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Pinched Nerve in Neck (Cervical Radiculopathy)
January 30, 20190547

Pinched Nerve in Neck (Cervical Radiculopathy):Definition, Causes, Symptoms, Treatment, and What to Do

What is a pinched nerve?

A “pinched nerve” is the common name for the medical condition “radiculopathy”. Radiculopathy is a blanket term used to describe the symptoms of abnormal spinal nerve root function.1-3

The spinal nerves are the 31 large nerves that exit the spinal cord. They transmit signals from the brain to the body (movement), and back (touch, temperature, pain).4

The “root” of a spinal nerve refers to the area just where the nerve leaves the spine. It does so through a small opening called a foramen.4

Figure 1: Structure of the spine and spinal nerves.

Left: cross-section of the spine, viewed from the top. Right: side-view.

(modified from iStockphoto.com/MedicalArtInc)

When the root of a spinal nerve fires incorrectly, it can lead to changes in signals both to and from the brain.2,4 That means, there can be changes in sense of touch, temperature, pain or muscle movement.2

If the nerve root that is not signaling properly leaves the spine between two of the vertebrae in the neck, the symptoms are referred to as “a pinched nerve in the neck” or “cervical radiculopathy”. A pinched nerve in the neck can lead to symptoms in the eyes, neck, upper back, shoulders, arms and/or hands, depending on the nerve affected.2

Figure 2: Spinal anatomy.

Schematic diagram of the human spine;

neck vertebrae (“cervical”) are highlighted in yellow.

(iStockphoto.com/wetcake)

What causes a pinched nerve?

There are a variety of reasons that a spinal nerve root might stop signaling properly.

By far the most frequent reason is that the nerve root becomes squeezed by surrounding tissues (hence the name “pinched nerve”). Conditions that cause the surrounding tissues to press in on a nerve root include:

  • Breakdown of spinal bone, joints and discs

A breakdown of the bone, discs or cartilage in the neck is the most common cause of compression of a cervical nerve root.5

Up to 70 percent of people reporting symptoms of a pinched nerve are found to have degeneration of the spine.5

In addition to direct pressure by movement of the bones or discs, increased spinal mobility can trigger growth of muscle and tendons around the spine to help stabilize the joints. This extra growth can put more pressure on a nerve root.3

Figure 3: Spinal degeneration.

Breakdown of vertebrae bone and disc tissue decreases the size of foramen, leading to pinched nerves.

Left: cross-section viewed from top. Right: side-view. (modified from iStockphoto.com/MedicalArtInc).

  • Herniated Disc

A herniated disc is another common cause of pinched nerves.6

This condition occurs when the soft gel (nucleus pulposus) that normally sits inside the discs between the vertebrae leaks out. If the gel presses into the foramen, it can squeeze the nerve root and cause the symptoms of a pinched nerve.3,6

Herniation of a disk in the neck can occur gradually from a breakdown in the stiffer outer-layer of the disk (the annulus fibrous). Or it may occur abruptly following an injury to the annulus fibrous.6

Figure 4: Herniated disc

Rupture of the nucleus pulposus into the foramen space leads to a pinched nerve.

Left: cross-section viewed from top. Right: side-view. (modified from iStockphoto.com/MedicalArtInc).

  • Trauma

Accidents or overexertion can cause damage to the neck that may lead to a pinched nerve. Actual movement of spinal structures into the foramen is possible. Damage may also cause swelling that may push in on the nerve root.3

  • Abnormal Blood Flow

Blood clots, bruises, and changes in blood pressure can cause blood vessels to expand and press on nerves, leading to the symptoms of a pinched nerve.7

  • Cancer

Though rare, tumors in or around the spine may lead to the symptoms of a pinched nerves. As tumors grow, they may themselves press into the foramen, or they may push on other tissues, which then press into the foramen.3

Direct changes in nerve signaling can also cause radiculopathies. Conditions that can alter the way nerves fire include:

  • Infection

The immune response to infections of the central nervous system can result in changes in nerve function. Infection of the central nervous system with, for example, HIV or tuberculosis, can lead to radiculopathies.8

  • Inflammation

Autoimmune conditions that affect nerve roots, such as Guillain-Barre Syndrome, may result in radiculopathies.8,9

How common are pinched nerves in the neck? Who is at risk?

Epidemiologists estimate that about 83 out of every 100,000 people experience a pinched cervical nerve each year.5

Individuals who regularly lift heavy objects, those who smoke, and those who have previously experienced radiculopathy in the lower back are at greater risk for developing radiculopathy in the neck.5

Men are slightly more likely to develop a pinched cervical nerve than women. The risk is higher for individuals between 50 and 54 years of age than any other age group.2

What are the symptoms of a pinched nerve in the neck?

The symptoms of a pinched nerve, in general, include localized3:

  • Pain
  • Shooting pains or electric-shock-like sensations
  • Numbness
  • Tingling
  • Muscle weakness
  • Loss of automatic reflexes

The severity of your symptoms will likely depend on the degree of compression or inflammation in the nerve root.

Where you experience these symptoms is specific to the nerve root involved.3

Radiculopathy of3:

  • C2 leads to symptoms around the eyes
  • C3 or C4 leads to symptoms in the neck or upper back
  • C5 leads to symptoms in the shoulder and biceps; you may lose strength in your shoulder
  • C6 leads to symptoms in the palm-side forearm, thumb and index finger; you may lose strength and reflexes in your biceps
  • C7 leads to symptoms in the non-palm-side forearm and the middle finger; you may lose strength and reflexes in your triceps
  • C8 leads to symptoms along the pinky side of your forearm and in the ring and pinky fingers; you may lose strength in the muscles needed to spread your fingers and/or make a fist

How is a pinched nerve in the neck diagnosed?

Around 75 percent of the time, your doctor can diagnose you with a pinched nerve in the neck based on a description of your symptoms alone.3

If your medical history is not sufficient, or if your doctor wants to confirm her suspicions, there are several diagnostic tests she might order.

Physical diagnostic tests

There are five common physical diagnostic tests your doctor might decide to perform. All five of them are designed to physically manipulate the nerve to either improve or irritate your symptoms. If these tests can recreate or relieve your symptoms, it will help confirm your diagnosis.3

  • Spurling’s test

For this test, your doctor will press on the top of your head. She will rotate your head toward the side you have been experiencing symptoms and press your head toward the same shoulder.3

If putting pressure on your neck from this angle recreates your symptoms, it will help your doctor confirm your diagnosis.

  • Valsalva maneuver

For this test, your doctor will ask you to take a deep breath. She will then have you plug your nose and close your mouth and ask you to try to force your breath out through your closed airways.10

If this triggers your symptoms, it may be a sign that you have a pinched nerve in your neck.3

  • Upper-limb tension test

In the upper-limb tension test, your doctor will manually move your arm through a complex series of postures that put increasing stress on your cervical spinal nerves.3,11

If any of these movements cause your symptoms to appear, it will help your doctor confirm your diagnosis.3

  • Shoulder-abductor sign test

For this test, your doctor will ask you to rest the hand of the arm in which you are having symptoms on the top of your head.3

If this position relieves your symptoms, it may help your doctor confirm your diagnosis.3

  • Neck traction

Neck traction involves gently pulling the head away from the shoulders. This creates more physical space between the vertebrae.3

If you have a pinched cervical nerve, neck traction will likely ease your symptoms by making more room for the nerve.3

Improvements in your symptoms during or after neck traction may help your doctor confirm your diagnosis.3

Electrodiagnostic tests

While not as reliable as imaging techniques, electromyography (EMG) can be helpful in diagnosing a pinched nerve in the neck.3

An EMG measures the electric signals coming from the nerves to the muscles of the arms.12

By observing differences in electrical signaling through at least two different muscles in the arm, doctors can pinpoint the nerve causing your symptoms.12

Imaging diagnostic tests

There are several diagnostic tests that allow your doctor to visualize your neck, spinal column, spinal cord and cervical nerves.

These tests allow your doctor to determine not only if you have a pinched nerve, but also exactly what is causing it.

Useful imaging tests include:

  • X-ray

Often, an X-ray will be the very first test your doctor will order if she suspects you may have a pinched nerve.3

X-rays allow your doctor to see all the bones in your neck. This can identify any changes in how your vertebrae are lined up, if any of the discs between your vertebrae have moved and if any bone spurs or arthritis is pressing into the foramen where your nerve should be.3

  • CT-scan

A CT-scan can provide even more detailed pictures of the bones in the neck.3

It may be able to detect hardening of soft tissues around the bones that an X-ray might not be able to pick up, helping to verify a narrowing of the foramen.3

  • Magnetic Resonance Imaging (MRI)

To visualize soft tissues as well as bone, your doctor may order and MRI.

An MRI scan allows your doctor to view the cervical nerves as they exit the spine, helping to pinpoint any areas of compression.

How is a pinched nerve in the neck treated?

If your pinched nerve is being caused by physical compression, there are three broad categories of treatments available to alleviate your symptoms and/or cure your condition.

Medications

Pain medications may be effective at easing your symptoms and help you complete normal daily activities.3,5

Medications that may be used to control the pain associated with a pinched nerve include5:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Oral or injected steroids
  • Opioids
  • Tri-cyclic antidepressants

Muscle relaxants, such as cyclobenzaprine and tizanidine, may be useful in helping relieve tension in the neck. This can aid in pain reduction and improve your range of motion.5

Non-surgical treatments

Most people can control their symptoms and cure their pinched nerve with non-surgical treatments and time. It is estimated that 75 to 90 percent of individuals with cervical radiculopathy do not require surgery.3

Non-surgical treatments for a pinched nerve in the neck focus primarily on helping ease the symptoms and improving the strength and range of motion in the neck. Many of these treatments serve both purposes at the same time.

Common non-surgical treatments your doctor might prescribe to treat your pinched nerve include:

  • Rest

Your doctor’s instructions for resting your neck may range from simply avoiding activities that trigger your symptoms to wearing a neck brace.3

If your doctor believes wearing a neck brace may be helpful for you, it is important to only wear the brace as long as instructed. Wearing the brace for too long can cause the muscles in your neck to weaken.3

Weakened neck muscles may cause your symptoms to worsen when you take the brace back off. This is because your neck muscles help stabilize your spine and keep the bones and discs in place. If they are weakened, it is more likely that the vertebrae or discs may slip into abnormal positions and put more or new pressure on a nerve root.3

  • Physical therapy and massage

While rest alone is often enough to improve your symptoms with time, adding active physical therapy to your treatment can shorten the amount of time it takes for your symptoms to abate.3

If your doctor orders physical therapy, your therapist will put together a plan specific to you, your medical history, and your symptoms.

Treatments may include3,5:

  • Stretches
  • Strength building exercises
  • Relaxation techniques
  • Massage
  • Superficial heat (heating pad/hot water bottle)
  • Deeper tissue heat (ultrasound)
  • Cooling or icing
  • Electrical stimulation
  • Traction

Combined, these treatments can help ease your symptoms immediately (for example with heating or electrical stimulation), and work long term to create more space for the nerve root, eliminating your symptoms permanently (for example through stretching, strength building and traction).3,5

  • Chiropractic adjustment

In some cases, your doctor may refer you to chiropractor to have your neck vertebrae adjusted. 3

Such treatments can be helpful for some people, but for others it may make the symptoms worse or trigger other medical conditions.3

Only see your chiropractor if your doctor believes it is a safe procedure for you.

Surgical treatments

Though most people can manage their symptoms with non-surgical treatment, some people need surgery to fully eliminate their symptoms.3

Certain individuals may need immediate surgery, before even trying non-surgical therapies. If your symptoms are extremely severe, your doctor may decide the best course of action is immediate surgery. Surgery is also immediately necessary if the pinch nerve is being caused by a broken vertebrae, especially if the break is unstable.3

Most people who end up requiring surgery, however, are those whose symptoms have not responded to non-surgical treatments.3 Generally, surgery is considered an option for those whose symptoms have not improved within 8 to 12 weeks.5

The goal of surgical treatments is to physically open up more space for the nerve root. This is almost always done by either removing the tissue pressing in on the nerve, or adjusting the height, shape and stability of the disc between the two vertebrae where the nerve is exiting the spine.3

Adjusting the shape and size of the disc space is usually done via an “anterior” spinal surgery. For this procedure, the surgeon creates an incision between the carotid artery and the esophagus. Once at the spine, he can remove any damaged bone or disc material and replace it with different organic tissue, plastic, carbon-fiber or metal pieces shaped to perfectly realign the vertebrae. Often, the surgeon will then fuse the two vertebrae together around the new disc to help stabilize the area and prevent the pinched nerve from coming back.3

This surgery, with fusion of the vertebrae, eliminates the symptoms of a pinched nerve in 90 percent of patients.3

Alternatively, your surgeon may decide entering your neck from the back is a better option for you. Here, the doctor can remove soft tissue that is pressing on your nerve root. He may also be able to shave down some bone if it has grown in to press on the nerve. If large amounts of bone need to be removed, your surgeon may have to fuse the two vertebrae sandwiching the nerve together to prevent the joint from becoming unstable and making your symptoms worse.3

Surgeries entering from the back of your neck are between 75 and 98 percent successful at eliminating the symptoms of a pinched nerve.3

Treatment for other causes of cervical radiculopathy

If your symptoms are being caused by an infection or an autoimmune condition, the treatment will be aimed at eliminating or controlling the infection, or modifying immune function, respectively. You may also be given therapies intended to manage your symptoms.8

Pinched Nerve in the Neck FAQs

  • What does a pinched nerve in your neck feel like?

The sensations you feel if a nerve in your neck is being pinched depends on how severe the compression is and which nerve is affected.3,5

In general, a pinched cervical nerve may cause any of the following symptoms in the eyes, shoulders, upper arm, lower arm, hand or fingers3,5:

  • Shooting pain
  • Electric-shock-like pain
  • Numbness
  • Tingling
  • Weakness
  • Loss of reflexes
  • Is a pinched nerve serious?

Whether or not your pinched nerve is “serious” depends on what is causing your symptoms.

Most causes of a pinched nerve, such as a herniated disc, heal on their own with time.3,5

However, some causes of a pinched nerve may be serious. For example, radiculopathy symptoms can be caused by a broken neck, an aneurysm, a blood clot, an autoimmune disease or a tumor.3,5,7,8

Additionally, if you have not been diagnosed with a pinched nerve, do not assume that radiculopathy symptoms mean you have a pinched nerve. Other serious conditions that require medical attention can cause similar symptoms, including diabetes and heart attacks.13,14

Please see a doctor if you have symptoms of a pinched nerve to rule out serious conditions.

  • How long does a pinched nerve in the neck last?

For most people, symptoms of a pinched nerve in the neck are significantly improved within a month after they appeared.15

  • How long does a pinched nerve in the neck take to heal?

For the majority of people, a pinched nerve in their neck heals within a month.15

  • How do I sleep with a pinched nerve in the neck?

There do not appear to be any specific recommendations for sleeping positions with neck pain from a pinched nerve.

However, there are recommendations for sleeping positions to relieve neck pain in general, which might be useful if you are experiencing a pinched nerve.16

If you can, try to sleep on your back. Place a small pillow under your neck to support it, and place pillows under the back of your thighs to raise your legs. This lets your spinal muscles lay flat against the bed and may help ease the tension in your neck. This may, in turn, relieve your symptoms and help you sleep.16

  • Can a pinched nerve in neck cause arm pain?

Yes. One of the main symptoms of a pinched nerve in your neck is pain, shooting pains or electric-shock-like pains in the arm, wrist, hand or fingers.3,5

References

  1. Mayo Clinic. Pinched Nerve Overview. Last updated August 8, 2017. http://www.mayoclinic.org/diseases-conditions/pinched-nerve/home/ovc-20314332. Accessed September 7, 2017.
  2. Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, Van Kleef M. Cervical Rardicular Pain. Pain Practice. 2010;10(1):1-17. Doi: 10.1111/j.1533-2500.2009.00319.x.
  3. Cardi JM, Pumberger M, Hughes AP. Cervical Radiculopathy: A Review. Musculoskeletal Journal of Hospital for Special Surgery. 2011;7:265-272. Doi: 10.1007/s11420-011-9218-z.
  4. Nogradi A, Vrbova G. NCBI Bookshelf: Anatomy and Physiology of the Spinal Cord. Available at https://www.ncbi.nlm.nih.gov/books/NBK6229/. Accessed Septmeber 7, 2017.
  5. Corey DL, Comeau D. Cervical Radiculopathy. Medical Clinics of North America. 2014;98:791-799. Doi: 10.1016/j.mcna.2014.04.001.
  6. Masse RN, Mesfin FB. NCBI Bookshelf: Herniation, Disc. Last updated July 13, 2017. Available at https://www.ncbi.nlm.nih.gov/books/NBK441822/. Accessed September 7, 2017.
  7. Benny BV, Nagpal AS, Singh P, Smuck M. Vascular causes of radiculopathy: a literature review. The Spine Journal. 2011;11:73-85. Doi: 10.1016/j.spinee.2010.09.027.
  8. Centner CM, Bateman KJ, Heckmann JM. Manifestations of HIV infection in the perifpheral nervous system. Lancet Neurology. 2013;12:295-309. Doi: 10.1016/S1474-4422(13)70002-4.
  9. Yuki N, Hartung H-P. Guillain-Barre Syndrome. New England Journal of Medicine. 2012;366:2294-2304. Doi: 10.1056/NEJMra1114525.
  10. Forfia PR, Opotowsky AR, Ojeda J, Rogers F, Arkles J, Liu T. Blood pressure response to the valsalva maneuver: a simple bedside test to determine the hemodynamic basis of pulmonary hypertension. Jounal of American College of Cardiology. 2010;56(16):1352-1352. Doi: 10.1016/j.jacc.2010.03.095.
  11. Legakis A, Boyd BS. The influence of scapular depression on upper limb neurodynamic test responses. Journal of Manual and Manipulative Therapy. 2012;20(2):75-82. Doi: 10.1179/2042618611Y.0000000020.
  12. Hakimi K, Spanier D. Electrodiagnosis of cervical radiculopathy. Physical Medicine & Rehablitation Clinics of North America. 2013;24:1-12. Doi: 10.1016/j.pmr.2012.08.012.
  13. Callaghan BC, Cheng H, Stables CL, Smith AL, Feldman EL. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurology. 2012;11(6):521-534. Doi: 10.1016/S1474-4422(12)70065-0.
  14. Mehta LS, Beckie TM, DeVon HA, et al. Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation. 2016;133:916-947. Doi: 10.1161/CIR.0000000000000351.
  15. Alentado VJ, Lubelski D, Steinmetz MP, Benzel EC, Mroz TE. Optimal duration of conservative management prior to surgery for cervical and lumbar radiculopathy: a literature review. Global Spine Journal. 2014;4:279-286. Doi: 10.1055/s-0034-1387807.
  16. Mayo Clinic. Neck Pain Prevention. Last updated July 9, 2015. http://www.mayoclinic.org/diseases-conditions/neck-pain/basics/prevention/con-20028772. Accessed September 8, 2017.

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