Pinched Neck Nerve – Cervical Radiculopathy, Compression
A cervical pinched nerve or nerve compression occurs as it leaves the spine in the neck and produces a condition known as cervical radiculopathy. The nerve may be compressed or irritated due to a herniated intervertebral disc, bone spurs, spinal stenosis or degenerative disc disease, and may produce symptoms such as pain, numbness or tingling in the arms, hands or shoulders.
Anatomy & Function of Cervical Spine
The parts of the spine which compromise the cervical vertebrae is the 7 upper most vertebrae, also known as the neck vertebrae. The cervical spine supports the head and connects it to the trunk, and due to its extensive mobility and flexibility it allows the neck to bend forwards and backwards, tilt sideways and rotate to the right or left. Each vertebra is separated from the next by an intervertebral disc, which consists of a tough outer layer surrounding a soft, gelatinous center. These intervertebral discs act not only as cushions and shock absorbers for the spine, but also contribute to the mobility, flexibility and stability of the spine. The opening in the center of each vertebra forms the spinal canal through which run the spinal cord, spinal nerves and arteries. The spinal nerves exit the spine at different levels and go on to supply the shoulders, arms and hands.
Symptoms of Cervical Nerve Compression
The symptoms of cervical nerve compression or pinched cervical nerves occur at the site of distribution of the nerve and may be in the shoulders, arms or hands.
- Pain occurs in the affected area of nerve distribution, such as shoulders, arms or hands. Neck pain is common, as also pain at the back of the head.
- Burning sensation.
- Tingling or “pins and needles” sensation.
- Numbness or decreased sensation.
- Muscle wasting may occur in later stages due to reduced movement as a result of the pain.
Causes of Cervical Nerve Compression
- Herniated intervertebral discs occurs when the outer layer of the disc ruptures, causing the contents of the disc to protrude into the spinal canal and cause pressure on the spinal nerves.
- Degenerative disc disease occurs when the intervertebral discs may degenerate or break down, and at the same time the vertebrae become thick and extend into the spinal canal.
- Bone spurs result due to conditions like osteoarthritis where there may be abnormal overgrowths of bone in the spinal canal or nerve root openings.
- Spinal stenosis is when bone spurs may cause narrowing of the spinal cord, thus producing pressure on the spinal cord and nerves. The most common cause of spinal stenosis is osteoarthritis, but other causes such as herniated disc, injury, spinal tumors or Paget’s disease of the bone may be involved.
- Kyphosis is a spinal deformity where there is excessive flexion of the cervical spine. Slight deformity may not be of much significance, but in severe cases there may be compression of the spinal cord or nerves, leading to pain and other associated symptoms.
- Spinal injury or injury to the backbone may occur after a fall or as a result of car accident injuries, where fracture of the vertebrae or other soft tissue damage may cause nerve compression.
- A tumor within the spine or spinal metastasis from cancer elsewhere in the body may case spinal cord compression.
- An abscess is the accumulation of pus or blood in the spinal cord may cause compression.
- Cervical dystonia or spasmodic torticollis is a rare condition which may occur at any age but is more common in middle-aged women. The neck muscles contract involuntarily, leading to painful twisting of the head to one side. This prolonged muscle contraction causes compression of the cervical nerves, leading to headaches, pain, tingling and numbness in the neck, radiating to the shoulders. The nerve compression may be severe and debilitating, often causing permanent nerve damage. There is no known cure for cervical dystonia but the condition may be self-limiting. Botulinum toxin injection, similar to botox used for cosmetic purposes, is helpful when injected into the affected muscles.
- Cervical spondylosis is an age related ‘wear and tear’ affecting the cervical spine may be termed as cervical spondylosis or cervical osteoarthritis. This is a progressive disease, affecting men and women equally after the age of 40, where the bones and cartilages of the cervical spine degenerate or may form bone spurs, causing compression of the nerves.
Symptoms of Cervical Nerve Compression
- Pain in the shoulders, neck arms or chest
- Stiff, tender neck
- Tingling or “pins and needles” sensation in the arms, hands, legs or feet.
- Numbness and weakness in the arms and legs.
- Difficulty in walking.
- Lack of co-ordination.
- Abnormal reflexes.
Diagnosis of Cervical Nerve Compression
Diagnosis is based on the case history and examination of the patient, but further tests may be done to confirm the diagnosis.
- Neck flexibility assessment is conducted by tilting the head and rotating the neck to determine the the range of motion of the neck.
- Neurological examination to determine the extent of pressure on the spinal nerves.
- X-ray of the cervical spine to find out any abnormalities, such as bone spurs.
- Computerized tomography or CT scan produces a more detailed image of the cervical spine than x-ray.
- Magnetic resonance imaging or MRI is the use of magnetic field and radio waves to get a detailed cross-sectional image of the spine to determine the extent of cervical spine damage.
- Myelogram to get a clearer picture of the spine, a dye is injected into the spinal canal and an x-ray or CT scan done.
Treatment is dependent on the duration and severity of symptoms.
- Neck brace or cervical collar – its use will limit neck movements and hence irritation to the nerves.
- Physiotherapy – exercises to strengthen the neck muscles.
- Medication :
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for pain relief.
- Muscle relaxants such as methocarbamol or cyclobenzaprine if there is associated neck spasm.
- Corticosteroid injections combined with local anesthetic into the joints between the vertebrae to relieve pain and inflammation, in more severe cases.
Hospitalization may be necessary for a week or two, in severe cases, to allow bed rest and traction on the neck so that the cervical spine is totally immobilized and pressure on the nerves is released. Surgery may be considered if all other treatments fail or if there is worsening of neurological symptoms such as weakness in the arms or legs. The type of surgery will depend on the underlying condition, such as bone spur or spinal stenosis, but surgery may not always be successful in eliminating all the symptoms.