Cervical Radiculopathy

Cervical radiculopathy can be thought of as a pinched nerve in the neck causing arm symptoms including pain, numbness,
tingling, and weakness. A couple common causes of cervical radiculopathy include disc protrusion usually in younger people and
arthritis (cervical spondylosis) in older individuals.

The spine is made of bones called vertebra that are stacked one on top of another from the tailbone to the neck. These vertebra
are separated from each other by soft cushions called discs. The discs should remain in between the front portion of the vertebra
called the vertebral bodies. The discs normally lie in front of the spinal canal which is the hollow area in the back part of the
vertebra through which the spinal cord and nerves run. A disc may slip out of place back into the spinal canal and this is called a
disc protrusion or disc herniation. Once the disc is protruded into the spinal canal, it may press upon the spinal cord or one of the
nerves (nerve roots) that branch out of the spinal cord. A pinched nerve will cause pain and numbness down the course of the
nerve. Nerves arising from the neck supply the arms while nerves arising from the low back supply the legs. So, a pinched nerve
in the neck will cause arm/hand pain and numbness while a pinched nerve in the low back will cause leg/foot pain and
numbness. Nerve compression may also result in weakness (eg, dropping objects from the hands or legs giving way causing a
person to fall).

Osteoarthritis commonly affects the large weight bearing joints such as the hip and knee. But, osteoarthritis also commonly
affects the spine including the neck. Bony enlargement and bone spurs form with osteoarthritis and this can narrow the spinal
canal and also the holes in the vertebra (neural foramina) through which the nerve roots exit the spine. This narrowing of the
spinal canal and/or neural foramina can cause pinched nerves producing symptoms similar to a disc protrusion. Neck motion
(especially bending the neck backwards or to the side of arm pain/numbness) can aggravate arm pain and numbness particularly
in cases of neural foraminal narrowing since certain neck positions lead to further neural foraminal closure. This occurs because
the neural foramina are located behind the bending axis of the neck. Furthermore, each neural foramen is made up half from the
vertebra above and half from the vertebra below it. So, tilting the neck to the left will narrow the left sided neural foramen while
tilting to the right will open or widen the left sided neural foramen.

Routine X-rays of the neck can help detect cervical spondylosis and degenerative disc disease (narrowing of the discs along with
bone spurs). More detailed analysis of cervical radiculopathy can be done using MRI and CT scanning which show the nerves,
discs, and vertebra.

With pure cervical radiculopathy, there will be negative physical exam findings and nerve conduction tests for
carpal tunnel
syndrome and Guyon's canal syndrome. But, it is possible for cervical radiculopathy to coexist with carpal tunnel syndrome and/or
Guyon's canal syndrome. There is a condition called "double crush syndrome" in which nerves compressed in one location (eg,
the cervical spine) will be more susceptible to compression injury at another location (eg, at the wrist as in carpal tunnel
syndrome and Guyon's canal syndrome).

Treatment of cervical radiculopathy can include the use of NSAIDs (nonsteroidal anti-inflamatory drugs) such as ibuprofen to
relieve nerve inflammation. A cervical pillow can be used in bed to help keep the neck flexed forward and prevent neck extension
(ie, the neck bent backwards) as well as to prevent lateral flexion (ie, tilting the neck to the right or left side) thereby minimizing
neural foraminal narrowing. Cervical traction is a technique whereby the head is lifted upwards away from the shoulders. This can
help to open the neural foramen and take pressure off of the nerves as they course through the neural foramen. A course of oral
steroids such as prednisone can be used to reduce nerve inflammation. NSAIDs and prednisone should not be used in people
with a history of gastric or duodenal ulcers. Prednisone should not be used in people with diabetes since blood sugar levels may
frequently become elevated. Epidural steroid injections are occasionally performed. This involves injecting steroid into the spine
between the vertebra so the steroid can bathe the involved nerves to help reduce inflammation.

Surgery can be considered in cases where symptoms persist despite nonoperative treatment. Surgery can include removal of a
degenerated disc followed by insertion of a bone graft into the disc space serving as a spacer to increase the height of the disc
space. A new procedure involves inserting an artificial disc into the degenerated disc space. The advantage of the artificial disc is
that it permits motion at the disc space as compared with fusion which eliminates motion at the fused disc space.

TM Gloves and the QwiTM Solution are not beneficial for the prevention or treatment of cervical radiculopathy. QwiTM Gloves are
specifically designed to protect the median and ulnar nerves only as they pass through the base of the palm into the hand. They
will not help when the site of nerve irritation or injury is located outside of the hand.

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This x-ray of a person's neck is taken from the side
(ie, a lateral view of the cervical spine). The front of
the neck is to the right side of the film and the back of
the neck is to the left side of the film. The bones of
the neck are called vetebrae. The rectangular part in
the front of the vertebra is called the vetebral body.
Soft tissue structures called discs separate the
vetebral bodies. The space (ie, the C5-6 disc space)
is narrowed between the #5 and #6 vetebral bodies
in this x-ray. This represents degeneration of the
C5-6 disc space. You can also see a bone spur
arising from the lower left side of the #5 vertebral
body in this x-ray. The bone spur can contribute to
nerve irritation.