Cervical Radiculopathy

Cervical radiculopathy is a condition caused by compression or irritation of a nerve root in the cervical spine (neck region), resulting in pain, numbness, or weakness that radiates from the neck into the shoulder, arm, or hand. The cervical spine comprises seven vertebrae (C1-C7) with intervertebral discs in between. The cervical nerve roots exit the spinal cord between each vertebra and form the cervical and brachial plexuses, which provide motor and sensory innervation to the upper extremities.

Cervical radiculopathy typically occurs due to:

• Herniated Disc: When the intervertebral disc's nucleus pulposus protrudes and compresses a nerve root.
• Degenerative Changes: Osteoarthritis or degenerative disc disease can cause bone spurs (osteophytes) or narrowing of the intervertebral foramina, leading to nerve compression.
• Spinal Stenosis: Narrowing of the spinal canal, often due to age-related changes, which compresses the nerve roots.
• Muscular tension and/or hypertrophy: overworked and knotted muscle fibers may compress the nerve at different locations, leading to neuropathic symptoms.

Compression of the nerve root impairs normal nerve function, causing the following major symptoms:

• Pain: Radiating from the neck down into the arm, often following a dermatomal pattern based on the affected nerve root.
• Numbness and Tingling: Sensory disturbances in specific areas of the upper limb.
• Muscle Weakness: Due to disruption in motor signals, leading to weakness in specific muscle groups innervated by the affected nerve root.

Diagnosis is typically confirmed through clinical examination, imaging (MRI or CT), and sometimes electromyography (EMG) to assess nerve function. Treatment from Medical Doctors often includes anti-inflammatory medications, and sometimes corticosteroid injections or surgery if symptoms persist. Traditional Korean Medicine treatment of cervical radiculopathy consists in both dealing with the locally affected areas and resolving the anatomical issue that is the source of the problems, as well as improving the general healing capacity of the patient. Acupuncture will be done in order to release any tension and knots in the affected areas, improve circulation, and support the strength-loading capacity of the muscles. This will help the patient mechanically sustain themselves throughout their daily activities. Herbal medicine might also be prescribed to speed up the healing process, and provide the body with the nourishment required.

Treatment Case: 42 years old male

   The patient is a construction worker who works long hours on his feet, lifting heavy objects repeatedly over his head. The patient has no prior neck or spine injuries but reports a history of mild lower back pain related to his physically demanding job. A few months ago, a toolbox fell from a few stories high and the patient had to hyperextend their neck in order to avoid the object. The patient was not struck and was relieved, but since that night began to feel pain radiating from the neck to the right arm with numbness and weakness. He especially feels this pain when reaching up to grab something or lift something, and it is worse at the end of the work day. The patient tried heat packs and rest but it provided little relief.

   The patient reported 9 out of 10 pain, radiating from the neck through the right shoulder and arm, accompanied by tingling and occasional numbness in the thumb and index finger. He described his pain as if “a person with a pitchfork was stabbing him”, and noted that he could not grab things as firmly as he used to before the accident.

   A physical examination found that there was limited neck extension and rotation to the right due to pain. A neurological examination found that there was reduced sensation in the C6 dermatome (thumb and index finger), mild weakness in wrist extensors, and diminished right biceps reflex, consistent with C6 nerve root compression.

   To alleviate nerve compression, improve neck mobility, restore strength, and promote functional recovery, acupuncture was done on the affected areas of the neck where the impinged nerve was causing much of the symptoms. Other often impinged areas of the upper limbs were also treated. Some light manual therapy was done such as gentle traction and mobilization techniques in order to decompress the cervical spine and relieve nerve irritation. The patient was also instructed on nerve-gliding exercises so as to manage the symptoms at home.

   After the second week of biweekly treatment, there was a slight reduction in pain, although the patient was still largely unable to perform the daily activities that he wished nor return to work. The tingling in the arm and fingers were also persistent. After the third week of treatment, there was more reduction in pain, and the tingling symptoms were slightly improved. The patient was able to drive their car to their own appointments without feeling much pain. After another two weeks of treatment, the patient was able to return to work. He still felt some pain, especially after a long and hard day of work. However, there was no tingling or numbness, and the patient felt his grip strength was about 85 to 90% of what it was before.