Pinched nerve in neck

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.

Click here: Second Opinion Arthritis Treatment Kit

A pinched nerve in the neck is one of the most common problems seen in a rheumatologists office. Often the patient will provide a history indicating a prior whiplash injury or other trauma. In older patients, the underlying cause is usually cervical spondylosis (osteoarthritis in the neck).

It is helpful to examine the anatomy of the neck to understand this problem.

The cervical spine (neck) is made up of seven vertebrae. The uppermost vertebra, C-1, articulates with the occiput of the skull above and with C-2 below.

The C1-occiput "joint" primarily allows flexion and extension, while C1-C2 provides rotation. Vertebrae C-3 through C-7 allow for varying degrees of flexion, extension, lateral bending, and rotation. Flexion centers on C-5 and C-6 and extension on C-6 and C-7.

Intervertebral disks are found from C2-3 and below and serve to cushion the vertebrae. Disk degeneration and herniation can lead to compression of the nerve root (radiculopathy) or spinal cord (myelopathy). The term “radiculopathy” refers to a pinched nerve.

Eight pairs of cervical spinal nerves exit through the intervertebral foramina.

The back portions of the cervical vertebrae have the facet joints, which are true synovial joints, while on the side of the vertebrae are the uncovertebral joints. Both joints can degenerate and produce pain with neck extension combined with lateral bending and rotation.

The muscles of the neck are divided into four major compartments: anterior (flexion), posterior (extension), and the lateral groups (lateral bending).

The most common injury is muscle strain. Muscle strains usually resolve within a few days to a couple of weeks, ligament sprains may take up to a few months, and disk injuries or herniations with radiculopathy can take up to 6 months for full recovery.

Pain that increases with activity but is relieved with rest or a change in position, is commonly referred to as mechanical pain.

It is important to determine whether the pain is localized or radiating. Localized pain generally points to muscle strains, ligament sprains, and facet or disk degeneration. Sometimes there may be radiation to the scapula or upper trapezius area as well. Pain that radiates into the arms frequently is due to nerve involvement.

Upper cervical nerve problems refer pain to the head (C-1, C-2), the neck (C-3), and the upper trapezius region (C-4). The C-5 nerve transmits pain to the shoulder and lateral arm. The C-6 nerve pattern is very similar but includes the radial forearm and thumb. The C-7 nerve refers pain to the posterior arm, dorsal forearm, and the index and middle fingers. The C-8 nerve radiates pain to the medial arm, ulnar forearm, and the ring and little fingers.

Ulnar neuropathy refers pain to the medial arm, forearm, and ring and little fingers, similar to a C-8 radiculopathy. Therefore, it's important to evaluate peripheral nerves as well as central ones. Carpal tunnel syndrome characteristically causes tingling in the thumb and first two fingers, and sometimes pain up the arm as high as the neck, appearing like a C-6 or C-7 radiculopathy. Shoulder degenerative joint disease or acromioclavicular, subacromial, or rotator-cuff pathology may be confused with a C-5 radiculopathy.

In addition to careful clinical examination, diagnostic studies such as magnetic resonance imaging (MRI) and electromyography (MRI) are helpful.

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