You have likely heard of someone complaining of a “pinched nerve” when referring to pain experienced in the neck or back that extends into the limbs. What exactly is a “pinched nerve” and how does it happen in the neck? What are the signs and symptoms of a pinched nerve? Who should you see if you think you have a pinched nerve? What tests can be performed to diagnose it and what are some treatment options?
What is a pinched nerve and how does it happen at the neck?
A “pinched nerve” is the layman’s term for a compression of a nerve. People usually talk about a pinched nerve in conjunction with the neck or back, but it can occur in many locations throughout the body, including the common places like the wrist and elbow, or other places such as at the ankle, knee, and more. The location of the compression will affect what types of signs or symptoms you will experience. The medical term for a pinched nerve at the neck or back is called a radiculopathy. There are three main ways that a radiculopathy occurs at the neck: disc herniation, stenosis, and osteophytes.[3]
- Disc Herniation: A disc herniation is more common in younger individuals. It occurs when the gelatinous internal material of the intervertebral disc, called the nucleus pulposus, pushes into or through the outer layer, called the annulus fibrosis. This herniation takes up space and can be a cause of compression to the nerve root along with inflammation produced from the herniation.
- Spinal stenosis: Spinal stenosis is a narrowing of the space between your vertebrae. It is caused by degeneration and is a natural process with aging. Depending on the significance of the narrowing, it can lead to a compression of nerve root.
- Osteophyte: Osteophytes is a fancy term for a bone spur or osteoarthritis. It is a growth of bone or spurring that occurs with degeneration or with abnormal forces pulling on the bone. Depending on the location of the osteophyte, it can lead to compression of the nerve root.
[1]
What are the signs and symptoms of a pinched nerve?
For a radiculopathy at the neck, or cervical spine, the common signs and symptoms often include a mixture of pain in the neck and down the arms, weakness, numbness, and more.[4] Not all radiculopathies at the neck present with the same symptoms and the symptoms depend on what level of the spine that is affected. In the neck, there are 7 cervical vertebrae (C1-C7) and 8 spinal nerve roots (C1-C8) – pictured below.
(Netter, pg 170)
Each spinal nerve root has an associated pattern of pain, muscle innervation, and skin sensation associated with each level. The muscles that derive from a certain nerve root are called a myotome. The pattern for skin sensation is called a dermatome. Below is a list of the spinal nerve root level and what areas are affected:
C5: The skin on the outside portion of the upper arm just below the shoulder. Muscles that raise the arm out to the side, bend the elbow and rotate the shoulder outwards.
C6: The skin along the outside portion of the lower arm and the thumb and index finger. The muscles that bend the elbow, rotate the elbow from palm down to palm facing up, and bend the wrist backwards.
C7: The skin along the back of the lower arm and to the middle finger. The muscles that straighten the elbow, straighten and bend the fingers backwards, and bend the wrist forwards.
C8: The skin along the inside portion of the lower arm and the ring and pinky finger. The muscles that spread the fingers in and out, bend the fingers into a fist, and move the thumb.
T1: The skin along the inside of the elbow. The muscles that spread the fingers in and out and move the thumb.
Who do I go see if I think I have a pinched nerve at the neck? What tests can be performed to diagnose it?
If you think you have a pinched nerve in your neck, you will want to consult with an orthopedic surgeon or neurosurgeon who specializes in the spine. The physician will go through a clinical exam to assess the signs and symptoms noted above to see if there is a pattern that could correspond with a certain nerve root. If they suspect a possible radiculopathy, or if they want to rule out a radiculopathy, they will usually order a nerve conduction study (NCS) and electromyography (EMG) as well as an MRI.
The nerve conduction study and electromyography (NCS/EMG) help to evaluate for and assess nerve function. The nerve conduction study does this through surface stimulation to the nerves to assess for nerve viability and speed. Electromyography is performed with a monopolar needle electrode to assess the electrical activity of the muscles and evaluate for nerve damage. When used together they can help diagnose a cervical radiculopathy or another neuropathic process that may be causing your symptoms, such as carpal tunnel syndrome, cubital tunnel syndrome, etc.
MRI stands for magnetic resonance imaging. It is performed with a machine that uses a magnetic field and computer-generated radio waves to create detailed images of the body. When assessing for a cervical radiculopathy, an MRI helps to get a picture of the vertebrae, intervertebral discs, the spinal cord and nerve roots, and the associated spaces through which the nerve travels to assess for a nerve root compression from any of the causes discussed above.
What are the different treatment options?
There are multiple options for treatment for a cervical radiculopathy. The most common treatments provided are surgery and physical therapy, but it can also include epidural injections. The best option for treatment may depend on the cause of your symptoms, severity of your symptoms, and the results from the diagnostic testing mentioned above. It is best to talk to your doctor, ask questions, and discus the different diagnostic tests and treatment options so that you can come to a consensus for the best way to proceed with treatment.
Board Eligible in Clinical EMG/NCS
Citations:
- Cervical Radiculopathy. (2021, June 25). Physiopedia, . Retrieved 17:40, January 20, 2022 from https://www.physio-pedia.com/index.php?title=Cervical_Radiculopathy&oldid=277352.
- Netter, F H(2018) Netter’s Atlas of Human Anatomy 7th edition, Philadelphia, PA Elsevier.
- Barrett I. et al. Cervical Radiculopathy Epidemiology, Etiology, Diagnosis, and Treatment. Journal of Spinal Disorders &Techniques. April 2015; 28:5.
- Eubanks, JD.Cervical Radiculopathy:Nonoperative Management of Neck Pain and Radicular Symptoms.American Family Physician 2010;81,33-40
