Referred pain from the cervical (neck) spine – cervical radiculopathy
The cervical spine (neck) consists of seven vertebrae. Nerves originate between each set of vertebrae and extend out into the upper limbs. These nerves supply sensation and movement from the shoulders down to the fingers. If irritation of these nerves occurs at their origin in the neck (cervical spine) symptoms will present in the upper limbs as well as at the neck.
Common causes of irritation include:
• Degenerative changes – As we age the discs between the vertebrae loose their water content and thus their shock absorbing ability. This may lead to the vertebrae pushing against each other causing compression of the nerve. On top of this the bones of the vertebrae also degenerate. This may lead to the formation of osteophytes (extra bone growths) that may narrow the passage of the nerves out of the spine and thus irritating them in the process.
• Herniated cervical disk – In this situation, the outer layer (annulus) of the disk cracks and the gel-like centre (nucleus) breaks through. This causes the disk to protrude, putting pressure on the nerve that exits the spinal column at that point.
• Spinal stenosis – This is when the central portion of the vertebrae narrows squeezing the spinal column and nerve roots.
• Shooting pain, pins and needles, numbness, or weakness in the shoulder, arm, forearm or hand.
• Neck pain that is worsened by movement
• Referred symptoms worsened with neck motion
• Muscle spasm in the neck/shoulder region
Your doctor and physiotherapist will do a thorough physical examination to determine the origin of your symptoms. X-rays or other scans may also be done to confirm the diagnosis. In most cases the initial management will be conservative consisting of a combination of rest, medication and physiotherapy.
Initial physiotherapy will aim to reduce pain and reduce the pressure on or irritation of the nerve at its origin in the spine. This may include the use of a soft collar for support of the neck, electrotherapeutic modalities, gentle soft tissue techniques, traction, ice and heat.
Once the condition has settled then treatment would become more vigorous. Your physiotherapist will provide you with strengthening and stretching exercises and treat any other co-existing/predisposing factors (e.g. poor posture, muscle imbalances, any problems in the upper limbs). Your physiotherapist will also educate you about long term management of this condition and any return to sport/activity. In some cases this condition does not resolve and surgery is required to take the pressure of the nerves. The procedure will depend on the underlying condition. Physiotherapy is usually recommended by your doctor post-operatively.