NECK PAIN coming from nerves

 Cervical radiculopathic pain refers to pain that originates from irritation, compression, or inflammation of one or more nerve roots in the cervical spine (the neck). These nerve roots branch out from the spinal cord and travel down the shoulders, arms, and also the upper back. When they are compressed or damaged, the condition is called cervical radiculopathy, and it often leads to pain that radiates from the neck to the shoulders, arms, hands, or between the shoulder blades. Consider a similar situation in the legs, known as sciatica.

Causes of Cervical Radiculopathy

Cervical radiculopathy is typically caused by conditions that put pressure on the nerve roots, including:

1. Herniated disc: A cervical disc may rupture or bulge, pressing against a nerve root.
2. Degenerative disc disease: Age-related changes in the spine can lead to the breakdown of discs, causing them to compress nerve roots.
3. Bone spurs (osteophytes): These bony growths can form as part of arthritis and may press on the nerve roots.
4. Spinal stenosis: Narrowing of the spaces in the spine, which can compress nerves.
5. Injury or trauma: Accidents, whiplash, or heavy lifting can result in nerve damage or irritation.
6. Tumors or infections: Though rare, abnormal growths or infections can cause nerve root compression.

Symptoms of Cervical Radiculopathic Pain

The symptoms can vary depending on which nerve root is affected, but common signs include:

• Radiating pain: Pain that starts in the neck and travels down into the shoulder, arm, hand, or fingers. It may follow a specific nerve path (dermatome).
• Numbness or tingling: Sensations of numbness or “pins and needles” in the affected arm, hand, or fingers.
• Weakness: Muscle weakness in the shoulder, arm, or hand, depending on the nerve root involved.
• Neck pain: Localized pain or discomfort in the neck, which can worsen with specific movements.
• Loss of reflexes: Diminished reflexes in the affected limb, such as in the triceps or biceps.
• Danger signs include balance issues, as you may feel your pelvis or legs are stiff and unstable, urinary incontinence, or numbness or tingling in the genital area. Discuss these concerns with your doctor.

Diagnosis

• Physical examination: Your doctor may assess reflexes, muscle strength, and sensation in the arms and hands, as well as evaluate neck movement.
• Imaging studies:

MRI or CT scans: These provide detailed images of the discs, nerves, and soft tissues, allowing for the precise location of nerve compression.

• • Electromyography (EMG): Measures the electrical activity of muscles to assess nerve function and confirm nerve root damage, typically required before surgery, as it guides the surgeon to the exact location of the problem.

Treatment of Cervical Radiculopathy

1. Conservative treatments:
   • Rest and activity modification: Avoiding movements that exacerbate symptoms.
   • Physical therapy: Exercises to strengthen neck and shoulder muscles, improve posture, and alleviate pressure on the nerve.
   • Medications:
     • Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation and pain.
     • Muscle relaxants are used to reduce pain and swelling.
     • In some cases, nerve pain medications like gabapentin may be prescribed.
   • Cervical traction: A therapy that gently stretches the neck to relieve pressure on the nerve root.
2. Interventional treatments:
   • Epidural steroid injections: Corticosteroids are injected into the epidural space to reduce inflammation around the affected nerve root and provide pain relief. It is a very effective treatment. It may be all you need. You can read more about epidural injections here. 
3. Surgical treatments (if conservative therapies fail):
   • Discectomy: Removal of a herniated disc that is pressing on a nerve root.
   • Foraminotomy: Widening the space where the nerve root exits the spinal canal.
   • Cervical fusion: Stabilizing the spine by fusing two or more vertebrae.

Prognosis (or What will happen in the long run?)

Most cases of cervical radiculopathy improve with conservative treatment, though recovery can take weeks to months. In severe cases, surgery may be required, but it generally has a success rate in relieving pain and restoring function.

How should I know if I need injections?

Typically, we allow 4 to 6 weeks for conservative treatment, which may include physical therapy, chiropractic treatment, traction, compression, acupuncture, or medication. If there is no relief, epidural injections will be offered.