Cervical Radiculopathy: Identifying a Compressed Nerve in the Cervical Region

Cervical Radiculopathy: Identifying a Compressed Nerve in the Cervical Region

When a nerve in the neck's spinal column is pinched, pain can be so bad that other, less obvious but still important, signs 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 electrical signals 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 to the muscles in the arms, which makes them contract.

So, when a cervical root is pinched, it can hurt, but it can also block nerve impulses coming in and going out, which can make patches of skin numb, muscles weak, or both. Cervical radiculopathy is the name of the syndrome that happens when the neck is pinched. The suffix “-pathy” implies injury or impairment, therefore radiculopathy means damage or impairment of a radicle (root).

There are four pairs of cervical roots that connect the spinal cord to the nerves in the arms. They are called C5, C6, C7, and C8, with the "C" standing for cervical. A pinch of any of these roots usually causes intense, deep pain in the shoulder that keeps the person who has it busy, but the shoulder pain is the least telling or helpful part of their symptoms.

The pain often shoots into the arm on the side that hurts, and moving the head and neck in particular ways can make the pain worse or bring it back. The pain in the arm isn't as bad as the discomfort in the shoulder, but where it hurts is typically the most important part of figuring out which root is pinched. Also, the pattern of numbness or weakness changes depending on which root is pinched. These patterns are nearly the same for everyone, and they are as follows:

When C5 is damaged, pain can travel over the top of the shoulder and into the first fourth of the arm. This is also where numbness can happen. When there is weakness, it means that the person can't lift their arm sideways to the level of their shoulder or higher. The doctor can't use any good reflexes, like a rubber hammer, to test this root.

When C6 is hurt, pain might travel all the way to the thumb, where numbness can also happen. When there is weakness, it means that you can't bend your elbow. The doctor can also check for C6 damage by using the biceps-reflex test, which involves hitting a tendon in the elbow's crook.

C7 problems can cause pain that goes all the way to the middle fingers, which is also where numbness happens. When there is weakness, it means that the elbow can't be straightened. The doctor can also check for C7 damage by hitting a tendon on the back of the elbow with the triceps-reflex.

Pain can go all the way to the little finger when C8 is damaged, and numbness can also happen there. Weakness affects some hand movements, such as the ability to touch the tips of the thumb and little finger together and to spread the fingers out to the sides. The doctor can't use any good reflexes to test this root.

After figuring out 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 disk (which means it has "slipped") or a bony spur. A herniated disk is more common in younger persons, while a bony spur is more common in older adults. There are soft disks between each pair of vertebral bodies (bones in the spine). Their thick outer membranes can get weaker, which lets inner disk material leak out into the side canals that the spinal roots have to travel through. This is similar to how toothpaste comes out of a tube. 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. Arthritic degeneration makes them. They can also trap and crush the spinal roots where they leave the spine.

How do doctors figure out if someone has cervical radiculopathy? As previously mentioned, the patient's history and examination frequently yield substantial and detailed information. When the pattern of nerve damage is unclear, nerve conduction studies and electromyography, which test the electricity in nerves and muscles, can assist find the problem. 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 were the best way to see the pinches in the spine until the 1980s. To do a myelogram, the doctor first did a lumbar puncture (sometimes called a spinal tap) on the patient's lower back. Then, he or she injected x-ray dye into the aqueous area 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 images displayed the column of dye together with any indentations in the column resulting from a herniated disk or bony spur.

MRI, or magnetic resonance imaging, was invented in the 1980s. It made pictures that were comparable to those made with a spinal tap or dye infusion, but it didn't require either of those things. Computed tomographic (CT) scans, which were invented in the 1970s, are usually the least useful of the spinal imaging methods. However, they can be quite helpful if a myelogram was done just before the scan. Each of these imaging tests has its pros and cons, and none of them is always the best, thus the tests need to be different for each instance.

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