Cervical radiculopathy
Neck hernia / cervical hernia / cervical disc protrusion

Cervical radiculopathy is a condition in which a nerve root in the neck becomes impinged in such a way that symptoms develop in the area innervated by the nerve. This is usually felt in the neck, arm and hand. The most well known form of cervical radiculopathy is the neck hernia.

Various factors can cause compression of a nerve root. This is usually caused by a neck hernia. We can distinguish between two forms: the 'soft' and the 'hard' neck hernia. Both forms will be discussed in this article.

Description of the condition

The upper part of the spinal column, the 'cervical spinal column', is formed by the neck vertebrae. These bones are stacked on top of each other and provide sturdiness of the spinal column. There are softer structures located between the hard vertebrae. These are the intervertebral discs. The intervertebral discs are slightly elastic and contribute to the shock absorbing capacity and mobility of the spinal column.

The spinal cord runs vertically through the spinal column. This is a large bundle of nerves that leaves the spinal column and run to all parts of the body. In the neck, a number of nerves leave the spinal column at each vertebra. They run to the arms and control the muscles and ensure that sensory (e.g. pain) signals are passed on to the brain.

A soft neck hernia is caused by a prolapsed intervertebral disc placing pressure on an spinal nerve root. This can occur quite suddenly and can cause severe pain. A soft structure is pressing on the nerve root.

If compression of a nerve root is caused by loss of quality (degeneration) or arthrosis (wear-and-tear) of the neck vertebrae, we call this a hard neck hernia. The space through which the nerve roots leave the spinal column gradually becomes smaller. As a result, the nerve roots become impinged between the hard bone structures.

Cause and origin

Signs & symptoms

• Pain in the neck.
  
• Pain in the arm, hand or shoulder region.
  
• Pins and needles, burning sensations or numbness in the arm and hand (fingers).
  
• Sometimes the pain can be felt as an 'electrical' shock that suddenly shoots through the arm.
  
• The symptoms can become worse with coughing, sneezing or pushing.
  
• Possible loss of sensation and/or loss of strength.
  
• Certain movements of the neck can make the symptoms worse. For example, simultaneously moving the head backwards and sideways. The physiotherapist will test this by means of the Spurling`s test.

Diagnosis

The diagnosis is made based on the patient's story, the physical examination and an MRI scan if surgery is being considered. A CT scan can sometimes be performed instead of an MRI. An EMG (electromyography) can provide additional information. However, this is not the protocal assessment to diagnose radiculopathy.

Treatment

The aim of the treatment is to reduce the compression of the nerve root. This is usually more successful in the case of a soft neck hernia than in the case of a hard neck hernia. Treatment initially consists of postural corrections. For example, the patient will be advised to avoid looking down for extended periods with tasks like reading or writing. In addition, the treatment can be aimed at training the neck and shoulder muscles, improving mobility and giving the nerve more space.

Wearing a semi-solid neck brace can have a positive effect on recovery in the acute phase, but should not be applied at random.

There is less scientific evidence to support that physiotherapeutic treatment is effective for hard neck hernias. However, treatment can be implemented due to a lack of alternatives other than surgical intervention. An anti-inflammatory injection may provide temporary pain relief. One must remember that this is not always without risks.

Exercises

Take a look at the online exercise programme here with exercises for cervical radiculopathy or neck hernia.

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your area.

References
Nugteren, K. van & Winkel, D. (2012). Onderzoek en behandeling van de nek. Houten: Bohn Stafleu van Loghum.