Pain in the neck and shoulder can arise from a variety of different injuries or conditions. One common cause is a pinched nerve from the upper spine, also known as cervical radiculopathy.
What are the symptoms of a pinched nerve?
Usually, cervical radiculopathy - or a pinched nerve, only affects one side of the body. There will be pain on that side of the neck, which then extends to the shoulder and can even radiate down the arm.
Symptoms of cervical radiculopathy include:
What are the causes of cervical radiculopathy (pinched nerve)?
Cervical radiculopathy usually arises from degenerative changes in the neck (cervical spine) that occur over time, as we age. Other factors include injuries, such as a bulging disc or muscle spasms - or anything that may increase pressure on the nerves from the neck.[1]
1. Bulging disc
A bulging disc is when the jelly-like centre (nucleus) of the disc pushes against its outer ring (annulus). This causes an outward pressure on the disc, which then pushes into the space within the spinal cavity that then increases the likelihood of a pinched nerve.[2]
2. Degenerative changes
Degenerative disc disease is when the discs of the spine deteriorate over time, they tend to lose height as well as fluid, making them more susceptible to problems. There is an increased chance of a pinched nerve, as the discs degenerate.
Diagnosing cervical radiculopathy (pinched nerve)
Physiotherapists are experts in the diagnosis of cervical radiculopathy and neck pain. They will begin by discussing your medical history and general health. Once they have a good understanding of your history, they will move on to a physical examination - testing the movement and strength of the neck and nearby structures.
If the physiotherapist is still unsure of the diagnosis, you may need to have some imaging done to confirm.
Imaging tests
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Ultrasonography is for examining bursitis and tendon changes like a tear or rupture. It shows a visualisation in standard tomographic planes and a linear transducer.
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An X-Ray can provide a series of angles of the bones and surrounding structures of the shoulder from an anteroposterior, Y view, and a transaxillary view to see signs of degeneration on the shoulder, displacement, or fractures to the bone.
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An MRI is more reliable in diagnosing a pinched nerve because it provides a view of the soft tissues on the neck and shoulder and even the effects of the pinched nerve, especially the weakened muscles.
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Computed tomography (CT Scan) now plays a secondary role in evaluating the impingement syndrome and seeing the changes in the bone from a literature review.
Treatment of cervical radiculopathy
Most cases of a pinched nerve in the neck can be managed by a physiotherapist. Treatment will consist of various treatment options, to ensure a reduction in pain and improvement of movement.
Step 1: Reduction of pain
Physiotherapists can use various manual therapy techniques, such as mobilisations, massage and traction techniques to reduce pain and alleviate any symptoms.
Step 2: Improve movement
Through further manual therapy, movement can also be improved upon, however, the most important factor in increasing movement will be a tailored exercise strategy. Your physiotherapist will create a program of exercises that are unique to you and your situation.
Outlook
Cervical radiculopathy may sound scary, however most cases can be managed by a physiotherapist, with a successful outcome. The most important thing to do is seek help immediately to ensure the best outcomes!
