Clinical Corner: Cervical Radiculopathy
Cole Hosenfeld
DC, DACBSP
The infamous pinched nerve a patient feels and presents to the office with is typically prefaced by the patient saying his or her neck and arm are numb, tingling, weak, and/or painful. The patient may describe the pain as dull, burning, sharp, or stabbing.
This is often the clinical presentation of a cervical radiculopathy, which is an irritation and/or compression of exiting nerve roots of the cervical spine that can create pain or other neurological symptoms. These symptoms can come on suddenly or gradually, developing overtime.
As you know, there are seven cervical vertebrae that house the upper portion of the spinal cord with 16 cervical nerve roots that exit the spine right and left, numbering C1-C8, with the C8 nerve root exiting below C7. As these nerve roots exit the spine, they continue to spread and branch to provide sensory (feeling) and motor (function) supply to areas of the upper torso and upper extremity.
When nerve compression or inflammation encroaches upon the nerve, a myriad of symptoms can result, including pain, numbness/tingling, and weakness. Depending on which nerve roots are involved, symptoms can be felt in the whole arm/hand or particular portions of the upper extremity. The patient typically reports extending his or her head with rotation or side bending is more painful and can find relief holding his or her hand to the back of the head (Bakody's sign), with the head flexed more forward.
Causes:
Any condition or dysfunction that creates irritation of the nerve root can cause cervical radiculopathy. Remember that the cervical spine is a complex anatomical network of cervical vertebrae, discs, joints, spinal cord, surrounding soft tissues of ligaments, muscles, tendons with circulatory structures such as veins, arteries, and nerves, and lymphatic structures weaving throughout the region.
Prolonged joint or segmental dysfunction tends to create an environment constantly under physical and chemical stressors as the body constantly has to adapt to our modern-day environment (e.g., riding in cars and sitting at computers). As our age progresses and this joint dysfunction continues to occur, structures break down and inflammation sets in to try to protect the area.
Prolonged inflammation to an area increases sensitivity to nerve tissues, thus increasing pain and other neurological symptoms. This joint dysfunction can progress into the following common disorder examples, which can cause a cervical radiculopathy:
• Herniated Disc: This is when the inner gelatinous material (nucleus pulposus) or outer ring of the disc(annulusfibrosus) chemically irritates through inflammation and/or impinges the exiting nerve root. This is often seen in people between 20 and 40 years of age.
• Cervical Degenerative Disc Disease: Degenerated discs are a common characteristic of aging and their presence does not always cause nerve pain. However, as the discs become thin and lose mobility, adhesions and spurs have a tendency to form, which causes inflammation and pinching of the traversing nerve roots and potentially causes a cervical radiculopathy. This is often seen in people over age 45.
• Cervical Spinal Stenosis: This typically occurs as the cervical spine degenerates causing narrowing of the main spinal canal or exiting foramen, which causes compression of the passing neural structures impinging the nerve root. This is often seen in people overage 55.
Diagnosis:
Clinical examination by the chiropractic physician is key to diagnosis, and X-rays may be beneficial depending on the particular case. If treatment does not provide sufficient relief of symptoms and improved function after four to six weeks of care, then MRI is the gold standard for further evaluation.
Treatment:
Treatment for cervical radiculopathy needs to be
multifaceted because these disorders have a higher incidence of surgical interventions than simple mechanical neck pain. The reduction of inflammation is a mainstay of treatment and can be achieved through education of proper ice therapies and nutrients, such as turmeric, ginger, and magnesium, along with a focus on dietary habits that limit inflammatory foods, such as sugar and wheat, with an emphasis on high water intake and nutrient-dense foods.
In combination with this, manual-care techniques, including manipulation, mobilization, massage, stretching, and passive range of motion (ROM) techniques, are essential for improving spinal function. Cervical traction and therapeutic modalities may be beneficial depending on case presentation. Exercise rehabilitation with an emphasis on symptom reduction, ranges of motion, and regional and full postural strengthening is extremely important.
If symptoms continue to progress with pain increasing, or if other symptoms such as weakness worsen, then collaboration with medical colleagues would be appropriate and typically medicinal intervention and/or injections may be utilized to help control inflammation. The last line of defense may be surgical intervention utilizing spinal fusion or disc replacement options. Remember, conservative treatments should always be the first line of defense, but when conservative treatment is
not effective, then collaboration is the key. Often when conservative intervention is not working, then these other methods may reduce discomfort and inflammation enough for manual treatment and exercise interventions to be more productive in allowing the body to heal itself and to further prevent future occurrence.
The trained therapy assistant is integral to the chiropractic physician's ability to set treatment parameters that are effective for the patient. A certified chiropractic therapy assistant is able to deliver safe and effective daily living advice, exercise instruction, stretches, and myofascial techniques, as well as utilize various modalities with patients suffering from cervical radiculopathies with confidence. Remember, the more educated and informed you are about disorders such as cervical radiculopathy for which you are providing treatment, the more confidence the suffering patient will have in your abilities. This confidence often creates the calm to change the patient's outcome positively.
Cole Hosenfeld, DC, DACBSP practices in R⅛*. Knoxville, Tennessee. He is board certified in sports medicine and practices in an integrative provider : \ I setting with a team ofparaprofessiona/s. He sits on ^KT i I Tennessee ,’v regulatory board and is co-author of the textbook Chiropractic Therapy Assistant: A Clinical Resource Guide. He can be reached by email: cole@applehealthwellness. com Contact Phone: (615) 383-6231
