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Neck, arm and hand pain: Cervical nerve root syndrome

Do you have neck pain that moves down the arm to the hand? One possible cause of these symptoms is when the nerve tissue gets compressed as it comes out of the spine at the neck. This condition is known as ‘cervical nerve root syndrome’. It can be a little complicated to explain, so we’ve broken it down for you, but if you have any questions, please just call us at [insert clinic name], and we’d be happy to chat more!

Anatomy


The section of the spine that runs through the neck is known as the ‘cervical’ spine (pronounced ser-vy-call). The cervical spine is made up of seven vertebrae (i.e. bones) that stack on top of each other in a slightly inwards curving column, when looked at from the side. The vertebrae are separated from each other by a disc and are connected to each other by small joints that run down the back part of the spine. The shape of the vertebrae as they stack on top of each other create small holes on the side, which nerves pass through on their way from the spinal cord to the arm (and vice versa). The points where the nerves pass through the holes are known as ‘nerve roots’ and it is at this location that they are susceptible to compression from other body parts. If compression occurs here, leading to symptoms, we have a case of cervical nerve root syndrome!

Causes

The main causes of a cervical nerve root syndrome include compression from:

A herniated disc; or

Spurs that develop on the vertebral bones

A cervical disc herniation can occur as a result of trauma to the neck, where the head and neck are forced into a forward bend (think of a whiplash injury during a car accident), or as a result of long-term postural strain (desk workers for example!). When the disc herniates, the disc material presses on the nerve root tissue as it passes by.

Bone spurs tend to develop from aging and degeneration. Long-standing forces acting on the bone of the vertebrae can lead to growth of ‘extra’ bone pieces. These are bone spurs and are also known as ‘osteophytes’. These can develop around the rim of the holes where the nerves pass through, which over time can compress on the nerve root.

Signs and symptoms

The symptoms of cervical nerve root compression vary depending on where the affected nerve root lives in the spine. Nerve roots exit the spinal cord where two vertebrae join and travel from the neck to the shoulder and down the arm as nerves. These nerves provide the muscles with electrical stimulation (and movement) and the skin with sensation, as well as other functions. Now earlier, we spoke about discs. Due to the curve of the spine in the neck, the lower discs and vertebrae in your cervical spine tend to be affected more than the higher-level discs and vertebrae. The degeneration from postural strain usually effect these lower cervical discs more severely, which is why they are the most diagnosed nerve root syndromes.

Symptoms may include any or all of the following:

Neck pain

Radiating upper limb pain (this may include shoulder, arm, forearm or hand pain)

Numbness

Pins and needles

Neck, shoulder and arm movement dysfunctions

Weakness of the upper limb, including grip weakness of the hand

Treatment

The initial stages of a nerve root syndrome can be very painful. When nerve tissue gets compressed, the initial response from the body is inflammation. Inflammation produces swelling and pain, and there is usually a period of 3-4 days when the pain is particularly bad. It is a good idea to see your chiro early on, so we can provide you with advice on how to manage the first stages of injury. We can also provide you with traction treatment which helps to decompress the nerve. Our hands-on treatment will be minimal early on, because the body needs time to adjust to the injury and you need time for the inflammation to reduce. Because the pain is initially quite severe, many people end up consulting their doctor, and pain medications may be prescribed to help them feel more comfortable. At this time, you may also be referred for CT or MRI imaging to confirm the diagnosis and aid with the treatment plan.

As the initial stages pass and the pain lessens, more rigorous treatment can start to be carried out. Non-surgical treatment options are always preferred with cervical nerve root syndromes. This is where our expertise in hands-on treatment comes into play. We will use a combination of soft tissue massage, joint mobilisation and manipulation, and dry needling, combined with flexibility and strengthening exercises to restore full movement back to the neck and upper limb regions.

The effects of a disc herniation can last anywhere from 3-6 months, depending on the severity. If your nerve root syndrome is caused by compression of a bony spur, we may need the opinion of a spine specialist. The effects of large spurs are unlikely to respond to hands-on treatment alone, so severe cases may need surgical intervention to fully decompress the nerve tissue and reduce the risk of long-term damage to the nerve.

There is good news though! Most cases of nerve root syndrome respond well to non-surgical treatment options and most people make a full recovery and can return to doing the work and leisure activities they love to do. If you have neck pain, please book an appointment with us today, so we can get you sorted pronto. Call now on 0413 774 399.

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© 2018 Dr. Claire Chittleborough

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