In this article, we intend to explain one of the most common causes of pain in the shoulder, arm, forearm and index finger. What you will read next:
Anatomy of the spine:
Our spine in the cervical part has seven vertebrae. Between both vertebrae (except between the first and second vertebrae) there is an oval intervertebral disc that actually acts as a spring between the bony vertebrae. This disc is solid and firm on the outside called anulus fibrosus while it has a soft and jelly center known as nucleus pulposus.
Spinal nerves:
From each intervertebral spaces, two pairs of nerves known as spinal nerve roots emerge one from the right and the other from the left. In total, our cervical region has eight pairs of spinal nerve roots. C1 is the first root of the cervical spinal nerve that passes above the first vertebra of the neck. C2 passes between the first and second vertebrae and so on. Finally between the vertebrae of the seven cervix and the first vertebra of the thoracic spine passes the C8. These roots are connected in the brachial neural network and the main nerve trunk of the upper limb. They make nerves around the neck, shoulders, arms, forearms, hands and fingers.
Cause of pain:
Both the movement of the muscles in these areas and their sensation are provided by the same nerve trunks. Any factor that puts pressure on the roots of the cervical spinal nerves, C1-C8, causes pain, weakness of muscles and numbness in the area covered by the related nerve.
C5 cervical nerve root:
In this article, we examine the C5 cervical nerve root. As we said, these pair of nerve roots comes out from the both sides of the intervertebral space of the fourth cervical vertebra at the top and the fifth cervical vertebra at the bottom. This nerve root later controls the deltoid muscle by participating in the main nerve trunk of the upper limb.
nerve root C5 controls the movements of the deltoid muscle. It is the muscle that covers the perimeter of the shoulder forming its exterior appearance. This muscle is made up of three bundles of muscle fibers in the back, middle and front, each part of which is responsible for performing specific movements in the shoulder joint. In any movement in which the arm moves from the side of the body upwards, the deltoid muscle will be involved.
Control of arm muscle biceps movements:
The biceps muscle is attached to two joints, the shoulder joint from above and the elbow joint from below. If the biceps contracts against the elbow joint, it causes the forearm to bend over the arm. This muscle also helps rotating the forearm outward.
Symptoms of cervical nerve root injuries:
Any factor that causes inflammation of this nerve root in the neck or any factor that damages it by applying too much pressure to it will cause the following symptoms in the injured person:
- Shoulder pain
- Numbness and tingling on the outside of the shoulder
- Pain in the outer part of the arm
- Numbness and tingling of the outer arm
- Weakness of the deltoid muscle (inability of the patient to move the arm attached to the trunk upwards)
- Biceps muscle weakness (inability to bend the forearm on the arm)
- Lack of biceps reflex
The above set of signs and symptoms is sometimes called C5 Root Syndrome.
Causes of Root C Five Syndrome
The main causes are:
- Degenerative changes
- Disc herniation
- Infections (osteomyelitis)
- Tumors
Degenerative changes:
As we get older, the flexibility of the disc decreases, the nucleus of the intervertebral disc tightens and the height of the disc decreases. As a result, the distance between the two vertebrae decreases and bone spurs appear from bones around disc. The passage of the root of the cervical spinal cord becomes narrower and the root becomes inflamed.
Osteoarthritis or degenerative changes in older people and people with a lot of neck movements cause inflammation in the fifth cervical root movement and therefore the signs and symptoms of C5 root syndrome.
Disc herniation:
In younger people that the nucleus of the disc is still jelly-like and soft, repetitive movements of the head and neck increase the pressure inside the disc which pushes the jelly nucleus toward the annulus. Hence, a part of the disc protrudes from the intervertebral space and presses on the protruding spinal cord. This pressure causes inflammation and inflammation causes reactive spasm of the neck muscles which will lead to a set of signs and symptoms of C5 root syndrome.
Tumors:
Like other causes, development of a tumor near the C5 nerve root will put pressure on the root causing the C5 root syndrome.
Diagnosis:
Clinical examination by a specialist along with the patient's history will help with tha correct diagnosis. Sometimes doctor may also use:
Treatment of C5 root Syndrome:
non-surgical treatment:
This includes taking non-steroidal anti-inflammatory drugs like Ibuprofen, naproxen and diclofenac which can relieve pain by reducing inflammation.
Corticosteroid injections:
Specialized injections of steroids around the inflamed root are performed by a specialist which reduce the inflammation of the root and therefore the associated pain and discomfort. Moreover, epidural injections of corticosteroids have been useful in some cases. In the acute pain phase, you can use a soft, temporary, and short-term collar. Using collar for a long time will have the opposite effect by weakening the strength of the supporting muscles.
Heating the painful area:
This can relieve the spasms of the muscles in the area that react to inflammation and help reducing the pain and discomfort.