• Glenn Charbonneau, P.T.

At the Root of Nerve Pain

What exactly is nerve pain? Why do I feel either pain, burning, numbness or tingling into my arm? How does this relate to my spine? In order to understand how nerves can produce pain, it’s important to understand their background.



Our spine can be organized into cervical (neck), thoracic (mid back), lumbar (low back) and sacrum (tail bone). Each region consists of vertebrae, which are bones that wrap around spinal cord for protection. The vertebrae have tunnels on each side called foramen, where nerve roots that stem off the spinal cord pass through to each side of the body. The nerves can be visualized as long cords extending from the spine to our hands and feet.  


A radiculopathy, also known as a “pinched nerve,” involves neck pain with secondary compression or irritation of exiting nerve roots leading to either pain, numbness, tingling or weakness into the affected shoulder, arm or leg. Common causes of neck radiculopathy include disk herniations, degeneration, bone spurs or inflammation. Other similar presentations may include: carpal tunnel syndrome, cardiac pain, shingles, rotator cuff tendinopathies and tumors.


In a cervical radiculopathy, referred pain involves the particular pattern experienced along your shoulder, arm or hand and may be worsened by either looking up or tilting your head to the affected side.



Diagnostic imaging can be performed at the discretion of your appropriate health care professional. Research recommends that x-rays be performed within 4-6 weeks if conservative management fails. If symptoms persist or worsen, then a magnetic resonance imaging (MRI) or computed tomography (CT) scan should be performed to evaluate for disk herniations and bone spurs. Note that MRI is not helpful in most cases due to the significant rates of false-negatives and false-positive findings. For instance, 57% of patients over the age of 64 have evidence for a disk herniation without a radiculopathy.


Research that included 27 trials (with a total of 2485 participants) examined the effect of exercise with neck pain and function. Strengthening exercises for the neck and shoulder appear to be beneficial for both cervical radiculopathies and headaches. Evidence suggests that physical therapy treatment begin with gentle range of motion, stretching, massage techniques and heat therapy within 6 weeks, and then progress to resisted strengthening exercises in the neck and shoulders as tolerated.


Prognosis is good for most neck radiculopathies, with 88% improving within 4 weeks following nonoperative management. Re-assessment is crucial to determine whether neurological finding are worsening, and to refer for imaging and specialists as warranted.




Sources


Childress, M.A. & Becker, B.A. (2016). Nonoperative Management of Cervical Radiculopathy. Am Fam Physician, 93(9), 746-54.


Eubanks, J.D. (2010). Cervical Radiculopathy: Nonoperative Management of Neck Pain and Radicular Symptoms. Am Fam Physician, 81(1), 33-40.


Gross  A, Kay  TM, Paquin  J.P., Blanchette  S., Lalonde  P., Christie  T., Dupont  G., Graham  N., Burnie  S.J., Gelley  G., Goldsmith  C.H., Forget  M., Hoving  J.L., Brønfort  G., & Santaguida  P.L. (2015). Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews, 1. doi: 10.1002/14651858.CD004250.pub5.


Tawa, N., Rhoda, A., & Diener, I. (2017). Accuracy of clinical neurological examination in diagnosing lumbo-sacral radiculopathy: a systematic literature review. BMC musculoskeletal disorders, 18(1), 93. doi:10.1186/s12891-016-1383-2


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