Cervical pinched nerves
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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The spinal cord originates at the base of the brain, runs down a central canal through the cervical and thoracic spine, and ends at the lower part of the lumbar spine.
Degeneration of the cervical spine can result in several different conditions that cause issues. These are usually divided between problems that come from mechanical dysfunction in the neck and problems which come from nerves being irritated or pinched. A cervical radiculopathy results when a nerve in the neck is irritated as it leaves the spinal canal. This condition occurs when a nerve root is being pinched by a herniated disc or a bone spur.
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 to the skin of the shoulder and arm. It also supplies electrical signals to muscles that move the arm or hand. When a nerve is irritated or pinched - by either a bone spur or an intervertebral disc, it causes the nerve to malfunction. This shows up as weakness in the muscles the nerve innervates, numbness in the skin and pain.
Bending the neck forward and backward, and twisting left and right, places pressure on the vertebrae and discs. The disc acts as a shock absorber. Flexing the neck compresses the disc. This increased pressure on the disc may cause the disc to bulge back toward the spinal canal and the nerve roots.
A herniated disc occurs when there is a tear in the annulus potion of the intervertebral disc so that part of the nucleus pulposus squeezes out of the center of the disc. This can cause the herniated nuclkeus to press against 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 (cytokines)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. 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.
In middle aged and older people, degenerative disc disease can cause bone spurs to form next to 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 the bone spurs are large enough they may begin to irritate the nerve root. This causes the same symptoms as a herniated disc. Pain runs down the arm and is accompanied by numbness and weakness in the muscles that the nerve supplies.
A cervical radiculopathy causes symptoms that may be felt in areas away from the neck. The symptoms may occur in the shoulder, the arm, or the hand. The symptoms will be felt in the area where the nerve that is irritated travels.
In addition to neck pain, there may also be headaches in the back of your head. These are sometimes referred to as occipital headaches.
Determining the cause of neck pain begins with a careful history and physical examination. After the history and physical examination, the physician will have a good idea as to the cause of the pain. Several diagnostic tests may also be performed to confirm the diagnosis.
Most cervical pathology will lead to pinching of either the C6 or C7 nerve roots in the neck, although sometimes the C5 or C8 nerves may be pinched. Depending on which nerve root is pinched, the following symptoms are likely:
• Pinched nerve at C5 will cause shoulder pain, deltoid weakness, and the biceps reflex may be lost.
• Pinched nerve at C6 causes weakness in the biceps and wrist extensors, and pain and numbness that runs down the arm to the thumb. On physical exam, the brachioradialis reflex (mid-forearm) may be diminished.
• Pinched nerve at C7 causes pain and numbness that runs down the arm to the middle finger. On physical exam, the triceps reflex may be reduced.
• Pinched nerve at C8 leads to hand dysfunction (this nerve supplies innervation to the small muscles of the hand). Pain and numbness can run to the outside of the hand (little finger).
The single best test to diagnose a herniated disc is an MRI (Magnetic Resonance Imaging) scan. An MRI scan can image nerve root impingement caused by a herniated cervical disk.
Occasionally, an EMG (electromyography) may also be done. An EMG is an electrical test that is done by stimulating specific nerves and inserting needles into various muscles in the arms that may be affected from a pinched nerve.
An EMG can also help rule out other nerve entrapment syndromes that can cause arm pain, such as carpal tunnel syndrome, brachial plexopathy, ulnar nerve entrapment, thoracic outlet syndrome, and other conditions.
Treatment of nerve impingement is directed at relieving the pain and then allowing the nerve to heal.
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