Susan is a homemaker who was involved in a rear end car collision. She is having moderate neck pain and numbness and tingling into her left middle finger. It is affecting all of her activities at home including her her ability to carry her son and do simple household activities at home. Even turning her head is bothersome. The pain is relentless and after one week of suffering she decides to go to her Doctors office. What does this patient have? Well if you have been following the Neck Pain Support Blog, you may guess a cervical radiculopathy. A cervical radiculopathy is often present when patients present with neck pain, radiation of pain into the arms and hands, numbness and tingling into the fingers, and weakness of the upper extremity muscles. How would your Doctor diagnose this problem if you walked in with the same symptoms?
Your doctor will do a thorough consultation and examination on you to determine what is going on. Simply prescribing medication such as muscle relaxers or pain pills will only provide you with temporary relief. Your doctor will first ask you specific questions about your symptoms. For example, how this neck pain started- was it due to a trauma? What is the level of pain? How does the pain travel? Does it hurt when you cough or sneeze? Do you have radiation into your arms and hands? Does the pain affect your activities of daily living? All these answers are helping the Doctor to determine what nerve root level is affected.
They may do orthopedic tests. Your neck range of motion will also be tested. Other tests that your Doctor can do are more neurological in nature. Your doctor may refer you to a neurologist or a chiropractor for this further testing. This neurological testing often involves looking at the motor, sensory and reflex portions of each nerve root in the neck.
- Motor: Looking at the strength of the muscles. For example to test C6 nerve root, the Dr may have test the strength of your biceps. To test C7 nerve root, the dr may test the strength of your wrist flexors.
- Sensory: Looking at your sensitivity for feeling. In this neurological portion, the Doctor will often use an instrument called a “pinwheel”- the Doctor will ask you to close your eyes and roll this pin wheel along the dermatomes of the cervical nerve roots. The pinwheel will be rolled on the right and left side and you will be asked- does this feel the same or different on the right side compared to the left side? For example it will be rolled on the upper arm on both sides, and then on the lower arms including the thumb and index finger etc. This will help to determine what nerve roots are affected. Although this sensory testing with a pinwheel can be a little uncomfortable (it can feel ticklish at times), it is not painful
- Reflex: A check of the upper extremity reflexes is also important - The Doctor may look to see if you have a normal response, look at the intensity of the reflex (you may show a hyper or hypo reflex) and also look to see if the reflex is symmetrical on both sides. For example they will check biceps, brachioradialis and triceps reflex.
Your Doctor may order a cervical x-ray. The x-ray may come back and show degeneration of the bones in the neck. It may also show misalignments in the cervical vertebra, which could definitely cause pressure to be put on the cervical nerves. But one the best ways to diagnose a radiculopathy (and your Doctor may not send you out for this immediately) is a cervical MRI. An MRI using magnetic waves and has the ability to show you what is going on by looking at slices of the area your doctor is interested in. The test does not require any special dye or needles and is painless. Most importantly it can show you what is going on at the disc level. For example, it may show a disc bulge at C5/C6 or a disc herniation at C4/5. Not only will the MRI show the discs, it will also highlight the soft tissues and muscles surrounding the area . If you are claustrophobic and have a fear of enclosed spaces, request an OPEN MRI center to make your exam more comfortable for you.
It is not always clearly understood where exactly the nerve root is being affected. The nerve may be affected at a different location along its path. For example, the median nerve runs along the outside of your arm. If pressure is applied to the median nerve it can cause symptoms related to carpal tunnel syndrome. The pressure on the median nerve root is at the wrist area, not in the neck. The Doctor may order additional electrical studies and do different orthopedic tests to determine the diagnosis.
Electrical studies look at how well the nerves are functioning and are called an EMG (electromyography) This test measures how long it takes a muscle to work once a nerve signals it to move. The time it takes will be slower if nerve pressure from radiculopathy has affected the strength of the muscle.
Another electrical test that may be used instead of EMG is cervical root stimulation (CRS). In this diagnostic test, the Doctor puts a small needle through the back of the cervical spine into the nerve where it leaves the spinal column. Readings of muscle action are then taken of the muscles on the front and back of the upper arm and along the inside of the lower arm. Doctors use the readings to determine which nerve is having problems.
Don’t ignore the symptoms of a cervical radiculopathy. It is very painful and will affect your activities of daily living, just like Susan's case. It is best to get this diagnosed right away to see what and where the issue is. Once you get it diagnosed you can make an informed decision about treatment and get onto the path of relief.
Additional Reading Resources:
- Part I: Neck Pain Resulting from a C5, C6, C7 or C8 Radiculopathy
- Part II: Are Your Severe Neck Pain Symptoms the Result of a Cervical Radiculopathy?
- Part III: The Causes of Severe Neck Pain Resulting from a Cervical Radiculopathy
- Part IV: Severe Neck Pain From a Herniated Disc: What are Your Treatment Options?
- Understanding your Disc Problem Like a Jelly Donut
- The Normal Cervical Curve in the Neck
- How to End Neck Pain Naturally by Doing A Cervical Traction Program at Home
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