Cervical Radiculopathy

Cervical radiculopathy (sometimes referred to in layperson’s terms as a “trapped nerve”) is an umbrella term used to describe several symptoms which are experienced as neck pain, with associated pain travelling down the arm and even into the hand. ^(1,3). This condition often develops suddenly without an obvious cause. In the younger adult, the cause of the nerve irritation may be compression on the nerve by the intervertebral discs of the cervical spine (neck). In an older individual, the cause of nerve compression may be due to the normal, age-appropriate changes of the cervical spine ⁽⁶⁾. It is this nerve compression and subsequent inflammation of the nerve that causes the radiating arm pain which, in most instances, is the most obvious symptom. The pain typically follows the distribution of the affected nerve, so maybe felt in specific locations in the arm. This may be accompanied by other symptoms, such as pins and needles, weakness or a loss of grip strength ⁽⁶⁾.

It is worth noting that a variety of other conditions can mimic cervical radiculopathy. For example, restriction or stiffness within the intervertebral joints of the neck can cause pain travelling down the arm without specific irritation of an affected nerve. This is often referred to as somatic referral and differs from true nerve-related arm pain.

Cervical radiculopathy refers to the compression and/or subsequent inflammation of an affected nerve root as it exits from the neck to travel into the arm. There are many potential causes of nerve root inflammation, including:

• Herniated intervertebral disc sometimes referred to as a disc bulge.
• Spondylolisthesis – occurs when a spinal segment moves from its normal position.
• Spinal stenosis – occurs when the column that your spinal cord travels down narrows causing compression.
• Other more sinister and significantly rarer conditions which might cause compression include infection and tumours, but these are extremely rare ^(3,7,10).

Studies report varying estimates of the number of people affected by cervical radiculopathy due to various factors including its definitions, i.e. some studies will define cervical radiculopathy by any form of radiating arm pain, whilst others will define it as pain originating from specific nerve compression, which is the most specific classification ⁽⁶⁾. Lifetime occurrence (which describes the proportion of people who experience cervical radiculopathy at some point during their lifetime) ranges from 13%–40% ^(8,9).

Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis. Your clinician may perform a series of tests to examine the range of movement of the neck, test the strength of the muscles in your arm and check your reflexes and sensation.

Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like magnetic resonance imaging (MRI) or X-rays are not required to achieve a working diagnosis. However, in persistent cases that have not responded to a period of appropriate conservative management, they may be warranted.

As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your cervical radiculopathy. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

• Medication – you might benefit from specific medication options prescribed by an appropriately trained healthcare professional.
• Surgery may be considered as a last resort if there is severe nerve compression, or where there are persistent symptoms that do not improve with conservative management ^(7,9).

cervical radiculopathy_web.pdf (guysandstthomas.nhs.uk)