Cervical radiculopathy is a clinical condition when any nerve root in the cervical region of the vertebral column becomes swollen or damaged resulting in changing in the normal neurological functions. Numbness in the hands, wrist, and arms, alteration in the normal reflexes, numbness, weakness, and sensations of pins and needles may arise due to this damage to the nerve.
Pathophysiology In Relation To the Structure of Spinal Column
The vertebral column is made up of 33 bones stacked together which protect our spinal cord. These bones are held in the right place by a network of muscles, ligaments, and tendons. Spinal nerves arise from the vertebral column and supply the different areas of the body like legs, feet, hands, and arms. Our vertebral column is not straight rather it has the shape of an S which is mandatory for the normal health of the spinal column. Intervertebral discs are present between each adjacent vertebral bones. When any damage to these disc occurs, this results in the exertion of pressure to the roots of nerves which become swollen and cause severe pain in the area supplied by them.
Causes of Cervical Radiculopathy
There may be many causes of cervical radiculopathy but the most important ones are described below.
- Stenosis of Cervical Foramen. A foramen is an opening in the bone through which a nerve root enter or exit the canal of the vertebral column. When a foramen becomes narrow or gets smaller, the nerve root is left with less space and becomes impinged. There may be many underlying causes of narrowing of foramina like degenerative changes due to cervical osteoarthritis, thickening of the cervical ligaments or a herniated disc that puts the pressure to the root of the nerve. The most commonly occurring cause of cervical radiculopathy is the stenosis of the cervical foramen.
- Cervical herniated disc. The disc hernia is said to take place when the inner soft jelly-like the material of the disc comes out of its outer ring called the annulus fibrosis. A herniated or bulging disc irritates and inflames the adjacent nerve roots which result in the form of cervical radiculopathy. There may be some underlying causes of a disc hernia like any trauma or some strenuous activity and that is the reason that it is a common cause of cervical radiculopathy in the younger individuals.
- If any part of the vertebral bone is damaged due to fracture, the spine becomes unstable and foramen gets narrowing. The consequence of which is the impinging and inflammation of the nerve roots. The fracture of vertebrae may also be caused by spondylolisthesis. It is a condition in which one vertebra is slipped before the other one.
- A tumour either is benign or malignant may grow in the cervical region of the spinal column and puts pressure on the nerve roots.
- Spinal infections specifically and the systemic infections less commonly may result in swelling of the nerve roots which are then damaged.
- It is a rare condition in which lumps (granulomas) are formed in any organ in the body. If granulomas are formed in the cervical region, that will cause cervical radiculopathy due to nerve compression.
Risk Factors for Cervical Radiculopathy
Some factors that may enhance the risk for the development of cervical radiculopathy are following:
- The risk of suffering from cervical radiculopathy generally enhances with the advancing age. This risk is at the peak point in a person of 40 to 50 years of age.
- Strenuous Activities. Some strenuous activities tend to exert high levels of stress on the cervical region of the vertebral columns such as heavy weight lifting practice or wrestling.
- Repetitive neck vibrations or motions. Such movements are happening to take place while driving a truck or diving head first from a board into the diving pool.
- Diabetes causes the alteration of blood flow to the nerves and thus the risk of nerve impinging is increased.
There are also some other risk factors which enhance the risk for one to suffer from nerve impinging. These include heavy smoking because smoking reduces the oxygen supply to muscles and ligaments and they become weak and previously having lumbar radiculopathy. Being overweight, poor body posture, poor lifting techniques, repeated motions and a family history of the degenerative bone disease also increase the risk for cervical radiculopathy.
The symptoms of the persons suffering from cervical radiculopathy are following:
- Pain in the arm, wrist, shoulders, neck and upper back region.
- Weakness in all these areas.
- Numbness of hands or arms.
- Tingling sensations in the area of supply of nerve
- Sensations of pins and needles.
The doctor diagnoses this condition after taking a good history and performing a good general physical examination. If necessary, he can order relevant investigations for the confirmation of diagnosis. These include radiological investigations, i.e. X-Ray, CT scan and MRI and some other investigations that include electromyography which is an electrical impulse testing. It is done to test the function of nerves.
Commonly, radiculopathy is able to be treated without surgery. Your doctor may prescribe some medications depending upon the severity of the condition. Commonly prescribed drugs are NSAIDs which are excellent painkillers and tend to decrease the inflammation. Commonly used NSAIDs are aspirin, naproxen, and ibuprofen.
Oral or injectable steroids medications are also prescribed to reduce swelling. If pain is very severe, narcotic painkillers are given. The patient is advised to wear a soft cervical collar to support the neck. Physical therapy also has good results in this regard. You can also apply hot or cold fomentations to reduce pain and swelling.
Prevention from Radiculopathy
You can avoid nerve compression and inflammation by adopting certain strategies which are described as following.
- By adopting good posture even during driving or sitting in front of T.V.
- By adopting good lifting techniques
- Performing regular and adequate physical activity including aerobics and weight-bearing exercises
- Maintaining your weight within the normal limit of BMI.
- Taking frequent short breaks during the period of continuous sitting.
- By doing frequent stretching practice
- Avoiding tilting your head for holding the cellular phone to the shoulders.
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