If you have neck pain that spreads to your arms and shoulders and is accompanied by tingling and sometimes numbness of the neck, arms and shoulders, you may be dealing with cervical root syndrome. In this post, we describe the clinical symptoms of cervical root syndrome, the causes of this syndrome and ways to prevent or treat it. What you will read next:
What is cervical Root Syndrome?
Generally speaking, when we call special medical condition a syndrome, it means that the patient has some signs and symptoms that mostly present together without known causes. A person with a cervical root syndrome has neck pain that may spread to the arms, hands, and fingers, or neck pain that is accompanied by a tingling sensation or numbness in the arms, hands, and/or fingers. Cervical means neck, and as mentioned above syndrome refers to the pain and discomfort which in addition to the neck, can include diffuse pain and shooting pain from the arm to the fingertips.
Even sometimes pain may spread to the scapula (the bone at the back of our shoulders) which is called cervical radiculopathy.
What does cervical roots mean?
The human spine has seven bony vertebrae in the neck called cervical vertebrae. Between all these vertebrae of the neck are discs that support the vertebrae. There is no disc between the first vertebra and the second vertebra.
What is Intervertebral disc building?
Discs have an oval soft structure in the middle called the nucleus, surrounded by a hard ring called annulus fibrosus, which tightly protects the soft core of the disc specially when the pressure on the disc increases. With a constant increase in pressure, the annulus may be ruptured forcing the nucleus to come out which will put pressure on the nerves. This pressure which is coming out of the cervical vertebrae, will cause radicular or diffuse pain in the arm and hand.
Nerve roots of the neck
Eight pairs of nerves come out of the spinal cord in the neck area, which are called the nerve roots of the neck. The pair means that at each intervertebral surface, a nerve comes out from the right and another nerve from the left of the intervertebral space. For example there are two nerves called C4 nerve roots which come out from the space between 3rd and 4th vertebra.
Ligaments
The spine is supported and protected by ligaments and muscles. Too much stretching or inflammation of these ligaments and muscles can also cause pain in the neck area.
Symptoms of Cervical Root Syndrome:
- Pain: The most common symptom is pain. Mostly it is the neck pain that shoots into the back, chest, shoulders, arms, hands, and fingers.
- Muscle weakness all the way from neck down to hands.
- Tingling in the path of pain
- Numbness in the path of pain
- Impaired coordination and location perception, especially in the hands and fingers
- Occasionally there is a reflex muscle spasm that causes localized pain.
- Pain, numbness, and weakness are exacerbated in certain positions of the neck.
- reduction in the movement range of the neck. This decrease in movements is more often seen in rotational movements of the neck and bending the neck to the right and left.
Causes of cervical radiculopathy; Root cervical syndrome
Degenerative changes:
As you get older, the soft core in the middle of the disc loses its water and moist and becomes hard and dry. Consequently, the height of the intervertebral disc decreases reducing the space between the two vertebrae. As a result, the bony body of the two vertebrae gets closer to each other, and the vertebrae near the disc begin to build bony spines to help strengthening the weakened disc. These bony spines narrow the space on either side of the vertebrae through which nerve roots pass and exit the space. These changes is called osteoarthritis. The nerve root will finally get stuck in the narrow hole and will be under constant pressure all the time. This is a natural process in life and will happen to everyone, but it is not clear why some people do not have pain despite these changes.
Herniated disc:
At a young age where the nucleus (jelly-like nucleus) in the middle of the disc is still soft and flexible and hasn't got stiff yet, due to the forces applied, the ring or annulus around the disc may be pushed out of the intervertebral space. This protruding disc which is called the herniated disc will put pressure on the nerve exiting from the spinal cord. This injury usually shows itself as radicular pain in the area of the pressed nerve. When you lift a heavy object, bend your neck regularly, or when you use a heavy, non-standard backpack, disc herniation and subsequent injuries can occur.
Tumor:
The growth of tumors like the other causes, can put pressure on the nearby nerve roots coming out of the spinal cord.
Differential diagnosis of spinal cord syndrome:
Diseases that can cause symptoms of spinal cord syndrome or cervical radiculopathy without any significant pressure on cervical nerves include:
Types of cervical radiculopathy
- Cervical nerve radiculopathy of C8
- Cervical nerve radiculopathy of C7
- Cervical nerve radiculopathy of C6
- Cervical nerve radiculopathy of C5
- Cervical nerve radiculopathy of C4
Cervical nerve radiculopathy of C8
The most common signs are:
- Pain in the inside of the forearm and hand
- Numbness inside of the forearm and the little finger
- Muscle weakness in the path of pain and anesthesia
Cervical nerve radiculopathy of C7
this is the most common cervical radiculopathy with the following signs:
- Pain in the outside and back of the arm and shoulder
- Numbness in the thumb and forefinger
- Decrease in triceps muscle reflex
- Weak flexor muscles of the wrist
- Weakness of the muscles that open the fingers
- Triceps weakness
Cervical nerve radiculopathy C6
The main signs are:
- Shoulder and upper arm pain
- Pain in the outer part of the forearm
- Pain in the outside of the thumb
- Numbness and tingling of the outer part of the forearm and thumb
- Decreased biceps muscle reflex and brachioradialis reflex
- Biceps muscle weakness
- Weak opener muscles
Cervical nerve radiculopathy C5
The most common symptoms are:
- Shoulder pain
- Pain in the outer part and upper arm
- Weakness of the deltoid muscle
- Shoulder numbness
- Reduce biceps muscle reflex
Cervical nerve radiculopathy C4
It is not very common and causes shoulder pain and deltoid weakness.
Necessary diagnostic measures:
In most cases, a clinical examination is sufficient to diagnose the source of pain. The followings are sometimes used to rule out diseases with similar diagnoses:
- Simple X-ray
- CT scan
- MRI (best way for diagnosing disc herniation and other soft tissue injuries)
- EMG-NCV: It may not show anything for the first two weeks
- Nerve conduction study, or NCV, which usually shows neural root dysfunction or denervation.
In case of suspicion of congenital abnormalities of the cranial base (basilar ovulation; platybasia), further studies may be necessary.
Treatment:
Non-surgical treatment:
- If you are in the acute phase of pain, you can temporarily use a standard cervical collar.
- Taking steroidal anti-inflammatory drugs
- Steroid injections
- Exercise
- Hot shower
Taking steroidal anti-inflammatory drugs:
Ibuprofen, diclofenac, naproxen, and related drugs help to heal and reduce pain by removing the inflammation that may have been developed in the stressed nerve root. Taking corticosteroids for a short period of time, with a doctor's prescription, may also help reducing the swelling and inflammation.
Steroid injections:
The injection should be given by a specialist. The injection is usually given next to an inflamed nerve which has perfect anti-inflammatory and pain-relieving effects.
Exercise:
Try to do stretching exercises as much as you can tolerate the pain. The sooner you can start the movements, the faster your rehabilitation will be. Avoid doing too much exercise.
Tips after treatment:
Most cases will improve with the tips given above. After recovery, try to prevent recurrence of pain attacks by doing standard and regular exercises.
Surgical treatment:
If the above treatments do not improve and relieve the pain and numbness, surgery will be your doctor's treatment choice. There are variety of methods and techniques that your surgeon will choose based on your examination and individual circumstances.