    • Resume normal activities inclusive of work as soon as possible.
    • Using hot and/or cold (ensuring that the skin is protected) may help relieve pain.
    • Use a supportive cushion to help you sleep at night.
    • Advice by a qualified physiotherapist will be helpful in most cases (8).

    How long will it take to recover?

    • This will depend upon several factors including, but not limited to, other medical conditions, stage of injury, your ability to follow your rehabilitation plan, etc.
    • Fortunately, most patients have a good outcome and usually improve within 6-12 weeks with the right help and advice (4, 6).
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    1. Introduction

    Cervical radiculopathy (sometimes referred to in layperson’s terms as a “trapped nerve”) is an umbrella term used to describe several symptoms which are experienced as neck pain, with associated pain travelling down the arm and even into the hand. (1,3). This condition often develops suddenly without an obvious cause. In the younger adult, the cause of the nerve irritation may be compression on the nerve by the intervertebral discs of the cervical spine (neck). In an older individual, the cause of nerve compression may be due to the normal, age-appropriate changes of the cervical spine (6). It is this nerve compression and subsequent inflammation of the nerve that causes the radiating arm pain which, in most instances, is the most obvious symptom. The pain typically follows the distribution of the affected nerve, so maybe felt in specific locations in the arm. This may be accompanied by other symptoms, such as pins and needles, weakness or a loss of grip strength (6).

    It is worth noting that a variety of other conditions can mimic cervical radiculopathy. For example, restriction or stiffness within the intervertebral joints of the neck can cause pain travelling down the arm without specific irritation of an affected nerve. This is often referred to as somatic referral and differs from true nerve-related arm pain.

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    2. Signs & Symptoms

    3. Causes

    Cervical radiculopathy refers to the compression and/or subsequent inflammation of an affected nerve root as it exits from the neck to travel into the arm. There are many potential causes of nerve root inflammation, including:

    • Herniated intervertebral disc sometimes referred to as a disc bulge.
    • Spondylolisthesis – occurs when a spinal segment moves from its normal position.
    • Spinal stenosis – occurs when the column that your spinal cord travels down narrows causing compression.
    • Other more sinister and significantly rarer conditions which might cause compression include infection and tumours, but these are extremely rare (3,7,10).

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    4. Risk Factors

    This is not an exhaustive list. These factors could increase the likelihood of someone developing cervical radiculopathy. It does not mean everyone with these risk factors will develop symptoms.

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    5. Prevalence

    Studies report varying estimates of the number of people affected by cervical radiculopathy due to various factors including its definitions, i.e. some studies will define cervical radiculopathy by any form of radiating arm pain, whilst others will define it as pain originating from specific nerve compression, which is the most specific classification (6). Lifetime occurrence (which describes the proportion of people who experience cervical radiculopathy at some point during their lifetime) ranges from 13%–40% (8,9).

    6. Assessment & Diagnosis

    Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis. Your clinician may perform a series of tests to examine the range of movement of the neck, test the strength of the muscles in your arm and check your reflexes and sensation.

    Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like magnetic resonance imaging (MRI) or X-rays are not required to achieve a working diagnosis. However, in persistent cases that have not responded to a period of appropriate conservative management, they may be warranted.

    7. Self-Management

    As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your cervical radiculopathy. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.

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    8. Rehabilitation

    Research is very clear that active self-management is key for a timely recovery. This includes advice about remaining active within limitations and resuming normal activities, inclusive of work, as soon as possible (8).

    Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing cervical radiculopathy. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point, as well as clearly highlighting exercise progression.

    9. Cervical Radiculopathy Rehabilitation Plans

    Early Plan

    This programme focuses on maintaining range of movement within the neck and low-level exercises aimed at the affected nerve(s). It is important not to further irritate the nerve so always work to a point of mild self-perceived tension only. We suggest you carry these exercises out daily prior to progressing onto the next stage of rehabilitation when your pain and function allow. Pain should not exceed 3/10 on your perceived pain scale whilst completing this exercise programme.

    Early Plan - Rating

    Intermediate Plan

    This is the next progression. More focus is given to progressive loading of the neck and shoulder regions, with further exercises aimed specifically at the affected nerve. Pain should not exceed 3/10 on your perceived pain scale whilst completing this exercise programme.

    Intermediate Plan - Rating

    Advanced Plan

    This is the next progression. More focus is given to progressive loading of the neck and shoulder regions, with further exercises aimed specifically at the affected nerve. Pain should not exceed 4/10 on your perceived pain scale whilst completing this exercise programme.

    Advanced Plan - Rating
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    10. Return to Sport/Normal Life

    For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.

    As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

    11. Other Treatment Options

    • Medication – you might benefit from specific medication options prescribed by an appropriately trained healthcare professional.
    • Surgery may be considered as a last resort if there is severe nerve compression, or where there are persistent symptoms that do not improve with conservative management (7,9).

    12. Links for Further Reading

    cervical radiculopathy_web.pdf (guysandstthomas.nhs.uk)

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    Book an Appointment

    Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.

    We have Pure Physiotherapy clinics across the country including Norwich, Dereham, Bolton, Manchester, Rochdale, Sheffield and Barnsley. Please view our clinics to find the closest physiotherapy clinic for you.

    References

    1. APTA. (2017). Neck Pain: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. American Physical Therapy Association. https://www.ncbi.nlm.nih.gov/pubmed/28666405.
    2.  Binder, A.I. (2007). Cervical spondylosis and neck pain. British Medical Journal 334(7592), 527-531.
    3.  Binder, A. (2007). The diagnosis and treatment of nonspecific neck pain and whiplash. Europa Medicophysical 43(1), 79-89.
    4.  BMJ. (2018). Assessment of neck pain. BMJ Best Practice. http://www.bestpractice.bmj.com.
    5.  Childress, M.A. and Becker, B.A. (2016). Nonoperative management of cervical radiculopathy. American Family Physician 93(9), 746-754.
    6.  Cohen, S.P. and Hooten, W.M. (2017). Advances in the diagnosis and management of neck pain. British Medical Journal. https://www.bmj.com/content/358/bmj.j3221.
    7.  Cote, P. et al. (2016). Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Spine Journal. Springer. https://www.ncbi.nlm.nih.gov/pubmed/26984876.
    8.  Kjaer, P. et al. (2017). National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. European Spine Journal. Springer. https://www.ncbi.nlm.nih.gov/pubmed/28523381.
    9.  NICE. (2018). Neuropathic pain in adults: pharmacological management in non-specialist settings. National Institute for Health and Care Excellence. http://nice.org.uk.
    10.  Thoomes, E.J., et al. (2017). Value of physical tests in diagnosing cervical radiculopathy: a systematic review. The Spine Journal 18(1), 179-189.
    Other Conditions in Neck, Neurological, Orthopaedics, Pain

    Whiplash Disorders

    An injury which typically occurs following a road traffic collision, often affecting the soft tissues of the neck.

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    Neck Pain

    Pain or discomfort in the neck and/or shoulder girdle, with or without pain referred to the arms.

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    Thoracic Outlet Syndrome

    A condition presenting with pain in the arm as a result of compression of structures around the neck/shoulder.

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    Cervical Disc Dysfunction

    Disk/joint-related issues that can cause pain, weakness and altered sensation in the neck and arms.

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