Cervical Radiculopathy: Diagnosing a Nerve That Is Pinched in the Neck

Cervical Radiculopathy: Diagnosing a Nerve That Is Pinched in the Neck

When a nerve is pinched in the spinal column of the neck, pain can be so strong that other, more subtle signs that could help doctors figure out what's wrong are missed.

The spinal cord in the neck is linked to the arm nerves by pairs of spinal nerves. These spinal nerves, which are also called roots or "radicles," send messages (electrical impulses) from the nerves in the arms to the brain about how the skin feels, such as touch, pain, heat, and cold. The cervical roots also send messages (also electrical impulses) from the brain through the arms' nerves to the muscles, which makes them contract.

So, when a cervical root is pinched, it can cause pain and numbness in patches of skin, weakness in muscles, or both by inhibiting nerve signals that come in and go out. Cervical radiculopathy is the name of the syndrome that happens when the neck is pinched. The suffix "-pathy" implies damage or impairment, therefore radiculopathy means that a radicle (root) has been damaged or impaired.

The spinal cord is connected to the nerves in the arms by four pairs of cervical roots. These roots are called by the part of the spinal cord they are joined to: C5, C6, C7, and C8, with the "C" standing for cervical. A pinch of any of these roots usually causes sharp, deep pain in the shoulder that keeps the person who has it from doing anything else. However, the shoulder discomfort is the least helpful or telling part of the person's symptoms.

The pain often moves into the arm on the side that hurts, and moving your head and neck in particular ways can make the discomfort worse or bring it back. The arm discomfort is not as bad as the shoulder ache, but where it hurts is frequently the best way to tell which root is pinched. The pattern of numbness or weakness also changes depending on which root is pinched. These patterns are nearly the same for everyone, and they are as follows:

When C5 is damaged, it can cause discomfort in the first fourth of the arm, which is also where numbness happens. Weakness means that you can't raise your arm to the level of your shoulder or above. The doctor can't use any good (rubber-hammer-type) reflexes to examine this root.

When C6 is damaged, pain can go all the way to the thumb, which is also where numbness can happen. When someone is weak, they can't bend their elbow. The doctor can also check for C6 damage by testing the biceps reflex, which involves hitting a tendon in the elbow's crook.

When present, C7 impairment can cause pain and numbness in the middle fingers. When someone is weak, they can't straighten their elbow. The doctor can also check for C7 damage by using the triceps reflex, which entails hitting a tendon on the back of the elbow.

When C8 is damaged, discomfort might travel all the way to the little finger. Numbness can also happen there. Weakness affects some hand movements, such as the ability to bring the tips of the thumb and little finger together and spread the fingers sideways. The doctor can't use any good reflexes to test this root.

Once you know what the common syndromes are, the next step is to figure out what created the pinch in the first place. Usually, it's either a herniated ("slipped") disc or a bony spur. Younger persons are more likely to have a herniated disc, while older adults are more likely to have a bony spur. Discs are soft structures that are found between each pair of vertebral bodies, which are the bones that make up the spinal column. Their normally robust outer membranes can get weaker and let inner disc material leak out, like toothpaste coming out of a tube, into the side canals that the spinal roots have to go through. This holds them in place and squeezes them. Bony spurs, on the other hand, are not soft at all. Instead, they are strong ridges of extra bone that are on the borders of the backbones. They come from the deterioration of arthritis. They can also trap and squeeze the spinal roots as they leave the spine.

How do doctors figure out if someone has cervical radiculopathy? As mentioned, the patient's history and examination are frequently quite useful and detailed. When the pattern of nerve damage is unclear, testing of nerve and muscle electricity, such as nerve conduction studies and electromyography, can assist pinpoint the damage. These electrical testing can also find problems with the nerves in the arms that might seem like cervical radiculopathy but need distinct medical care.

Myelograms took the greatest photos of the pinches in the spine until the 1980s. To do a myelogram, the doctor began by putting a needle into the patient's lower back (also called a lumbar puncture or spinal tap) and injecting x-ray dye into the aqueous gap between the membrane that covers the spinal cord and its roots. Then, the subject was angled such that the dye flowed into the right region in the neck. Standard x-ray pictures showed the column of dye and any bumps or dips in the column that were caused by a herniated disc or bony spur.

In the 1980s, magnetic resonance imaging (MRI) was invented. It made pictures that were comparable to those made by a spinal tap or dye infusion, but without the need for either of those procedures. Computed tomographic (CT) scans, which were first used in the 1970s, are usually the least useful of the spinal imaging procedures. However, they can be quite helpful if a myelogram was done right before them. None of these imaging tests is usually the best, thus testing must be tailored to each patient. Each test has its own pros and cons.

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