The construction of the cervical spine is somewhat different from other areas of the spine. For example, cervical vertebrae have an extra opening where the blood supply for the brain runs and vertebrae C1 and C2 (better known as atlas and axis) have a different construction because they have a different function than the rest. Namely, they are largely responsible for carrying the head. Also, relative to each other, these vertebrae have the greatest ability to rotate(turn) compared to the rest of the cervical vertebrae.
Nerves exit from all levels of the cervical spine. Each of these levels has its own supply area to which specific areas of the skin and muscles are connected. Sometimes it happens that pressure is put on one of these exiting nerves (on the nerve root), causing symptoms.
Causes may include a herniated disc, stenosis, aging structures. In young people who experience radiating pain from the neck, it is more likely to be a herniated disc. Usually at the C6 and C7 level. In people who are older, it is more likely that the radiating pain is caused by often a natural process of aging. The space where the nerve exits becomes smaller and can become pinched. A very small portion of these symptoms may be caused by other structures such as a fracture or serious illnesses. But this almost never occurs. Radiating pain from the neck is called a radicular syndrome in the medical world. This means that the radix(nerve root) is involved in the symptoms.
Complaints with a radicular can include;
- sharp/shooting pain through the arm
- tingling and/or a numb or dull feeling
- decreased strength in certain muscles
- reduction or increase in pain with certain postures/movements
- Reduced reflexes in the triceps or biceps
The physical therapy examination consists of several parts. Differences in position/height of different body parts are normal and not wrong or abnormal. However, an abnormal position may be related to pain-avoiding behavior. We often see that people hold the neck/head in a certain position that makes more room for the nerve in question.
During the functional examination, active and passive movement patterns are examined. It is quite common for neck pain to include the shoulder girdle in this examination (vice versa as well). The purpose of this examination is to determine to what extent it is possible to move and how fluidly this is done. In addition, the presence or absence of pain with some (parts) of movements can also provide relevant information.
When a cervical radiculopathy is suspected, we can use several tests that lead to increasing or decreasing the likelihood that a radicular syndrome is present.
- The upper limb tension test A is used to tension the nerves from the brachial plexus. Normally this does not cause any problems, at most a little strange "pulling" sensation in the arm. If there is nerve provocation, this may cause recognizable symptoms. This test is mainly intended to exclude. This means that if there are no particularities with this test, the chance of a radicular syndrome is not great.
- The spurling test is used to reduce the space between the vertebrae (foramen intervertebrale) by applying pressure to the head in a specific position. This test is designed to correctly enclose a radicular syndrome and thus make it more likely.
- The cervical distraction test is used, unlike the spurling test, to actually create more space in the intervertebral foramen. It is a test that can be used to confirm the presence of a radicular syndrome. This test can only be used properly if at the time of performing it, nerve-related symptoms are also present.
- At the cervical rotation test the patient is asked to rotate the head to the side where the symptoms are. The test is positive with a rotation of the head of less than 60 degrees. *The mobility of the neck decreases with age. So this test says more in relatively younger people who by nature can still turn their heads well.
In addition to performing these examinations tied to cervical radicular syndrome, we have other tools that give us a picture of nerve function. For example, we can compare left and right strength between different muscles. For this we use so-called KENN muscles (also called KEY muscles). These are specific muscles that are controlled by a specific segment. Since it can happen that a radicular image involves loss of strength, performing these tests can help in identifying the location of the problem.
Reflexes also provide a picture of the function of the nerve. The most relevant for this are the biceps tendon reflex (C5-C6) or triceps tendon reflex (C7-C8). Testing these reflexes with a reflex hammer provides a picture about the function of the nerves associated with the segment.
If necessary, the physical therapist can contact the family doctor to request an MRI examination or CT scan. However, this is not always necessary. We know that the course of a radicular syndrome is favorable. By this we mean that complaints always recover within a certain period of time with the help of adequate physical therapy, consisting of exercises, advice and insight into the symptoms you will be helped on your way as best as possible!
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