If you have pain or numbness in your arm or shoulder, this could be a sign that you have a condition called cervical radiculopathy. This is a condition that results from degeneration of the cervical spine, the section that is made up of the first seven vertebrae in your spine. The cervical spine is located in your neck, so the pain may initially come from your neck and radiate down your arm. Even without neck pain, you may experience pain in your shoulders and arms due to cervical radiculopathy.
With cervical radiculopathy, the pain or numbness that you experience is the result of a pinched nerve. The nerve branches off of the spinal cord and down your arm, so a problem at its root can result in a sensation of pain further down. Because the nerve is what causes you to feel sensation in your arm and shoulder and because it is also the means by which your muscles get the message to move, these faculties can also be blocked by radiculopathy. That is why, in addition to feeling pain, you may also experience numbness or muscle weakness.
First Possibility: Herniated Disc
A pinched nerve may be the result of a herniated disc in your neck. Normal movement of your neck is facilitated by vertebral discs, soft-tissue components that act as cushions or shock absorbers between your vertebrae. When you bend your neck, the discs compress slightly on that side and bulge slightly on the opposite side.
If you sustain a neck injury, the pressure may cause a vertebral disc to compress too much on one side. This may be the result of a fall, a car accident, or any other event that may cause your neck to move sharply and suddenly, putting sudden stress on a cervical disc.
When one side of the disc is injured, it can develop a crack. These fractures happen in the outer ring of the disc, which is a soft-tissue layer known as the annulus fibrosus. A fracture will often heal on its own, but the resulting scar tissue is much weaker than a healthy disc. Whether through the cracks itself or through the weakened scar tissue, if the outer band of the disc is breached, the center of the disc can also experience problems.
The center of the disc is called the nucleus pulposus. It is a gel-like component in the vertebral disc. If it is damaged, it can dryout. When the gel-like substance leaks out of fractures in the disc it can put pressure on the spinal cord or on the nerve roots. In addition to the pressure, the chemical content of the nucleus can irritate the nerves, resulting in inflammation. This may be the cause of your radiculopathy, and in turn, of the pain in your neck, shoulders, or arms.
Most of the time, surgery will not be required to fix your herniated disc and relieve your radiculopathy. Your doctor may either recommend over the counter pain medication or prescribe stronger medication for severe pain. These may be anti-inflammatories or muscle relaxants. A few days of hot/cold therapy may also relieve the pain caused by a herniated disc.
In addition to these non-surgical treatments, your doctor may also send you to a physical therapist. He or she will give you exercises to massage and stretch your neck muscles. This will relieve pain and increase the flexibility of your neck. Temporary neck bracing or traction may also be recommended to stabilize your neck.
Surgery may be necessary for serious injuries as well as herniated discs that do not respond well to non-operative treatments. The most common surgery to treat this problem is a cervical discectomy. This is usually done from an incision in the front, or anterior, of the neck. The herniated disc is partially or completely removed. This relieves the pressure on the spinal cord or the nerve.
The resulting empty space between the vertebrae may be filled with a bone graft, which will then naturally fuse the vertebrae together as the body heals during recovery.
Second Possibility: Cervical Spondylosis
If you have not suffered a neck injury, your radiculopathy may not be the result of a herniated disc. The cause may be arthritis in your neck. This is officially known as cervical spondylosis. This is a disease related to osteoarthritis and occurs most commonly in elderly adults. In fact, over 90 percent of adults who are aged 65 and older show signs of cervical spondylosis and osteoarthritis.
Cervical spondylosis occurs when the wear and tear that you experience as you age affects the vertebral discs. Instead of a sudden injury, the effects of time make the annulus fibrosus crack or fracture. As the nucleus pulposus dries up and the disc shrinks, the vertebrae around the disc move closer together. This causes the facet joints of the vertebrae to rub together.
When the bones rub against each other without the soft cushion of the cervical disc between, bone spurs may develop. This is the body’s natural reaction to the degeneration occurring within your neck, as it tries to shore up the spine by creating more bone. The spurs may then pinch the nerve roots or the spinal cord, resulting in radiculopathy.
As with a herniated disc, your doctor may first recommend non-surgical treatment plans. You may first have a period of bed rest, accompanied by medication to help ease your pain. A cervical collar or a brace may be worn to support your neck and keep you from further aggravating the pain. Then, gradually, your doctor will have to return to normal activity.
As you begin to move your neck and return to your daily routine, your doctor may also recommend physical therapy. A therapist can help you to gain better habits through posture exercises. He or she will also direct you into exercises that will stretch and strengthen your muscles. Hot/cold therapy may also help.
If the treatment plan including pain management, bracing, and exercise does not suffice, you may have to have a surgery in your cervical spine. Often, the most effective surgery is an ACDF, which stands for anterior cervical discectomy and fusion. This approach is done through an incision in the front (anterior) of the neck.
The disc that has been degenerated by arthritis will be removed. A bone graft will fill in the empty space and keep the vertebrae from compressing any further. Then, by using instrumentation such as screws, hooks, or a metal plate, the spine will be stabilized. Over time, the vertebrae will fuse together.