The construction of the cervical spine is somewhat different from that of 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. These vertebrae also have the greatest ability to 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 linked. Sometimes it happens that one of these exiting nerves (the nerve root) is put under pressure and complaints arise.
Causes can include, for example, a herniated disc, stenosis, aging structures. In young people who experience radiating pain from the neck, it is more likely that this is a hernia. Usually at the level of C6 and C7. 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 can be caused by other structures such as a fracture or serious disease conditions. But this almost never happens. 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 complaints.
Complaints associated with a radicular can include;
- sharp/shooting pain through the arm
- tingling and/or a numb or dull sensation
- reduced strength in certain muscles
- reduction or increase in pain with certain postures/movements
- Reduced reflexes in the triceps or biceps
The physiotherapy examination consists of several parts. Differences in position/height of different body parts are normal and not wrong or abnormal. However, it may be that a deviant position is related to pain-avoiding behavior. Often we see people holding the neck/head in a certain position that makes more room for the nerve concerned.
During the functional examination the active and passive movement pattern is examined. It is quite common that in case of neck pain also the shoulder girdle is included in this examination (vice versa also). The purpose of this examination is to determine to what extent it is possible to move and how fluently this is done. In addition, the presence or absence of pain in some (parts) of the movements can also provide relevant information.
When a cervical radiculopathy is suspected, we can use several tests that will increase or decrease 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 the most a strange 'pulling' sensation in the arm. If there is a nerve provocation, it may be that this gives recognizable symptoms. This test is mainly intended to exclude. This means that if there are no abnormalities 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 include a radicular syndrome and thus make it more likely.
- The cervical distraction test is used, unlike the spurling test, to actually make more room 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 if, at the time of performance, nerve-related complaints are also present.
- At the cervical rotation test The patient is asked to rotate the head to the side where the symptoms are located. The test is positive if the head rotation is less than 60 degrees. *The mobility of the neck decreases with age. This test therefore says more something in relatively young people who by nature can still turn their heads well.
In addition to performing these studies tied to a 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 to identify the location of the problem.
Reflexes also give an idea of the function of the nerve. The most relevant for this are the biceps tendon reflex (C5-C6) or triceps tendon reflex (C7-C8). By testing these reflexes with a reflex hammer, an image is formed 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. With this we mean that complaints always recover within a certain period of time. With the help of adequate physiotherapy, consisting of exercises, advice and insight into the symptoms you will be helped as much as possible on your way!